What Causes Chest Pain?

While you may think chest pain is a sure sign of a heart problem or write it off as indigestion, there is a wide range of possible causes.

It may feel like pressure, tightness, or squeezing in your chest. It can be persistent or come and go depending on your activity level or position. Sometimes chest pain also radiates to other areas like the shoulders, arms, neck, jaw, upper abdomen, or back.

Sources of chest pain may be conditions affecting the heart and blood vessels (cardiovascular system), respiratory system (pulmonary), gastrointestinal system, or musculoskeletal system. At times it can be psychological in nature. Here are some potential health issues to keep in mind as you try to determine why you're in pain.

Don't delay getting care if you have any new or severe chest pain. Contact your healthcare provider or call 911 and go to the emergency room. Healthcare professionals will be able to perform the examinations and tests needed to diagnose the cause and get you appropriate treatment.

Cardiovascular Causes 

Cardiovascular disease is a broad term describing conditions involving the heart and blood vessels. In the United States, approximately 1 out of every 4 deaths is attributed to heart disease, making it the leading cause of mortality by a landslide. Some primary cardiovascular conditions that produce chest pain are listed here.

Coronary Artery Disease 

Coronary artery disease (CAD) is the most common type of heart disease in the United States. Your coronary artery supplies blood, oxygen, and nutrients to your heart. With CAD, plaque accumulates along the arterial wall.

This plaque is made up of cholesterol deposits. Over time, plaques cause the arteries to narrow, causing a partial or total blockage of blood flow.  

Coronary Artery Dissection

A coronary artery dissection is a result of a spontaneous tearing in the coronary artery wall. This tear occurs when blood gets trapped in one of the arterial wall layers, causing it to bulge inward. Coronary artery dissections can cause a heart attack because blood cannot reach the heart, but fortunately, this condition is uncommon.

Hypertrophic Cardiomyopathy 

Hypertrophic cardiomyopathy (HCM) affects the heart tissue directly, causing the heart muscle to become abnormally thick and making it harder to pump blood.

HCM often goes undiagnosed because many people have minimal symptoms. However, in a small number of people, HCM can cause shortness of breath, chest pain, or abnormal heart rhythms resulting in sudden death.

Mitral Valve Prolapse 

In mitral valve prolapse (MVP), the two valve flaps of the mitral valve in the heart don't close smoothly or evenly and bulge or prolapse upward into the left atrium. Since mitral valve prolapse is not typically a dangerous condition, most people don't require treatment.

Myocardial Infarction 

The technical term for a heart attack is a myocardial infarction. Heart attacks happen when there's a blockage or slowdown of blood flow to the heart, usually from plaque buildup in the arteries (atherosclerosis).

A common cause is a ruptured plaque leading to the formation of a clot that blocks blood flow. This damages or destroys the heart muscle.

Myocarditis

Myocarditis is an inflammation of the heart muscle (myocardium) that causes the decreased ability of the heart to pump normally. In most cases, myocarditis is a relatively mild condition. In some people, however, myocarditis can be more severe and lead to heart failure.

Pericarditis

Pericarditis is the swelling of the saclike tissue that surrounds the heart (pericardium). Swollen layers of the pericardium rub against each other, causing chest pain. Pericarditis is frequently mild and may clear up on its own with minor treatment. Sometimes more intense interventions are needed to prevent complications.

Pulmonary Causes

Pulmonary diseases are types of diseases that affect the lung and other parts of the respiratory system. Chest pain associated with respiratory conditions may be mild and lingering rather than sudden. These are some pulmonary conditions that may cause chest pain.

Asthma

Asthma is a respiratory condition marked by inflammation and spasms in the bronchi of the lungs, causing difficulty in breathing. While there is no cure for asthma, you can manage the symptoms by avoiding asthma triggers and using medication properly.

COPD

Chronic obstructive pulmonary disease (COPD) refers to diseases that cause airflow blockage and breathing-related problems. Emphysema and chronic bronchitis are the most common conditions that contribute to COPD. COPD is a progressive disease that gets worse over time. But luckily, the symptoms are treatable.

