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Understanding Chest Pain

Chest pain can be a dull, sharp, stabbing, burning, or crushing pain in the chest. Many health conditions can cause chest pain, some of which are life-threatening, such as a heart attack. That’s why it’s important to seek immediate medical help for unexplained chest pain. Common causes of non-cardiac chest pain include acid reflux and muscle pain in the chest wall.

If you’re wondering, “Why does my chest hurt?” read on to learn about possible causes of chest pain and when to seek medical advice and emergency medical attention. The nature of your chest pain and other symptoms accompanying chest pain can provide clues about the potential cause. Most chest pain can be treated by treating the underlying condition causing it.

Types of Chest Pain

Sharp Chest Pain

Sharp chest pain can feel like a stabbing pain in your chest. Possible causes of chest pain that is a sudden, sharp, or stabbing pain include heart problems, lung problems, acid reflux, muscle strains, and panic attacks. Find out how to tell the difference between a heart attack and a panic attack.

Crushing Chest Pain

Crushing, oppressive, squeezing, tearing, and pressure-like chest discomfort are often related to heart issues such as angina, heart attack, pericarditis, or aortic dissection.

Burning Chest Pain

Chest pain that feels like a burning sensation might be due to gastrointestinal issues such as gastroesophageal reflux disease (GERD), stomach ulcers, gastritis, or hiatal hernia. It can also be due to panic attacks or more serious causes like heart attack, pericarditis, and pneumonia.

Dull or Aching Chest Pain

A dull ache in the chest can be due to a chest injury or rib injury, muscle strains and sprains, and chronic pain syndromes like fibromyalgia.

Common Causes of Chest Pain

Heart-Related Causes

• Myocardial infarction (heart attack), which occurs from a lack of blood flow to the heart muscle due to a blocked artery.

• Angina pectoris (chest pain due to a reduction in the heart’s blood supply in people with coronary heart disease).

• Aortic dissection (a life-threatening condition in which a tear develops in the wall of the aorta, the main blood vessel that carries blood (oxygen-rich blood) from the heart to the rest of the body).

• Pericarditis (inflammation of the pericardium or sac that surrounds the heart).

• Aortic aneurysm (a bulging in the aorta at a weak spot that can cause sudden, severe chest pain, abdominal pain, or back pain).

• Valvular heart disease (for example, mitral valve prolapse or aortic valve stenosis).

• Congenital abnormalities (chest pain is rare in heart conditions present from birth but may be a symptom in congenital cardiomyopathies (problems with the heart muscle).

• Cardiac arrest (when the heart suddenly stops beating) can be associated with symptoms such as chest pain, palpitations, shortness of breath, dizziness, nausea, sweating, and loss of consciousness. Find out the difference between cardiac arrest and a heart attack.

Symptoms that indicate cardiac chest pain (related to heart conditions) include a sharp pain in the chest, chest pressure or chest tightness, radiation of the pain to the jaw or left arm, severe pain that is worse with activity and gets better with rest, chest pain that continues for many hours, a rapid heartbeat, shortness of breath, dizziness, cold sweat, nausea, and vomiting.

Pulmonary Embolism and Other Lung Conditions

• Pulmonary embolism (a blood clot in the lung arteries).

• Lung infections such as pneumonia, COVID-19, and tuberculosis (TB) can cause chest pain when you breathe deeply.

• Pleuritis (inflammation of the pleura or membrane covering the lungs).

• Pulmonary hypertension (high blood pressure in the blood vessels of the lungs).

• Pneumothorax (collapsed lung) occurs due to leakage of air into the space between the lungs and the wall of the chest cavity.

• Chronic obstructive pulmonary disease (COPD) can cause chest tightness or heaviness.

Associated symptoms that indicate a pulmonary (lung-related) cause of chest pain include chest pain that gets worse with taking a deep breath or coughing, shortness of breath, trouble breathing, shallow or rapid breathing, lightheadedness, fatigue, sweating, fast heartbeat, fever, chills, chronic cough, coughing up blood, swelling in the feet or abdomen, and a blue/gray tinge to the skin.

