Chest Pain
Chest pain is one of the most common reasons people seek emergency medical care. Pain can come from the heart, lungs, esophagus, muscles, ribs, or nerves — and the cause is not always serious, but it can be life-threatening.
Quick Facts
- Common causes: Heart, lung, digestive, musculoskeletal
- Emergency?: Possibly — see warning signs below
- ICD-10: R07.9
- Affected area: Chest, sometimes radiates
When to Seek Emergency Care
- Feels like pressure, squeezing, fullness, or crushing weight
- Radiates to your arm, jaw, neck, back, or shoulder
- Is accompanied by shortness of breath, sweating, nausea, or lightheadedness
- Comes on suddenly and is severe
- Lasts more than a few minutes or goes away and comes back
- Follows an injury or occurs with coughing up blood
- Occurs with a fast or irregular heartbeat or fainting
Do not drive yourself. Heart attack and pulmonary embolism are time-critical emergencies.
Understanding Chest Pain
Chest pain refers to any discomfort, pressure, or pain felt anywhere from the neck to the upper abdomen. It is a symptom rather than a diagnosis — many different structures inside the chest can cause it, and the same underlying problem can feel very different from one person to the next.
Most chest pain in adults turns out not to be a heart attack, but because heart attacks and other serious causes can be fatal if missed, all unexplained chest pain should be evaluated promptly.
Types of Chest Pain
By quality of the pain
- Pressure or squeezing — often described as an elephant sitting on the chest; classically associated with heart-related causes.
- Sharp or stabbing — more often musculoskeletal, pleural (lung lining), or related to nerves.
- Burning — frequently caused by acid reflux or esophageal irritation.
- Aching or sore — common with muscle strain or costochondritis.
- Tearing — a tearing sensation moving to the back can suggest aortic dissection (medical emergency).
By location
- Central — behind the breastbone; common for cardiac or esophageal causes.
- Left-sided — possible heart-related, but also lung, muscle, or rib.
- Right-sided — more often lung, gallbladder, or musculoskeletal.
- Radiating — to arm, jaw, neck, or back; raises concern for heart attack or aortic problems.
Common Causes
Heart-related (cardiac) causes
- Angina — chest discomfort from reduced blood flow to the heart, often triggered by exertion.
- Heart attack (myocardial infarction) — blocked blood flow causing heart muscle damage.
- Pericarditis — inflammation of the sac around the heart, often sharp and worse when lying flat.
- Aortic dissection — a tear in the body's main artery; sudden, severe, often tearing pain.
Lung-related causes
- Pulmonary embolism — a blood clot in the lungs; sudden, sharp pain often with shortness of breath.
- Pneumonia — chest pain that worsens with breathing or coughing.
- Pleurisy — inflammation of the lung lining.
- Pneumothorax (collapsed lung) — sudden sharp pain with breathlessness.
Digestive causes
- GERD (acid reflux) — burning behind the breastbone, often after meals.
- Esophageal spasm — squeezing pain that can mimic a heart attack.
- Gallbladder problems — pain that can radiate to the right chest.
- Peptic ulcer — burning upper abdominal pain that may reach the lower chest.
Musculoskeletal causes
- Costochondritis — inflammation where ribs meet the breastbone; pain reproducible by pressing on the chest.
- Muscle strain — typically follows new physical activity or heavy lifting.
- Rib injury or fracture — usually after trauma or severe coughing.
Other causes
- Anxiety or panic attacks — can cause real, intense chest discomfort.
- Shingles — burning chest pain that may precede a rash.
Diagnosis
Because so many conditions can cause chest pain, evaluation typically starts with a focused history, a physical exam, and tests aimed at ruling out the most dangerous causes first.
Common tests
- Electrocardiogram (ECG/EKG) — measures the heart's electrical activity; often the first test in an emergency setting.
- Blood tests — including cardiac troponin (heart muscle damage) and D-dimer (clot screening).
- Chest X-ray — looks at the lungs, heart shape, and ribs.
- CT scan — often used to rule out pulmonary embolism or aortic dissection.
- Echocardiogram — ultrasound of the heart, used for structural problems.
- Stress test — checks how the heart performs under exertion (outpatient setting).
Treatment
Treatment depends entirely on the underlying cause. A few examples:
- Heart attack — emergency procedures to restore blood flow (e.g., angioplasty), plus medications.
- Angina — nitroglycerin, beta-blockers, lifestyle changes, sometimes procedures.
- GERD — antacids, acid-reducing medications, diet changes.
- Costochondritis — anti-inflammatory medications and rest.
- Pulmonary embolism — anticoagulants (blood thinners).
- Anxiety-related chest pain — relaxation techniques, therapy, sometimes medication.
Prevention
You cannot prevent all causes of chest pain, but you can lower your risk of the most serious ones:
- Don't smoke; avoid secondhand smoke.
- Keep blood pressure, cholesterol, and blood sugar in target range.
- Exercise regularly and maintain a healthy weight.
- Eat a balanced diet rich in vegetables, whole grains, and lean protein.
- Manage stress and get enough sleep.
- Get up and walk on long flights or car trips to reduce clot risk.
When to See a Doctor
Seek emergency care for any chest pain with the warning signs at the top of this page.
Schedule an appointment for chest pain that:
- Is mild but persistent or recurring
- Happens with exertion and gets better with rest
- Wakes you from sleep
- Is associated with a chronic cough or heartburn
- Started after a fall or chest injury, even mild
Frequently Asked Questions
No. Most chest pain is not from a heart attack — it can come from muscles, the esophagus, lungs, or anxiety. But because heart attacks are life-threatening, any sudden, severe, or unexplained chest pain should be evaluated urgently.
There is no fully reliable way to tell them apart at home. Heart-related pain often feels like pressure or squeezing, can radiate to the arm or jaw, and may come with sweating or shortness of breath. Heartburn often burns, is worse after meals, and improves with antacids. If you are uncertain, seek emergency care.
Yes. Panic attacks and chronic anxiety can produce intense, real chest pain that can feel indistinguishable from cardiac pain. However, anxiety should only be considered the cause after dangerous conditions have been ruled out.
Costochondritis is inflammation of the cartilage connecting the ribs to the breastbone. It causes sharp, localized chest pain that is typically reproducible by pressing on the affected area. It usually resolves on its own but can be relieved with anti-inflammatory medication.
If you suspect a heart attack and emergency services tell you to chew an aspirin, do so. Do not delay calling 911 to look for an aspirin, and do not take aspirin if you have a known allergy or bleeding disorder.
References
- National Heart, Lung, and Blood Institute. Chest Pain.
- American Heart Association. Heart Attack Symptoms in Women.
- Mayo Clinic. Chest pain — Symptoms and causes.