Causes of Chest Pain: Signs and Symptoms

  • Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

There are many causes of chest pain, not just limited to heart attacks.

What Is Chest Pain?

Chest pain is discomfort or pain anywhere from a person's neck to the upper part of the abdomen. The discomfort or pain may be described as:

  • Tightness
  • Squeezing
  • Crushing
  • Tearing (or ripping)
  • Stabbing
  • Burning
  • Aching
  • Sharp
  • Dull
  • Palpitations (uneasiness or discomfort in chest because of a rapid heartbeat)
  • Constant
  • Intermittent
Chest pain can be a sign of a serious medical condition.

What Causes Chest Pain?

Chest pain may be caused by many different problems; although many people think chest pain is due only to problems with the heart, this is not true. Chest pain may arise as a result of problems with any of the structures located between the neck and the upper part of the abdomen. For example, the following is a list of tissues and organs that when disease is present may result in chest pain:

  • Heart
  • Lungs
  • Chest muscles
  • Bones (ribs, sternum, and clavicles for example)
  • Esophagus
  • Nerves
  • Stomach
  • Pancreas
  • Gastrointestinal tract
  • Skin

Some causes of chest pain are medical emergencies (most heart problems, for example) and need to be evaluated immediately by medical caregivers. If you have chest pain and are unsure of the cause, seek medical attention immediately to have medical personnel evaluate you for the cause of your chest pain.

Chest pain can be caused by heart related illnesses.

Heart-Related (Cardiac) Causes of Chest Pain

Heart problems are a common cause of chest pain. Coronary artery disease may result in a reduced blood flow to the heart tissue. The sharp pain it can cause is termed angina. This pain may spread to the left arm, both arms, shoulders, upper back, and even cause pain in the jaw. It may also cause pain in the back of the chest. Exercising, working hard, going up a flight of stairs or even emotional stress can trigger this chest pain. Another common cause of heart-related pain is a myocardial infarction or “heart attack.” This is due to a significant reduction or complete blockage of blood flow to an area of the heart muscle. Myocardial infarction often causes crushing or squeezing pain and/or tightness in the chest; this heart problem is a medical emergency.

Other conditions may also cause heart muscle problems. In general, anything that causes the heart muscle to become inflamed (a viral infection of heart tissue, for example) can result in myocarditis (damage to the heart muscle due to inflammation). This can result in discomfort or palpitations in the chest along with shortness of breath. Abnormal heartbeats (arrhythmias) may result in regular or irregular heartbeats that can be too fast or slow. Fast heartbeats may result in palpitation symptoms, while slow heartbeats may result in weakness and difficulty breathing. The major blood vessels that are connected to the heart can be damaged by weakness or elevated pressure (hypertension) resulting in arterial dissection or tearing of the vessels. A person experiencing arterial dissection may have severe chest pain similar to that of a myocardial infarction. This situation is also a medical emergency.

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Pain in the chest can also originate from the GI tract.

Gastrointestinal (GI) Causes of Chest Pain

Some parts of the gastrointestinal tract lie between the neck and the upper abdomen. Problems with GI tract organs or organs or structures connected to the GI tract may cause pain in the chest region. The following problems may result in discomfort or pain that may be interpreted as chest pain:

  • Gastroesophageal reflux disease (GERD), resulting often in a burning pain
  • Hiatal hernia (burning discomfort)
  • Rupture, perforation, or inflammation of the esophagus, resulting in moderate to severe chest pain that increases with breathing, swallowing, and/or vomiting
  • Inflammation of the gallbladder (cholecystitis), gallstones, or intermittent or complete bile duct blockage, resulting in intermittent or constant aching pain
  • Pancreatitis, pancreatic duct blockage, or pancreatic cancer, producing relatively constant upper abdominal and/or lower chest pain that can radiate to the back and may increase when eating
Chest pain can be caused by lung related conditions.