Pleuritis 

The pleura is a thin membrane that lines the lungs' outer surface and the chest cavity's interior. In pleuritis, the pleura becomes inflamed, causing the pleural membranes to rub against each other, causing pain. Pleuritis is also called pleurisy.

Treatment for pleuritis depends on the underlying cause. In some cases, it goes away on its own without treatment.

Pneumonia 

Pneumonia is an infection that inflames the air sacs of one or both lungs, which may then fill with fluid or pus. Pneumonia can be mild or life-threatening and is most serious in infants, young children, people over 65, or those with weakened immune systems.

Most of the time, pneumonia is treated at home, but severe cases may be treated in the hospital.

Pneumothorax 

A pneumothorax is a collapsed lung. In pneumothorax, air leaks into the space between the lung and chest wall (outside the lung), causing it to collapse. There are several possible causes for collapsed lungs, including chest injuries or underlying lung conditions such as COPD, asthma, or pneumonia.

Treatment involves inserting a chest tube between the ribs to remove excess air. 

Pulmonary Embolism 

A pulmonary embolism is a blood clot in the lung that occurs when a clot in another part of the body becomes lodged in the lung's blood vessels. The blood clot restricts blood flow to the lungs, lowers oxygen levels in the lungs, and increases blood pressure in the pulmonary arteries.

A pulmonary embolism is seldom fatal when diagnosed and appropriately treated. However, pulmonary embolisms can be life-threatening if untreated. 

Pulmonary Hypertension 

Pulmonary hypertension is high blood pressure that affects the arteries in the lungs and the heart. With pulmonary hypertension, the arteries in the lungs become narrow or blocked, making it harder for blood to flow, raising the blood pressure in the lungs.

Pulmonary hypertension can lead to heart failure as the heart has to work harder to pump blood through the arteries. There is no cure for pulmonary hypertension. However, there are different types of treatments available.

Gastrointestinal Causes

Gastrointestinal is a term that is used to describe any condition that occurs within the gastrointestinal tract. Chest pain related to problems with the gastrointestinal tract usually occurs within the esophagus, the tube that connects the mouth to the stomach. 

Acid Reflux 

Acid reflux, known as gastroesophageal reflux disease (GERD) when chronic, is a condition in which stomach contents containing acid leak back into your esophagus. In GERD, the valve that is at the end of the esophagus does not close correctly.

Heartburn, a burning sensation in the chest caused by the irritation to the lining of the esophagus, is a symptom of acid reflux. GERD is a common condition, affecting 20% of the U.S. population. GERD is not dangerous in the short term. However, persistent GERD can cause other health problems, including cancer.

Esophageal Contraction Disorder

Esophageal contraction disorder, also known as esophageal spasms, occurs when muscles in the esophagus spasm or contract, making it harder for your food to reach your stomach.

Esophageal spasms are rare. Medical experts estimate that esophageal contraction disorder affects 1 in 100,000 people. Treatments focus on relaxing the muscles to relieve symptoms. 

Esophageal Hypersensitivity

Also known as "reflux sensitivity," esophageal sensitivity is considered a form of nonerosive reflux disease. People with this disorder tend to feel the pain of acid reflux more quickly and intensely than those without a hypersensitivity.

Esophageal Rupture or Perforations

Esophageal ruptures are tears that penetrate the esophagus wall, causing food and digestive fluid to leak into the chest, causing inflammation and, in some cases, fluid buildup in the lungs.

Ruptures may occur during vomiting or when swallowing a large piece of food that becomes stuck in the esophagus, or during a surgical procedure. Esophageal ruptures are highly dangerous and require prompt surgical repair.

Gallbladder

The gallbladder is a sac located under the liver. It stores and concentrates bile that has been produced in the liver. Bile helps with the digestion of fat and is released from the gallbladder into the upper small intestine in response to food.

