Everything you need to know about pain in the chest
No doubt about it, chest pain or discomfort can be distressing or even frightening. It can be sharp or dull, or even manifest as a pressure-like sensation, squeezing, choking, numbness, or some other type of discomfort. Depending on the underlying cause, the symptoms can last from less than a second to days or weeks, can occur frequently or rarely, and might occur either unpredictably or under specific, known circumstances. Because chest pain can accompany medical conditions ranging in seriousness—heartburn, anxiety, angina, and heart attack, for example—it is important for a doctor to evaluate you as quickly as possible.Besides pain quality and timing, the precise location of chest pain is also variable among patients. For instance, what someone reports as chest pain may actually be upper abdominal pain from an ulcer or gastroesophageal reflux disease, or even referred pain from a slipped disk in the neck.Even more, pain may begin in the chest but then move (radiate) to other areas of the body. For example, with angina, patients may describe a significant pressure on or constriction in their chest—which some describe as an “elephant on my chest” or “like wearing a tight bra,” respectively. That pain radiates to their arms, shoulders, neck, and lower jaw.
Illustration by Alexandra Gordon, Verywell
Chest pain can be caused by medical conditions affecting any of the organs located in the chest or upper abdomen, including the heart, blood vessels, lungs, airways, muscles, bones, esophagus, or stomach.Though not exhaustive, this list covers some of the more common causes of chest pain
The heart is the first organ doctors and patients consider when a person is experiencing chest pain.
Acute Coronary Syndrome
- Trouble breathing
Mitral Valve Prolapse
Pulmonary problems, such as asthma, bronchitis, pneumonia, and pleuritis, often produce chest pain, as does a pulmonary embolus—a potentially life-threatening cause of chest pain that results when a blood clot in the leg or pelvis travels to the lungs.With pulmonary embolus, in addition to sharp chest pain that worsens with a deep breath, a person may experience trouble breathing, a fast heartbeat, cough, and symptoms of a deep venous thrombosis (calf tenderness and warmth). Albeit rare, some patients with a pulmonary embolus, lose consciousness or cough up blood.
Chest Wall Pain
- Regurgitation of food or fluids
- A taste of acid in the throat
- Problems swallowing (called dysphagia)
- Persistent hoarseness
- The sensation of a lump in the throat or sore throat that doesn’t get better
If untreated, heartburn can lead to serious consequences, including ulcer formation, Barrett’s esophagus, and esophageal cancer.
Peptic Ulcer Disease
- A fast heartbeat
When to See a Doctor
From reviewing this long list of possible causes of your chest pain, it’s clear to see why you need to be seen by a doctor. A medical evaluation is the only way to know for sure what’s behind this alarming pain and to make sure you’re getting the right treatment.While there are no hard-and-fast rules for determining if your chest pain is dangerous or constitutes an emergency, there are some general guidelines that can be very helpful. Here are just a few of the reasons to seek immediate medical care when experiencing chest pain:
- Your chest feels tight or that you are being crushed.
- Pain is traveling to your shoulders, arm, neck, throat, or lower jaw.
- You are also experiencing weakness or shortness of breath.
- The pain is getting progressively worse over 15 minutes.
- You feel a sense of “impending doom” (like something is very wrong).
A medical history and physical exam will set the stage for what comes next in terms of the diagnostic process. Depending on what your doctor suspects, you may get blood work, imaging, or other tests, or a combination of these.
It is through a careful, but brief and succinct medical history that a doctor decides whether or not your chest pain could be life-threatening.
Labs and Tests
- An electrocardiogram (ECG)
- Stress test
- Blood tests, called cardiac enzymes to rule out a heart attack, and to look for evidence of inflammation or autoimmune conditions
- Pulmonary function tests
For example, if there is an inkling that your chest pain could be heart-related, an electrocardiogram and cardiac enzymes will be promptly ordered. On the other hand, if you have a fever, your chest pain is associated with coughing, and your doctor hears wheezing on your lung exam, you will likely require imaging.
Besides the numerous potential causes of chest pain, your doctor will also keep in mind conditions that refer pain to the chest—a classic example being cervical radiculopathy.Arthritis in the cervical spine (your neck), a herniated disc, or cervical spinal stenosis (narrowing of the spinal canal) may compress nerve roots that refer pain to the chest. If your doctor suspects cervical radiculopathy as the source of your pain, an MRI of the neck may be ordered. Of course, an MRI would only be ordered once potentially life-threatening sources of chest pain are ruled out first.
Treatment of chest pain depends on the diagnosis.
- Stable angina: Treatment entails aspirin and a beta-blocker or nitrate to decrease the workload on the heart and relax the blood vessels that supply it. You will also likely be referred to a cardiologist for preventive heart care.
- Pneumonia: Treatment involves an antibiotic, along with possible oxygen, fluid support, and hospitalization, depending on the patient’s age and the severity of the infection.
- Pulmonary embolism: The vast majority of patients will be started on a blood thinner (called anticoagulation) to prevent the formation of new clots.
- Chest wall pain: A nonsteroidal anti-inflammatory (NSAID) and/or a muscle relaxant may provide relief.
- Acid reflux/peptic ulcer disease: A medication that blocks acid production, like a proton pump inhibitor, can ease the pain associated with these conditions.
- Panic attack: For anxiety-related chest pain, treatment of the underlying anxiety disorder with a combination of talk therapy and an antidepressant is warranted.
- Herpes Zoster: For this diagnosis, your doctor will prescribe an antiviral and prescription pain medication.
Procedures and Surgery
In the case of a heart-related cause for the chest pain, if acute coronary syndrome is diagnosed with an ECG and elevated cardiac enzymes, rapid transfer to cardiac catheterization will likely be in order, followed by monitoring and medical care within a hospital’s coronary care unit.
While you may feel a tad overwhelmed reading about all the various causes and treatments for chest pain, keep in mind that many diseases related to chest pain can be prevented.Most notably, by following the below lifestyle strategies, you can reduce your risk of developing heart disease:
- Smoking cessation
- Eating a low-fat diet rich in fruits and vegetables
- Regular exercise
- Weight loss, if you are overweight or obese
Likewise, to reduce anxiety-related chest pain, be sure to work relaxation strategies into your everyday routine.