Chest pain

Overview

Chest pain appears in many forms, ranging from a sharp stab to a dull ache. Sometimes chest pain feels crushing or burning. In certain cases, the pain travels up the neck and into the jaw and then spreads to the back or down one or both arms.

Many different problems can cause chest pain. The most life-threatening causes involve the heart or lungs. Because chest pain can be due to a serious problem, it's important to seek immediate medical help.

Symptoms

Chest pain can feel different depending on what's triggering the symptom. Often, the cause has nothing to do with the heart — though there's no easy way to tell without seeing a health care provider.

Heart-related chest pain

Chest pain is often associated with heart disease. But many people with heart disease say they have a mild discomfort that they wouldn't really call pain. Chest discomfort due to a heart attack or another heart problem may feel like:

• Pressure, fullness, burning or tightness in the chest.
• Crushing or searing pain that spreads to the back, neck, jaw, shoulders, and one or both arms.
• Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity.
• Shortness of breath.
• Cold sweats.
• Dizziness, lightheadedness or weakness.
• Racing heartbeats.
• Nausea or vomiting.

Other types of chest pain

It can be difficult to tell if chest pain is related to the heart or caused by something else. Usually, chest pain is less likely due to a heart problem if it happens with:

• A sour taste or a sensation of food reentering the mouth
• Trouble swallowing
• Pain that gets better or worse when you change body position
• Pain that gets worse when you breathe deeply or cough
• Tenderness when you push on your chest
• Pain that continues for many hours

The classic symptoms of heartburn — a painful, burning sensation behind the breastbone — can be caused by problems with the heart or the stomach.

When to see a doctor

If you have new or unexplained chest pain or think you're having a heart attack, call 911 or emergency medical help immediately. Don't ignore the symptoms of a heart attack. If you can't get an ambulance or emergency vehicle to come to you, have a neighbor or a friend drive you to the nearest hospital. Drive yourself only if you have no other option.

Causes

Chest pain has many possible causes, all of which need medical care.

Heart-related causes

Examples of heart-related causes of chest pain include:

• Angina. This is chest pain caused by poor blood flow to the heart. This is often caused by the buildup of thick plaques on the inner walls of the arteries that carry blood to the heart. These plaques narrow the arteries and restrict the heart's blood supply, particularly during physical activity.
• Heart attack. A heart attack results from blocked blood flow to the heart muscle, often from a blood clot. Angina can be the main symptom felt during a heart attack.
• Aortic dissection. This life-threatening condition involves the main artery leading from the heart, called the aorta. If the inner layers of this blood vessel separate, blood is forced between the layers and can cause the aorta to rupture.
• Inflammation of the sac around the heart, called pericarditis. This condition usually causes sharp pain that gets worse when breathing in or lying down.

Digestive causes

Chest pain can be caused by disorders of the digestive system, including:

• Heartburn. This is a painful, burning feeling behind the breastbone. It occurs when stomach acid washes up from the stomach into the tube that connects the throat to the stomach. That tube is called the esophagus.
• Swallowing disorders. Problems with the esophagus can make swallowing difficult and even painful.
• Gallbladder or pancreas problems. Gallstones or inflammation of the gallbladder or pancreas can cause stomach pain that spreads to the chest.

Muscle and bone causes

Some types of chest pain are associated with injuries and other problems affecting the structures that make up the chest wall. These conditions include:

• Costochondritis. In this condition, the cartilage of the rib cage, particularly the cartilage that joins the ribs to the breastbone, becomes inflamed and painful.
• Sore muscles. Chronic pain syndromes, such as fibromyalgia, may cause long-term pain that affects the chest muscles.
• Injured ribs. A bruised or broken rib can cause chest pain.

Lung-related causes

Many lung problems can cause chest pain, including:

• A blood clot in the lung, called a pulmonary embolism. A blood clot that gets stuck in a lung artery can block blood flow to lung tissue.
• Inflammation of the membrane covering the lungs, called pleurisy. This condition causes chest pain that gets worse when you breathe in or cough.
• Collapsed lung. Chest pain due a collapsed lung typically begins suddenly. It can last for hours. It usually causes shortness of breath. A collapsed lung occurs when air leaks into the space between the lung and the ribs.
• High blood pressure in the lung arteries, called pulmonary hypertension. This condition affects the arteries carrying blood to the lungs. It can cause chest pain.

Other causes

Chest pain also can be caused by:

• Panic attack. If you have periods of intense fear with chest pain, you may be having a panic attack. Panic attack symptoms also include a rapid heartbeat, rapid breathing, a lot of sweating, shortness of breath, nausea, dizziness and a fear of dying. It can be hard to tell the difference between a heart attack and a panic attack. Always seek medical help if you aren't sure of the cause of chest pain.
• Shingles. This condition can cause intense pain and a band of blisters from the back around to the chest area.

Diagnosis

Chest pain doesn't always signal a heart attack. But that's what health care providers in the emergency room usually test for first because it's potentially the most immediate threat to your life. They also may check for life-threatening lung conditions — such as a collapsed lung or a blood clot in the lung.