Gastrointestinal Causes of Chest Pain

• Heartburn can cause chest pain, which is typically a burning pain behind the breast bone due to reflux of stomach acid into the esophagus.

• Gallbladder problems (gallstones or gallbladder inflammation).

• Pancreatitis (inflammation of the pancreas).

• Gastritis (inflammation of the stomach can cause pain in the middle of the chest).

• Esophageal spasms (abnormal contractions in the muscles of the esophagus).

• Swallowing disorders (pain with swallowing due to problems with the esophagus can feel like chest pain).

Associated symptoms that indicate a gastrointestinal cause of chest pain include a sour taste in the mouth, regurgitation (a sensation of food re-entering the mouth), a burning sensation in the chest, trouble swallowing, pain with swallowing, a feeling that something is stuck in your throat, cough, sore throat, pain in the middle or upper abdomen, nausea, vomiting, gas, bloating, worsening symptoms after fatty meals, fever, sweating, and loss of appetite.

Chest Pain Caused by Muscle and Bone Problems

• Costochondritis (inflammation of the cartilage that joins the ribs to the breastbone).

• Rib injuries, including rib fractures.

• Muscle soreness due to sprains and strains.

• Chronic pain syndromes such as fibromyalgia.

Other symptoms that indicate muscle and bone problems include back pain, tenderness, discomfort when pressing upon the chest wall, chest pain that is worse with taking a deep breath, coughing, sneezing, or moving, fatigue, difficulty breathing, and swelling or bruising of the skin.

Neurological Conditions

Shingles (herpes zoster) is a viral infection caused by the varicella-zoster virus. It can cause a sharp shooting or burning pain in a band-like distribution in the chest and back areas. Other symptoms include a skin rash with fluid-filled blisters, tingling, itching, and tenderness.

Psychological Causes

Panic attacks are brief episodes of intense fear and anxiety in the absence of any real danger. People with panic disorder can experience physical symptoms during a panic attack, including chest pain, chest tightness, a pounding or racing heartbeat, difficulty breathing, sweating, trembling, stomach pain, and nausea.

How to Know If My Chest Pain Is Serious

Warning Signs

Chest pain due to a serious condition may feel like pressure or tightness in the chest. It can be a sharp stab or a searing pain that spreads to other parts of your body, such as the jaw, neck, shoulders, arms, and back. Other warning signs include chest pain that lasts more than a few minutes or keeps coming back and chest pain that is worse with activity and better with rest. Accompanying symptoms may include a racing heartbeat, trouble breathing, dizziness, weakness, nausea, and cold sweats. 

When to Seek Urgent Medical Help

Seek emergency medical help for any new or unexplained chest pain. Call 911 or have someone drive you to the nearest emergency room. Drive yourself to the hospital only if there is no other option.

Symptoms to Monitor

Noncardiac chest pain can feel similar to cardiac (heart) pain. Seek prompt medical care for any unexplained pain in the chest. A professional medical evaluation is necessary to receive a proper diagnosis and treatment.

Diagnosis of Chest Pain

Healthcare providers can identify the cause of chest pain based on your symptoms, medical history, physical examination, laboratory tests, imaging studies, and other investigations.

Immediate Tests in the Emergency Room

• Electrocardiogram (EKG or ECG) to measure the electrical activity of the heart and diagnose a heart attack.

• Chest X-ray to visualize the heart and lungs and diagnose conditions such as a broken rib, pneumonia, or collapsed lung.

• Blood tests to check for proteins that are elevated in people with a heart attack.

• CT scan to diagnose pulmonary embolism or aortic dissection.

• Coronary angiography to see how blood moves through the heart.

Further Testing 

• Echocardiogram to obtain pictures of the heart using sound waves.