Gallbladder diseases cause inflammation, infection, stones, or blockage of the gallbladder. Surgery to remove the gallbladder may be necessary if there are gallstones or the gallbladder is not functioning normally.

Hiatal Hernia 

A hiatal hernia occurs when part of the upper stomach pushes through an opening in the diaphragm and into the chest cavity. Hernias occur more often in people who are overweight and those who smoke.

Some people with hernias have GERD, and treatment involves treating the symptoms of GERD. People with a hiatal hernia who have severe, long-lasting GERD whose symptoms are not relieved by medical therapies may benefit from surgery.

Pancreatitis 

Pancreatitis is inflammation of the pancreas, a large gland behind the stomach that makes insulin and digestive enzymes. Acute pancreatitis occurs suddenly and is a short-term condition. Most people with acute pancreatitis get better, and it goes away in several days with treatment. In chronic pancreatitis, the pancreas may become damaged and require additional treatment. 

Peptic Ulcer 

Peptic ulcer disease is a condition in which sores or ulcers develop in the lining of the stomach or the first part of the small intestine called the duodenum. Ulcers are usually caused by pain-relieving nonsteroidal anti-inflammatory drugs (NSAIDs) or Helicobacter pylori (H. pylori) bacteria. In most cases, healthcare providers treat ulcers with medication. 

Bone, Muscle, or Nerve Causes

Chest pain may result from overuse or an injury to the chest area from a fall or an accident, or it may result from a virus.

Broken Rib

Broken or bruised ribs are usually caused by a fall, a blow to the chest, or severe coughing. Broken ribs generally heal themselves in three to six weeks. In 85% of cases, no special treatment is required. However, if you're still in pain after two months, you may need surgery.

Muscle Strain 

A muscle strain occurs when there has been stretching or tearing of the muscle fibers. Muscle strain often occurs during heavy lifting or when taking part in sports activities.

Treatment usually involves rest, ice, compression, and elevation of the injured area. Symptoms of muscle strain usually improve within several weeks, although severe muscle strain may require surgery. 

Shingles 

Shingles is a painful rash with blisters usually occurring on one side of the face or body. The virus that causes chickenpox lies dormant in your nervous system for years. Then it can reactivate along the nerve paths to produce the shingles rash.

The rash typically scabs over in seven to 10 days and fully clears up within two to four weeks. Shingles is common; 1 out of every 3 people in the United States will develop shingles in their lifetime. Recombinant zoster vaccine (RZV, Shingrix) is recommended to prevent shingles in adults 50 and older.

Psychological Causes 

Along with the physical reasons for chest pain, there are potential psychological causes.

Anxiety 

Anxiety disorders involve excessive fear or anxiety. Anxiety disorders are the most common type of mental disorders and affect nearly 30% of adults at some point in their lives. Anxiety disorders are treatable, and there are treatments available such as psychotherapy and medications.

Panic Attacks 

Panic attacks are sudden, brief feelings of fear and physical reactions that occur in response to nonthreatening situations. Every year, up to 11% of Americans experience a panic attack. Approximately 2% to 3% of them go on to develop panic disorder. Psychotherapy and medication are effective ways to treat panic attacks. 

When to See a Healthcare Provider

Chest pain may be a sign of a life-threatening emergency or something much less serious. Pain that's severe, new, persistent, or leaves you feeling dizzy, weak, or short of breath requires immediate medical attention. For chest pain that isn't as extreme, a call to your primary care healthcare provider can help you decide on the best next steps.

If you are unsure why you're experiencing chest pain, it's always better to give your healthcare professional a call rather than brushing your symptoms aside. Even if the cause of chest pain isn't putting you in immediate danger, you could benefit from treating underlying conditions and protecting your health in the long term.

A Word From Verywell

Many people let the fear of a potential health problem stop them from seeking the medical attention they need. Addressing chest pain right away will give you peace of mind and the best chance of avoiding dangerous consequences.