Chest Pain
Chest pain is discomfort or pain in the chest area between your neck and upper abdomen. While chest pain can be alarming and may signal a serious heart condition, many cases have less serious causes. Understanding the different types and knowing when to seek emergency care is crucial for your health.
Quick Facts
- Common emergency complaint
- Many possible causes
- Not always heart-related
- Can be life-threatening
- Requires careful evaluation
⚠️ Call 911 Immediately If You Experience:
- Chest pain with pressure, squeezing, or crushing sensation
- Pain spreading to jaw, left arm, or back
- Shortness of breath with chest pain
- Chest pain with dizziness, sweating, or nausea
- Sudden, severe chest pain with tearing sensation
- Chest pain with rapid or irregular heartbeat
- New or different chest pain if you have heart disease
Do not drive yourself to the hospital. Call emergency services for immediate medical attention.
Understanding Chest Pain
Chest pain can manifest in various ways - from a sharp, stabbing sensation to a dull ache, from burning to crushing pressure. The pain may be localized to one spot or spread across the chest. It can last seconds, minutes, or persist for hours or days.
While many people immediately think of heart problems when experiencing chest pain, the chest contains many organs and tissues that can cause pain, including the heart, lungs, esophagus, muscles, ribs, and nerves. Even organs below the chest, like the stomach and gallbladder, can cause chest pain.
The challenge with chest pain is distinguishing between life-threatening causes that require immediate attention and less serious conditions that can be managed with routine care. When in doubt, it's always better to seek immediate medical evaluation.
Types of Chest Pain
Cardiac Chest Pain
- Pressure or squeezing sensation
- May radiate to arms, jaw, or back
- Often triggered by exertion
- May be accompanied by shortness of breath
- Can occur at rest in heart attacks
Pulmonary Chest Pain
- Sharp pain that worsens with breathing
- May be accompanied by cough
- Can be one-sided
- Associated with shortness of breath
- May worsen when lying down
Gastrointestinal Chest Pain
- Burning sensation (heartburn)
- May worsen after eating
- Can be relieved by antacids
- May have sour taste in mouth
- Often related to position
Musculoskeletal Chest Pain
- Sharp, localized pain
- Worsens with movement or touch
- May follow injury or strain
- Can be reproduced by pressing
- Often one-sided
Common Causes
Heart-Related Causes
- Heart Attack: Blocked blood flow to heart muscle
- Angina: Reduced blood flow to heart, often with coronary atherosclerosis
- Pericarditis: Inflammation of heart lining
- Myocarditis: Inflammation of heart muscle
- Aortic dissection: Tear in aorta wall (emergency)
- Heart failure: Weakened heart pumping
- Arrhythmia: Irregular heartbeat
Lung-Related Causes
- Pulmonary embolism: Blood clot in lung (emergency)
- Pneumonia: Lung infection
- Pleurisy: Inflammation of lung lining
- Pneumothorax: Collapsed lung
- Asthma: Airway inflammation and narrowing
- COPD: Chronic lung disease
- Pulmonary hypertension: High blood pressure in lungs
Digestive Causes
- GERD: Acid reflux disease
- Esophageal spasm: Muscle contractions in esophagus
- Peptic ulcer: Stomach or duodenal ulcer
- Gallstones: Can cause referred chest pain
- Pancreatitis: Inflammation of pancreas
- Hiatal hernia: Stomach pushes through diaphragm
Musculoskeletal Causes
- Costochondritis: Inflammation of rib cartilage
- Muscle strain: From exercise or injury
- Rib fracture: Broken or bruised ribs
- Fibromyalgia: Widespread pain condition
- Shingles: Viral infection affecting nerves
Other Causes
- Anxiety and panic attacks: Can mimic heart attack
- Stress: Physical manifestation of emotional stress
- Drug side effects: Certain medications
- Caffeine overdose: Excessive stimulant intake
Pain Characteristics by Cause