Immediate tests

Some of the first tests a health care provider may order when diagnosing the cause of chest pain include:

• Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays or prints the test results. An ECG can show if the heart is beating too fast or too slowly. An ECG can help show if you have had or are having a heart attack.
• Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins.
• Chest X-ray. An X-ray of the chest shows the condition of the lungs and the size and shape of the heart and major blood vessels. A chest X-ray also can reveal lung problems such as pneumonia or a collapsed lung.
• Computerized tomography (CT) scan. CT scans can spot a blood clot in the lung or find an aortic dissection.

Follow-up testing

Depending on the results from the first tests for chest pain, you may need more testing, which may include:

• Echocardiogram. Sound waves are used to create videos of the heart in motion. Sometimes, a more detailed echocardiogram may be done to get better pictures of the heart. A small device may be passed down the throat to obtain better views of different parts of the heart.
• Computerized tomography (CT) scan. Different types of CT scans can be used to check the heart arteries for blockages. A CT coronary angiogram also can be done with dye to check the heart and lung arteries for blockages and other problems.
• Stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart rhythm is watched. Exercise tests help show how the heart reacts to exercise. If you can't exercise, you might be given medicines that affect the heart like exercise does.
• Coronary catheterization. This test helps health care providers see blockages in the heart arteries. A long, thin flexible tube is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the tube to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

Treatment

Chest pain treatment varies depending on what's causing the pain.

Medications

Medicines used to treat some of the most common causes of chest pain include:

• Artery relaxers. Nitroglycerin — usually taken as a tablet under the tongue — relaxes heart arteries so blood can flow more easily through the narrowed spaces. Some blood pressure medicines also relax and widen blood vessels.
• Aspirin. If health care providers think that your chest pain is related to your heart, you'll likely be given aspirin.
• Clot-busting drugs, also called thrombolytics. If you are having a heart attack, you may receive these medicines. These work to dissolve the clot that is blocking blood from reaching the heart muscle.
• Blood thinners. If you have a clot in an artery going to your heart or lungs, you'll likely be given medicines to prevent more clots from forming.
• Acid-reducing medicines. If chest pain is caused by stomach acid splashing into the esophagus, a health care provider may suggest these medicines. They reduce the amount of acid in the stomach.
• Antidepressants. If you're having panic attacks, your health care provider may prescribe antidepressants to help control symptoms. Talk therapy, such as cognitive behavioral therapy, also might be recommended.

Surgical and other procedures

Other treatments for some of the most dangerous causes of chest pain include:

• Angioplasty and stent placement. This treatment helps remove a blockage in an artery going to the heart. The health care provider inserts a thin tube with a balloon on the end into a large blood vessel, usually in the groin. The provider guides the tube to the blockage. The balloon expands. This widens the artery. The balloon is deflated and removed with the tube. A small wire mesh tube called a stent is often placed in the artery to keep it open.
• Coronary artery bypass surgery. This type of open-heart surgery creates a new pathway for blood to flow around a blockage in the heart. The surgeon takes a blood vessel from another part of the body and uses it to create the new pathway.
• Emergency repair surgery. You may need emergency heart surgery to repair a ruptured aorta, also called an aortic dissection. It's a life-threatening condition.
• Lung reinflation. If you have a collapsed lung, a health care provider may insert a tube in the chest to expand the lung.

Preparing for an appointment

If you're having severe chest pain or new or unexplained chest pain or pressure that lasts more than a few moments, call 911 or emergency medical services.

Don't waste any time for fear of embarrassment if it's not a heart attack. Even if there's another cause for your chest pain, you need to be seen right away.

What you can do

Share the following information with the emergency care providers, if possible:

• Symptoms. Describe your symptoms in detail. Note when they started and anything that makes the pain better or worse.
• Medical history. Tell your providers whether you've had chest pain before and what caused it. Tell them whether you or any close family members have a history of heart disease or diabetes.
• Medicines. Having a list of all the medicines and supplements you regularly take helps emergency care providers. You might want to prepare such a list in advance to carry in your wallet or purse.

Once you're at the hospital for chest pain, it's likely that you'll be examined quickly. Based on results from blood tests and a heart monitor, your health care provider may be able to quickly determine if you are having a heart attack — or give you another reason for your symptoms. You or your family may have many questions. If you haven't received the following information, you may want to ask:

• What's the most likely cause of my chest pain?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Do I need to stay in the hospital?
• What treatments do I need right now?
• Are there any risks associated with these treatments?
• What are the next steps in my diagnosis and treatment?
• I have other medical conditions. How might that affect my treatment?
• Do I need to follow any restrictions after returning home?
• Should I see a specialist?

Don't hesitate to ask more questions.

What to expect from the doctor

A health care provider who sees you for chest pain may ask:

• When did your symptoms start? Have they gotten worse over time?
• Does your pain spread to any other parts of your body?
• What words would you use to describe your pain?
• Do you have trouble breathing, dizziness, lightheadedness or vomiting?
• Do you have high blood pressure? If so, do you take medicine for it?
• Do you or did you smoke? How much?
• Do you use alcohol or caffeine? How much?
• Do you use illegal drugs, such as cocaine?