Causes of Chest Pain and Treatment Options

Everything you need to know about pain in the chest

Female doctor examining patient with stethoscope
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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.

Causes

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.

Cardiac Causes

The heart is the first organ doctors and patients consider when a person is experiencing chest pain.

Angina

"Typical” angina or stable angina due to coronary artery disease—when the arteries that supply your heart become clogged with fatty deposits—refers to pain or discomfort that arises as a result of the heart muscle not receiving enough oxygen. Stable angina worsens during exercise (due to the heart's increased demand for oxygen), eases with rest, and overall, occurs predictably, meaning it doesn't change in frequency or get worse with time.

While unstable angina (see below) requires emergent medical care, stable angina does not. A diagnosis of stable angina, though, does require pain control and preventive heart care (so the fatty deposits don't progress). A prompt appointment with your doctor or cardiologist is needed.

Note, too, that angina may also arise as a result of microvascular coronary artery disease, or less commonly, coronary artery spasm.

Acute Coronary Syndrome

Acute coronary syndrome (ACS), which includes unstable angina or a heart attack (called a myocardial infarction), is a medical emergency.

Unstable angina means that a person's usual heart-related chest pain is worsening, getting more frequent, and/or simply not following a typical pattern. Unstable angina may progress to a heart attack, which is when blood flow to an area of the heart is either slowed or blocked off. An expeditious diagnosis of acute coronary syndrome is paramount to prevent permanent heart damage.

Besides chest pain or discomfort, a person with acute coronary syndrome may experience other symptoms, such as:

  • Trouble breathing
  • Sweating
  • Nausea
  • Dizziness
  • Palpitations
  • Malaise
  • Weakness

Mitral Valve Prolapse

Mitral valve prolapse (MVP)—when the valve pushes into the left ventricle of the heart—is often blamed for episodes of chest pain, though it probably causes chest pain much less often than many doctors tend to believe. In addition to chest discomfort, some people with mitral valve prolapse experience dizziness, shortness of breath, palpitations, and exercise intolerance.

Pericarditis

Pericarditis, which refers to inflammation of the sac that surrounds your heart, typically produces fairly sudden chest pain that is sharp or stabbing and worsened when taking a deep breath or coughing. A distinctive feature of pericarditis is that leaning forward while seated tends to ease the chest pain.

Aortic Dissection

Aortic dissection is a catastrophic condition that produces sudden, severe chest or back pain that moves to the abdomen. Besides a tremendous "ripping" or "tearing" pain, a person may pass out or experience significant trouble breathing or symptoms of a stroke.

Noncardiac Causes

It may come as a surprise to some, but many people who are evaluated for chest pain are diagnosed with conditions that have nothing to do with the heart.

Some of the non-cardiac medical problems that can cause chest pain are quite significant and require aggressive treatment, such as a pulmonary embolus or severe case of pneumonia. Others, like heartburn, are more benign and can be treated successfully with simple strategies like taking a medication or adopting lifestyle strategies, like a change in diet or smoking cessation.

Lung Problems

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

Chest wall pain (musculoskeletal chest pain) is more common than many people realize, and while not particularly significant from a medical standpoint, it can be quite alarming. There are different manifestations of chest wall pain, with costochondritis—an inflammation of the costal cartilage that joins your rib bone to your breastbone—being perhaps the most common one. Costochondritis is often described as a sharp or stinging pain that is reproducible when you or the doctor press on the affected chest wall area.

Other causes of chest wall pain include rheumatic diseases like fibromyalgia or rheumatoid arthritis, rib fractures, and, rarely, a metastatic tumor (for example, breast or lung cancer that has spread to the ribs or soft tissues of the chest wall).

Heartburn

Heartburn, which is often experienced as a burning sensation behind the breastbone after eating, is a common cause of chest pain. Besides pain, a person with heartburn may also note symptoms such as:

  • 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

Peptic ulcer disease may produce a burning or hunger-like pain that is perceived as coming from the chest, although it's usually felt in the upper abdomen. Nausea, belching, and feeling full sooner than usual after eating are other common symptoms.

Like heartburn, without treatment, serious complications may occur including ulcer bleeding, which may cause vomiting up blood or black stools, and perforation, which causes sudden, severe pain due to a hole forming in the wall of the stomach or upper section of the small intestines.

Anxiety

Anxiety or panic disorder is commonly accompanied by chest pain, potentially related to hyperventilation (fast breathing). With a panic attack—a sudden episode of intense fear or discomfort that lasts for several minutes to an hour— other physical symptoms often arise as well. These may include:

  • A fast heartbeat
  • Dizziness
  • Stomachache
  • Headache

Herpes Zoster

Herpes zoster (called shingles) is a painful, blistering rash that is caused by a reactivation of the chickenpox virus. The rash appears in a band-like pattern and may occur on the chest. Oftentimes, a person notes excess skin sensitivity or abnormal sensations like itching, burning, or numbness and tingling at the site of the rash, a couple of days before it appears. Shingles is most common in people over the age of 50 and those with a weakened immune system, but may occur in anyone at any age.

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).

Diagnosis

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.

Medical History

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.

Pain Characteristics

Your doctor will inquire about the onset of your pain (abrupt versus gradual), its quality (for example, ripping, tearing, burning, sharp, or reproducible with pressing on it), its precise location and whether it radiates, triggering factors (for example, exercise can trigger angina while eating may trigger heartburn), and alleviating factors (for example, rest eases stable angina pain).

Associated Symptoms

Your doctor will also inquire about symptoms associated with your pain. For instance, with acute coronary syndrome, a person may experience dizziness, sweating, or nausea. With lung-related chest pain, a person may report a cough or trouble breathing.

Physical Examination

After checking your vitals, your doctor will perform a careful physical exam. Using a stethoscope, your doctor will listen to your heart sounds to determine whether there is an abnormal rhythm, murmur, or extra heart sound. Next, he will listen to your lungs for abnormal sounds like "wheezing"( a whistling sound) or "crackles" (a high pitched popping sound).

An abdominal exam and a careful musculoskeletal exam, in which your doctor presses on your chest to see if the pain is reproduced, is also important, as is a skin exam to evaluate for rash or areas of excessive skin sensitivity.

Labs and Tests

If considered necessary, your doctor may order one or more of the following 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.

Imaging Tests

Like labs and tests, whether or not your doctor orders imaging tests depends on his underlying suspicion. For example, if your doctor hears a murmur and/or suspects a valve-related problem, an echocardiogram may be ordered.

For a possible lung cause of your chest pain, your doctor may order a chest X-ray or a computed tomography (CT) scan, especially the latter if he is concerned about a pulmonary embolism.

With a suspected gastrointestinal source of your pain, an upper endoscopy or an abdominal ultrasound may be ordered.

Differential Diagnoses

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

Treatment of chest pain depends on the diagnosis.

Medication

A number of different medications may be used to treat a particular condition.

  • 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.

    Aortic dissection is another condition, albeit much less common than acute coronary syndrome, that requires emergent care. A cardiothoracic surgeon must repair of the torn aorta.

    For pulmonary embolism, treatment first entails providing sufficient oxygenation. Then, depending on the severity and location of the blood clot, a person may undergo thrombolysis (a procedure that involves breaking up the clot), embolectomy (surgical removal of the blood clot), or placement of an inferior vena cava filter.

    Prevention

    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.

    A Word From Verywell

    “Chest pain” is a term loosely used to describe any unusual or disturbing pain or discomfort that occurs in the general area of the chest. While chest pain often turns out to be due to a benign condition, all too often it indicates a serious, potentially life-threatening medical problem. Chest pain is something you should never ignore. 

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