Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Chest tightness; Chest pressure; Chest discomfort
Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are not dangerous to your health, while other causes are serious and even life-threatening.
Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the chest from the neck, abdomen, and back.
Heart problems that can cause chest pain:
- Angina or a heart attack is pain that occurs because your heart is not getting enough blood and oxygen. The most common symptom is chest pain that may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
- A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body (aortic dissection) causes sudden, severe pain in the chest and upper back.
- Swelling (inflammation) in the sac that surrounds the heart (pericarditis) causes pain in the center part of the chest.
Lung problems that can cause chest pain:
- A blood clot in the lung (pulmonary embolism)
- Collapse of athe lung (pneumothorax)
- Inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.
- Pneumonia causes a sharp chest pain that often gets worse when you take a deep breath or cough.
Other causes of chest pain:
- Panic attack, which often occurs with fast breathing
- Inflammation where the ribs join the breast bone or sternum (costochondritis)
- Shingles, which causes sharp, tingling pain on one side that stretches from the chest to the back, and may cause a rash
- Strain or inflammation of the muscles and tendons between the ribs
Chest pain can also be due to the following digestive system problems:
- Spasms or narrowing of the esophagus (the tube that carries food from the mouth to the stomach)
- Gallstones cause pain that gets worse after a meal (most often a fatty meal)
- Heartburn or gastroesophageal reflux (GERD)
- Stomach ulcer or gastritis (burning pain occurs if your stomach is empty and feels better when you eat food)
In children, most chest pain is not caused by the heart.
For many causes of chest pain, it is best to check with your doctor or nurse before treating yourself at home.
If injury, overuse, or coughing has caused muscle strain, your chest wall is often tender or painful when you press a finger on the site of the pain. This can often be treated at home. Try acetaminophen or ibuprofen, ice, heat, and rest.
If you know you have asthma or angina, follow your doctor's instructions and take your medications regularly to avoid flare-ups.
See: Heartburn for information about treatment at home.
When to Contact a Medical Professional
Call 911 if:
- You have sudden crushing, squeezing, tightening, or pressure in your chest.
- Pain spreads (radiates) to your jaw, left arm, or between your shoulder blades.
- You have nausea, dizziness, sweating, a racing heart, or shortness of breath.
- You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.
- Your angina symptoms occur while you are at rest.
- You have sudden, sharp chest pain with shortness of breath, especially after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement, especially if one leg is swollen or more swollen than the other (this could be a blood clot).
Your risk of having a heart attack is greater if:
- You have a family history of heart disease
- You smoke, use cocaine, or are overweight
- You have high cholesterol, high blood pressure, or diabetes
Call your doctor if:
- You have a fever or a cough that produces yellow-green phlegm
- You have chest pain that is severe and does not go away
- You are having problems swallowing
- Chest pain lasts longer than 3 to 5 days
What to Expect at Your Office Visit
Emergency measures will be taken, if needed. You may need to go to the hospital if your heart problem is serious, or the cause of the pain is unclear.
The doctor will do a physical exam and monitor your vital signs (temperature, pulse, breathing rate, blood pressure). The physical exam will focus on the chest wall, lungs, and heart. Your doctor may ask questions such as:
- Is the pain between the shoulder blades? Under the breast bone? Does the pain change location? Is it on one side only?
- How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, tight, pressure-like, crushing, aching, dull, heavy)
- Does it come on suddenly? Does the pain occur at the same time each day?
- Is the pain getting worse? How long does the pain last?
- Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?
- Is the pain worse when you are breathing deeply, coughing, eating, or bending?
- Is the pain worse when you are exercising? Is it better after you rest? Does it go away completely, or is there just less pain?
- Is the pain better after you take nitroglycerin medicine? After you drink milk or take antacids? After belching?
- What other symptoms do you have?
Which tests are done depends on the cause of the pain. Often, one or more of the following tests may be done first:
Brown JE, Hamilton GC. Chest Pain. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 18.
Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.
Sabatine MS, Cannon CP. Approach to the patient with chest pain. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 53.
Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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