Chest pain - Health Guide

What is chest pain?

chest pain is Angina or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

But, angina is not a disease. It is a symptom of an underlying heart problem, usually coronary heart disease (CHD).There are many types of angina, including microvascular angina, Prinzmetal’s angina, stable angina, unstable angina and variant angina. View an animation of angina(link opens in new window).

This usually happens because one or more of the coronary arteries is narrowed or blocked, also called ischemia.

Angina can also be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the heart’s smallest coronary arteries and is more likely to affect women than men. Coronary MVD also is called cardiac syndrome X and non-obstructive CHD. Learn more about angina in women.

Depending on the type of angina you have, there are many factors that can trigger angina pain. The symptoms also vary based on the type of angina you have.

Types of Angina

Knowing the types of angina and how they differ is important.

Stable Angina / Angina Pectoris
Unstable Angina
Variant (Prinzmetal) Angina
Microvascular Angina

What causes chest pain?

Chest pain. The first thing you may think of is heart attack. Certainly chest pain is not something to ignore. But you should know that it has many possible causes. In fact, as much as a quarter of the U.S. population experiences chest pain that is not related to the heart. Chest pain may also be caused by problems in your lungs, esophagus, muscles, ribs, or nerves, for example. Some of these conditions are serious and life threatening. Others are not. If you have unexplained chest pain, the only way to confirm its cause is to have a doctor evaluate you.You may feel chest pain anywhere from your neck to your upper abdomen. Depending on its cause, chest pain may be:

Sharp
Dull
Burning
Aching
Stabbing
A tight, squeezing, or crushing sensation

Here are some of the more common causes of chest pain.

Chest Pain Causes: Heart Problems

Although not the only cause of chest pain, these heart problems are common causes:

Coronary Artery Disease, or CAD. A blockage in the heart blood vessels that reduces blood flow and oxygen to the heart muscle itself. This can cause pain known as angina. It’s a symptom of heart disease but typically does not cause permanent damage to the heart. It is, though, a sign that you are a candidate for a heart attack at some point in the future. The chest pain may spread to your arm, shoulder, jaw, or back. It may feel like a pressure or squeezing sensation. Angina can be triggered by exercise, excitement, or emotional distress and is relieved by rest.

Myocardial infarction (heart attack). This reduction in blood flow through heart blood vessels causes the death of heart muscle cells. Though similar to angina chest pain, a heart attack is usually a more severe, crushing pain usually in the center or left side of the chest and is not relieved by rest. Sweating, nausea, shortness of breath, or severe weakness may accompany the pain.

Myocarditis. In addition to chest pain, this heart muscle inflammation may cause fever, fatigue, fast heart beat, and trouble breathing. Although no blockage exists, myocarditis symptoms can resemble those of a heart attack.

Pericarditis. This is an inflammation or infection of the sac around the heart. It can cause pain similar to that caused by angina. However, it often causes a sharp, steady pain along the upper neck and shoulder muscle. Sometimes it gets worse when you breathe, swallow food, or lie on your back.Hypertrophic cardiomyopathy. This genetic disease causes the heart muscle to grow abnormally thick. Sometimes this leads to problems with blood flow out of the heart. Chest pain and shortness of breath often occur with exercise. Over time, heart failure may occur when the heart muscle becomes very thickened. This makes the heart work harder to pump blood. Along with chest pain, this type of cardiomyopathy may cause dizziness, lightheadedness, fainting, and other symptoms.

Mitral valve prolapse. Mitral valve prolapse is a condition in which a valve in the heart fails to close properly. A variety of symptoms have been associated with mitral valve prolapse, including chest pain, palpitations, and dizziness, although it can also have no symptoms, especially if the prolapse is mild.

Coronary artery dissection. A variety of factors can cause this rare but deadly condition, which results when a tear develops in the coronary artery. It may cause a sudden severe pain with a tearing or ripping sensation that goes up into the neck, back, or abdomen.