Heart Attack Pain
- Crushing, squeezing, or pressure sensation
- Center or left side of chest
- May radiate to arms, jaw, neck, or back
- Lasts more than a few minutes
- Accompanied by sweating, nausea, shortness of breath
- Not relieved by rest or position change
Angina Pain
- Similar to heart attack but usually less severe
- Triggered by physical activity or stress
- Relieved by rest or nitroglycerin
- Predictable pattern
- Usually lasts 5-15 minutes
GERD/Heartburn Pain
- Burning sensation behind breastbone
- Often occurs after eating
- Worse when lying down or bending over
- May have acid taste in mouth
- Relieved by antacids
- Can last hours
Musculoskeletal Pain
- Sharp, stabbing pain
- Localized to specific area
- Worsens with movement or deep breathing
- Tender to touch
- May follow injury or unusual activity
- Position-dependent
Risk Factors for Serious Chest Pain
Cardiovascular Risk Factors
- Age (men >45, women >55)
- Family history of heart disease
- High blood pressure
- High cholesterol
- Diabetes
- Smoking
- Obesity
- Sedentary lifestyle
Other Risk Factors
- Previous heart problems
- Blood clotting disorders
- Recent surgery or immobilization
- Cancer history
- Chronic lung disease
- Autoimmune conditions
- Drug or alcohol abuse
Diagnosis and Evaluation
Diagnosing the cause of chest pain requires careful evaluation. Healthcare providers use various tools:
Initial Assessment
- Medical history: Detailed description of pain and symptoms
- Physical examination: Checking vital signs, heart, and lungs
- Risk factor assessment: Evaluating likelihood of heart disease
Common Tests
- Electrocardiogram (ECG): Records heart's electrical activity
- Blood tests: Check for heart damage markers (troponin)
- Chest X-ray: Views heart, lungs, and chest structures
- CT scan: Detailed images of chest organs
- Echocardiogram: Ultrasound of heart function
- Stress test: Heart function during exercise
- Coronary angiography: Views heart blood vessels
Specialized Tests
- D-dimer: For suspected blood clots
- Arterial blood gas: Oxygen levels in blood
- Upper endoscopy: For digestive causes
- Pulmonary function tests: For lung problems
Treatment Approaches
Treatment for chest pain depends entirely on the underlying cause. Here are common approaches:
Emergency Treatments
- Heart attack: Clot-busting drugs, angioplasty, surgery
- Pulmonary embolism: Blood thinners, clot removal
- Pneumothorax: Chest tube insertion
- Aortic dissection: Emergency surgery
Cardiac Treatments
- Medications: Aspirin, nitroglycerin, beta-blockers
- Procedures: Angioplasty, stent placement
- Surgery: Bypass surgery for severe blockages
- Lifestyle changes: Diet, exercise, smoking cessation
Non-Cardiac Treatments
- GERD: Antacids, proton pump inhibitors, lifestyle changes
- Musculoskeletal: Pain relievers, rest, physical therapy
- Anxiety: Counseling, relaxation techniques, medications
- Lung conditions: Antibiotics, inhalers, oxygen therapy
Prevention Strategies
- Heart disease prevention: Healthy diet, regular exercise, weight management
- Control risk factors: Manage blood pressure, cholesterol, diabetes
- Quit smoking: Significantly reduces heart and lung disease risk
- Stress management: Regular relaxation, adequate sleep
- Regular check-ups: Monitor cardiovascular health
- Know your family history: Understand genetic risks
- Proper posture: Prevent musculoskeletal pain
- GERD prevention: Avoid trigger foods, eat smaller meals
When to See a Doctor
Seek Immediate Emergency Care For:
- New or unexplained chest pain
- Chest pain with heart attack symptoms
- Sudden, severe chest pain
- Chest pain with difficulty breathing
- Chest pain after trauma
Schedule a Doctor's Visit For:
- Recurring chest pain with activity
- Chest pain that concerns you
- Changes in chronic chest pain pattern
- Chest pain with risk factors for heart disease
- Persistent heartburn not relieved by medication