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Tobacco use may lead or contribute to one of the following causes of dyspnea or chest pain: pneumonia, acute attack of emphysema, pulmonary embolism (blood clot in the lung), aortic aneurysm (a widening of the main artery leaving the heart, caused by a weakening in the wall of the artery), and aortic dissection (a tearing of the wall of the aorta, which, if it ruptures, bleeds profusely)