Chest Pain Causes: Lung Problems

Problems with the lungs can cause a variety of types of chest pain. These are common causes of chest pain:

Pleuritis. Also known as pleurisy, this condition is an inflammation or irritation of the lining of the lungs and chest. You likely feel a sharp pain when you breathe, cough, or sneeze. The most common causes of pleuritic chest pain are bacterial or viral infections, pulmonary embolism, and pneumothorax. Other less common causes include rheumatoid arthritis, lupus, and cancer.

Pneumonia or lung abscess. These lung infections can cause pleuritic and other types of chest pain, such as a deep chest ache. Pneumonia often comes on suddenly, causing fever, chills, cough, and pus coughed up from the respiratory tract.

Pulmonary embolism. When a blood clot travels through the bloodstream and lodges in the lungs, this can cause acute pleuritis, trouble breathing, and a rapid heartbeat. It may also cause fever and shock. Pulmonary embolism is more likely following deep vein thrombosis or after being immobile for several days following surgery or as a complication of cancer.Pneumothorax. Often caused by an injury to the chest, pneumothorax occurs when a part of the lung collapses, releasing air into the chest cavity. This can also cause pain that gets worse when you breathe as well as other symptoms, such as low blood pressure.

Pulmonary hypertension. With chest pain resembling that of angina, this abnormally high blood pressure in the lung arteries makes the right side of the heart work too hard.

Asthma. Causing shortness of breath, wheezing, coughing, and sometimes chest pain, asthma is an inflammatory disorder of the airways.

Chest Pain Causes: Gastrointestinal Problems

Gastrointestinal problems can also cause chest pain and include:

Gastroesophageal reflux disease (GERD). Also known as acid reflux, GERD occurs when stomach contents move back into the throat. This may cause a sour taste in the mouth and a burning sensation in the chest or throat, known as heartburn. Factors that may trigger acid reflux include obesity, smoking, pregnancy, and spicy or fatty foods. Heart pain and heartburn from acid reflux feel similar partly because the heart and esophagus are located close to each other and share a nerve network.

Esophageal contraction disorders. Uncoordinated muscle contractions (spasms) and high-pressure contractions (nutcracker esophagus) are problems in the esophagus that can cause chest pain.

Esophageal hypersensitivity. This occurs when the esophagus becomes very painful at the smallest change in pressure or exposure to acid. The cause of this sensitivity is unknown.

Esophageal rupture or perforation. A sudden, severe chest pain following vomiting or a procedure involving the esophagus may be the sign of a rupture in the esophagus.

Peptic ulcers. A vague recurring discomfort may be the result of these painful sores in the lining of the stomach or first part of the small intestine. More common in people who smoke, drink a lot of alcohol, or take pain-killers such as aspirin or NSAID’s, the pain often gets better when you eat or take antacids.

Hiatal hernia. This common problem occurs when the top of the stomach pushes into the lower chest after eating. This often causes reflux symptoms, including heartburn or chest pain. The pain tends to get worse when you lie down.Pancreatitis. You may have pancreatitis if you have pain in the lower chest that is often worse when you lie flat and better when you lean forward.

Gallbladder problems. After eating a fatty meal, do you have a sensation of fullness or pain in your right lower chest area or the right upper side of your abdomen? If so, your chest pain may due to a gallbladder problem.

Chest Pain Causes: Bone, Muscle, or Nerve Problems

Sometimes chest pain may result from overuse or an injury to the chest area from a fall or accident. Viruses can also cause pain in the chest area. Other causes of chest pain include:

Rib problems. Pain from a rib fracture may worsen with deep breathing or coughing. It is often confined to one area and may feel sore when you press on it. The area where the ribs join the breastbone may also become inflamed.

Muscle strain. Even really hard coughing can injure or inflame the muscles and tendons between the ribs and cause chest pain. The pain tends to persist and it worsens with activity.

Shingles. Caused by the varicella zoster virus, shingles may prompt a sharp, band-like pain before a telltale rash appears several days later.

