If a patient presents with back pain and usual anterior chest pain, consider high-risk chest pain, such as aortic coarctation, tension pneumothorax, pulmonary embolism or acute coronary syndrome. In addition to this, if the back and anterior chest pain are both present at the same time, moderate risk chest pain is evident with coronary artery disease and unstable angina, especially if the right coronary branch of the coronary artery is blocked, then there is significant back pain accompanied by anterior chest pain. Back pain and anterior chest pain can also occur in respiratory diseases, such as massive pneumonia, pleural effusion, and pleurisy. Mildly dangerous chest pains, such as intercostal neuralgia and herpes zoster pain, can also occur in the back and anterior chest at the same time.