Lung-Related (Pulmonary) Causes of Chest

The lungs are a well-known source of chest pain when certain conditions are present. Some of the problems that cause chest pain include:

  • Pulmonary embolism (a blood clot in a pulmonary artery can cause chest discomfort and/or shortness of breath with pain that can be sharp, stabbing, burning, or aching)
  • Pulmonary hypertension (elevated pressure in the arteries that carry blood to the lungs can cause chest pressure or pain)
  • Pleurisy (inflammation of the membrane that covers the lungs causes intermittent chest pain with localized tenderness in the chest with breathing and/or coughing)
  • Collapsed lung (sudden onset of sharp chest pain on the side of the chest where the lung collapsed and shortness of breath that is relatively constant)
  • Pneumonia (infection of the lungs that may cause sharp or stabbing chest pain especially with breathing and coughing, usually associated with fever, muscle aches, and fatigue)
Nerves and muscles can cause chest pain as well as illnesses like the shingles virus.

Muscle or Nerve Disorders That Cause Chest Pain

Muscles in the chest and their supportive components such as ligaments can become injured during trauma or inflamed because of overuse even during severe coughing spells. The resulting chest pain is usually described as constant or intermittent and worsens (for example, goes from an ache to sharp pain) with activity or coughing. The area is tender when it is pressed or moved.

Nerve pain in the chest can come from any chest nerves that are pinched, cut, or crushed by trauma. However, one source of burning and/or sharp pain in the chest can be caused by shingles. Herpes zoster viruses remain in the body for years after a chickenpox infection and may later reactivate and follow the nerve distribution on the chest, usually producing a sharp pain in a band on one side of the chest. This chest pain may occur before the characteristic rash of shingles develops.

Chest pain can also be caused by problems in the rib bones.

Bone Problems That Cause Chest Pain

The ribs and the sternum are the two bone areas most often associated with chest pain. Trauma can cause rib fractures that produce sharp pain when moving the chest, especially when taking deep breaths. Rib cancers also can produce chest pain. Pain and tenderness may occur at or near the site of the cancer while the affected bone area produces a more constant dull pain or aching in the chest. Inflammation may occur at the junctions where the ribs meet the sternum. This condition is called costochondritis. The area is tender when palpated and when the person moves in certain directions or takes deep breaths. This pain is often reproducible when palpating the sternum.

Psychological Causes of Chest Pain

Psychological disorders such as anxiety, mental stress, and/or panic attacks can cause people to have sharp chest pains and rapid heartbeats that may result in a tightness or discomfort in the chest. The psychological disorders that cause chest pain are usually accompanied by fear, a sense of doom, or anxiety. These disorders are often accompanied by shortness of breath, dizziness, rapid breathing, and sweating along with chest pain.

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Some lung conditions and cancers cause chest pain.

Other Potential Causes of Chest Pain

There are other potential causes of various types of chest pain. Some examples include metastatic cancers that spread into the lungs, chronic obstructive pulmonary disease (COPD), asthma, diaphragm irritation, mitral valve prolapse (MVP), and others. Although many conditions may potentially cause chest pains, cardiac and lung problems are the chief causes of chest pain that may require emergency treatment.

When to See a Doctor for Chest Pain

If you are experiencing chest pain -- there are so many potential causes (some of which are medical emergencies) -- you should be evaluated by a medical caregiver to determine the underlying cause. If your chest pain is intermittent or you have problems swallowing or have a fever and/or chills, you should seek urgent evaluation by a medical caregiver.

Chest Pain in Women

Women who are experiencing a heart attack may have some less pronounced and sometimes different symptoms than men. For example, pain of a heart attack may be only expressed as discomfort in the neck, jaw, shoulders, and/or back. Women may have right arm pain instead of left arm pain and complain more of indigestion, nausea, and fatigue than men. Nonetheless, women with these symptoms should be seen in an emergency department to be evaluated.

Severe chest pain can be a sign of a medical emergency.

When Is Chest Pain a Medical Emergency?

Some types of chest pain require emergency medical evaluation. This includes chest pain that:

  • Comes on suddenly
  • Has the characteristics of pressure, squeezing, and/or tightness underneath your sternum or in your left chest
  • Radiates to your jaw, left arm, and/or back
  • Is accompanied by shortness of breath, nausea, dizziness, rapid heart rate, or a very low heart rate, sweating, pale skin color, and/or mental status changes such as confusion

If chest pain originates from an unknown source, the safest thing to do is to call 9-1-1 and be examined by a physician in an emergency department.

Reviewed on 2/29/2016
References
REFERENCES:

Medscape: “Myocardial Infarction Differential Diagnosis”

Medscape: “Angina Pectoris in Emergency Medicine Workup”

American Heart Association: “Heart Attack Symptoms in Women”

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