What Is Chest Pain?
- Tearing (or ripping)
- Palpitations (uneasiness or discomfort in chest because of a rapid heartbeat)
Quick GuideHeart Disease: Symptoms, Signs, and Causes
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:
- Chest muscles
- Bones (ribs, sternum, and clavicles for example)
- Gastrointestinal tract
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.
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.
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
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)
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.
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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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.
Healthy Heart Resources
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.
Quick GuideHeart Disease: Symptoms, Signs, and Causes
Medscape: “Myocardial Infarction Differential Diagnosis”
Medscape: “Angina Pectoris in Emergency Medicine Workup”
American Heart Association: “Heart Attack Symptoms in Women”
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Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis.
Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Coronary Artery Disease Screening Tests (CAD)
Coronary heart disease or coronary heart disease (CAD) screening tests can be used to potentially prevent a heart attack or cardiac event in a person without heart disease symptoms, and can assist in diagnosing heart disease in individuals with heart disease symptoms. Examples of coronary heart disease tests include:
- electrocardiogram (ECC, EKG),
- exercise stress test,
- radionuclide stress test,
- stress echocardiography,
- pharmacologic stress test,
- CT coronary angiogram, and
- coronary angiogram.
Costochondritis and Tietze SyndromeCostochondritis is inflammation of the cartilage where the ribs attach to the sternum. Tietze syndrome affects the same region of the chest and causes inflammation, tenderness, and swelling. Anti-inflammatory medications, rest, physical therapy, and cortisone injections are suitable methods of treatment for both costochondritis and Tietze syndrome.
Emphysema (Lung Condition)Emphysema is a COPD (chronic obstructive pulmonary disease) that often occurs with other obstructive pulmonary problems and chronic bronchitis. Causes of emphysema include chronic cigarette smoking, exposure to secondhand smoke, air pollution, and in the underdeveloped parts of the world. Symptoms of emphysema include chronic cough, chest discomfort, breathlessness, and wheezing. Treatments include medication and lifestyle changes.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes. Signs and symptoms of esophagitis include:
- Mouth sores
- Chest pain
- Bad breath
- Sore throat
- Difficulty swallowing
Treatment of esophagitis includes diet, lifestyle changes, and medication depending upon the cause.
Gastroesophageal Reflux Disease (GERD)GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are:
- regurgitation, and
Heart AttackHeart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include
- congested lungs,
- fluid and water retention,
- fatigue and weakness, and
- rapid or irregular heartbeats.
There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
Interstitial Lung Disease (Interstitial Pneumonia)Interstitial lung disease refers to a variety of diseased that thicken the tissue between the lungs' air sacks. Viruses, bacteria, tobacco smoke, environmental factors, cancer, and heart or kidney failure can all cause interstitial lung disease. Shortness of breath, cough, and vascular problems are symptoms caused by interstitial lung disease, and their treatment depends on the underlying cause of the tissue thickening.
Pulmonary hypertension is an increase pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur, for example:
- Ankle swelling (edema)
- Heart palpitations
- Chest pain
- Decreased appetite
- Pain in the upper right side of the belly (abdomen)
- Fainting (syncope)
- Lightheadedness, particularly during physical activity
- Swelling in the legs and ankles
- A bluish color to the lips and skin
People at risk of developing pulmonary hypertension are those who:
- Live at high altitudes
- Have a family history of the condition.
- Have diseases and conditions that may put them at risk of developing pulmonary hypertension
- Use illegal drugs like cocaine, and certain diet drugs.
NIH. National Heart, Lung, and Blood Institute. "What is Pulmonary Hypertension?" Updated: Aug 2011
NIH. PubMed Health. "Pulmonary Hypertension (PH)."
CDC. Division for Heart Disease and Stroke Prevention. "Pulmonary Hypertension Fact Sheet." Updated: Jul 22, 2014.