Other Potential Causes of Chest Pain

Another potential cause of chest pain is anxiety and panic attacks. Some associated symptoms can include dizziness, sensation of shortness of breath, palpitations, tingling sensations, and trembling.

When to See the Doctor for Chest Pain

When in doubt, call your doctor about any chest pain you have, especially if it comes on suddenly or is not relieved by anti-inflammatory medications or other self-care steps, such as changing your diet.

Call 911 if you have any of these symptoms along with chest pain:

A sudden feeling of pressure, squeezing, tightness, or crushing under your breastbone
Chest pain that spreads to your jaw, left arm, or back
Sudden sharp chest pain with shortness of breath, especially after a long period of inactivity
Nausea, dizziness, rapid heart rate or rapid breathing, confusion, ashen color, or excessive sweating
Very low blood pressure or very low heart rate

Call your doctor if you have any of these symptoms:

Fever, chills, or coughing up yellow-green mucus
Problems swallowing
Severe chest pain that does not go away

What symptoms may occur with chest pain?

You may have other symptoms that occur with chest pain. Identifying symptoms you may be having can help your doctor make a diagnosis. These include:

Heart-related symptoms

While pain is the most common symptom of a heart problem, some people experience other symptoms, with or without chest pain. Women, in particular, have reported unusual symptoms that later have been identified as being the result of a heart condition:

chest pressure or tightness
back, jaw, or arm pain
fatigue
lightheadedness
dizziness
shortness of breath
abdominal pain
nausea
pain during exertion

Other symptoms

Symptoms that may indicate your chest pain isn’t heart-related include:

a sour or acidic taste in your mouth
pain that only occurs after you swallow or eat
difficulty swallowing
pain that’s better or worse depending on your body position
pain that’s worse when you breathe deeply or cough
pain accompanied by a rash
fever
aches
chills
runny nose
cough
feelings of panic or anxiety
hyperventilating
back pain that radiates to the front of your chest

How is chest pain diagnosed?

Seek emergency treatment immediately if you think you may be having a heart attack and especially if your chest pain is new, unexplained, or lasts more than a few moments.

Your doctor will ask you some questions, and your answers can help them diagnose the cause of your chest pain. Be prepared to discuss any related symptoms and to share information about any medications, treatments, or other medical conditions you may have.

Diagnostic tests

Your doctor may order tests to help diagnose or eliminate heart-related problems as a cause of your chest pain. These may include:

an electrocardiogram (ECG or EKG), which records your heart’s electrical activity
blood tests, which measure enzyme levels
a chest X-ray, which is used to examine your heart, lungs, and blood vessels
an echocardiogram, which uses sound waves to record moving images of the heart
an MRI, which is used to look for damage to the heart or aorta
stress tests, which are used to measure your heart function after exertion
an angiogram, which is used to look for blockages in specific arteries

How is chest pain treated?

Your doctor might treat chest pain with medication, noninvasive procedures, surgery, or a combination of these methods. Treatment depends on the cause and severity of your chest pain.

Treatments for heart-related causes of chest pain include:

medications, which may include nitroglycerin and other medications that open partially closed arteries, clot-busting drugs, or blood thinners
cardiac catheterization, which may involve using balloons or stents to open blocked arteries
surgical repair of the arteries, which is also known as coronary artery bypass grafting or bypass surgery

Treatments for other causes of chest pain include:

lung re-inflation for a collapsed lung, which your doctor will perform by inserting a chest tube or related device
antacids or certain procedures for acid reflux and heartburn, which are used to treat the symptoms
anti-anxiety medications, which are used to treat chest pain related to panic attacks

What is the outlook for people with chest pain?

Your doctor can treat and resolve chest pain caused by many common conditions. These may include acid reflux, anxiety attacks, and asthma or related disorders.

However, chest pain can also be a symptom of a life-threatening condition. Seek immediate medical treatment if you think you may be experiencing a heart attack or another heart problem. This can save your life.

Once your doctor makes a diagnosis, they can recommend additional treatments to help you manage your condition.

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