Hi thanks for contacting HCM... In angina due to vasoconstriction pain is severe constricting type.... It can radiate to neck and shoulder... As patient is autistic he can t explain pain properly ...so rule out cardiac cause by .... ECG or 2D echo .... If no cardiac cause present then take hiatry about respi symptoms like runny nose , cough , fever to rule out bronchitis and pneumonia like condition...chest x ray done if needed .... Auscultation also done. If still cause not found then it could be musculoskeletal pain ....if ribs tender on touch then costochondritis is the cause...Brufen given for it... As I have given best advise but it doesn t replace physical examination for proper diagnosis... Take care... Dr.Parth