• Stress test to see how the heart responds to physical activity.

• CT scans to obtain detailed images and check for blockages in the arteries of the heart.

• Coronary catheterization to study blood flow in the heart.

Treatment of Chest Pain

Immediate Treatment for Chest Pain

If the cause of your chest pain is a heart attack, doctors can give you drugs to break up a clot in your artery. They can also do an emergency angioplasty to open narrowed or blocked blood vessels and place a stent (small metal tube) to keep the artery open. Sometimes, heart surgeons do an emergency heart bypass surgery to restore blood flow to the heart muscle. Learn more about medications after a heart attack.

Medical Treatments and Interventions

Some of the medications used to treat chest pain include:

• Nitrates, such as nitroglycerin, to widen the arteries that supply blood to the heart. 

• Blood pressure medicines to relax the blood vessels.

• Aspirin for cardiac chest pain. 

• Thrombolytics (blood clot dissolving drugs) such as alteplase (t-PA), streptokinase, reteplase, urokinase, tenecteplase, prourokinase, and anistreplase (APSAC)*.

• Anticoagulants (blood thinners) such as warfarin (Coumadin), heparin, apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and enoxaparin (Lovenox). 

• Antiplatelet drugs such as aspirin and clopidogrel (Plavix) to prevent platelets from clumping together to form blood clots.

• Acid-reducers such as H2 blockers and proton pump inhibitors for chest pain related to stomach acid backflow into the esophagus.

• Antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), and venlafaxine (Effexor XR) to treat panic attacks.

*Urokinase, anistreplase, and streptokinase are no longer available in the U.S. Prourokinase is not available in the U.S., and additional testing is required to be approved by the FDA. 

Home Remedies, Lifestyle Changes, and Prevention Tips

Home remedies and lifestyle changes for chest pain depend on the underlying cause. For example, if you have lung or heart issues, you should work with your healthcare team to develop a healthy lifestyle plan including eating a heart-healthy diet, getting regular exercise, ensuring enough sleep, managing stress, and quitting smoking and excessive alcohol use. You should also work with your healthcare professional to control risk factors for heart disease, such as high blood pressure, high cholesterol, diabetes, and obesity. However, chest pain can present in many ways. Therefore, it is always important to be evaluated by a physician when experiencing unusual chest pain.

Find out: Can Stress Cause A Heart Attack?

Frequently Asked Questions about Chest Pain

How Do I Make My Chest Stop Hurting?

You can make your chest stop hurting by treating the underlying cause. It’s very important to get a proper diagnosis of chest pain. Some of the causes of chest pain are life-threatening conditions like heart attack, while other causes are not as serious, such as acid reflux.

Why Does My Chest Hurt For No Reason?

Your chest can hurt for many reasons, including problems related to your heart, lungs, esophagus, muscles, nerves, bones, and other causes. A healthcare provider can find the reason for your chest pain and treat it appropriately.

What Causes Chest Pain in a Female?

The causes of chest pain in women are similar to the causes of chest pain in men, including cardiac and noncardiac causes. Spontaneous coronary artery dissection (SCAD) is a rare condition that causes chest pain - this condition is more common in women in their 40s and 50s (although it can occur at any age and also in men). Studies also show that women are more likely than men to overlook heart attack symptoms and delay seeking treatment. This is typically due to the fact that women often experience atypical symptoms of heart attacks, which can be mistaken for heartburn, indigestion, or anxiety, leading to a delay in treatment. Survival rates after a heart attack are lower in women than in men. Additionally, women are also at higher risk of heart failure following a heart attack compared to men. 

How Do I Know If My Chest Pain Is Serious?

It is highly recommended that you seek emergency medical help for any unexplained or severe chest pain that lasts more than a few minutes. While there are many causes of chest pain, ranging from mild to serious, you should never delay care. Timeliness plays a vital role if chest pain is a sign of a heart attack, pulmonary embolism, or other serious complications.