Sharp Chest Pain

What sharp chest pain usually means

Sharp, stabbing pain that you can point to with one finger, or that changes with breathing, movement or pressure, is less typical of a heart attack than pressure or squeezing. But "less typical" does not mean "never". About 1 in 8 heart attacks causes pain described as sharp. So the overall picture matters: age, risk factors, breathlessness and how sudden the pain was. For a broader overview of all chest pain, see chest pain.

Causes of sharp chest pain

Chest wall causes (most common)

• Costochondritis: inflammation of the cartilage joining the ribs to the breastbone. Sharp or aching pain beside the breastbone, reproduced by pressing on the spot, often worse with deep breaths or arm movement. It can last weeks.
• Muscle strain: after workouts, lifting, twisting or a bad bout of coughing. Pain with specific movements.
• Rib fracture or bruising: after a fall, blow or severe coughing. Very sharp pain on breathing and pressing.
• Precordial catch syndrome: a sudden, sharp, pinpoint pain on the left side lasting seconds to a few minutes, usually at rest and in children and young adults. It worsens with breathing in and goes away on its own. It is harmless.
• Slipping rib syndrome: pain at the lower rib margin with a clicking sensation.
• Shingles: sharp, burning or stabbing pain in a band on one side, days before a rash appears.

Lung causes

• Pleurisy: inflammation of the lining around the lungs, usually from a viral infection. Sharp pain on breathing in or coughing, which may spread to the shoulder.
• Pulmonary embolism: a blood clot in the lungs. Sudden sharp pain on breathing in, breathlessness, fast heart rate, sometimes coughing blood. Risks include recent surgery or immobility, long travel, cancer, pregnancy, estrogen-containing pills and previous clots.
• Pneumothorax (collapsed lung): sudden one-sided sharp pain and breathlessness. Common in tall, thin young men and smokers, and in people with COPD or asthma.
• Pneumonia: sharp pain on breathing with fever, cough and colored phlegm.

Heart causes

• Pericarditis: inflammation of the sac around the heart, often after a viral infection. Sharp central or left-sided pain, worse lying flat and breathing in, eased by sitting up and leaning forward. Sometimes pain spreads to the top of the shoulder.
• Aortic dissection: sudden, severe tearing or ripping pain to the back. Rare but an emergency.
• Heart attack: occasionally described as sharp, especially in women and younger people.

Digestive and other causes

• Esophageal spasm or acid reflux: usually burning or squeezing, but can be sharp.
• Gallbladder attacks: right upper belly pain spreading to the right chest or shoulder blade.
• Panic attacks: sharp or stabbing pains with fast breathing, palpitations and tingling.

Comparing causes of sharp chest pain

Sharp pain on the left side of the chest

Sharp left-sided chest pain worries people because the heart is thought to be on the left. In fact the heart is near the center, and heart attack pain is usually central pressure. Left-sided sharp pain is most often chest wall pain, precordial catch, pleurisy or anxiety. Still, if it comes with breathlessness, sweating, nausea or fainting, or if you have heart disease risk factors, get emergency care.

Sharp chest pain that comes and goes

Brief, recurrent stabs of pain lasting seconds, especially at rest, are usually from the chest wall or nerves. Pain that comes on with exertion and goes with rest suggests angina even if it feels sharp, and needs prompt assessment.

How doctors find the cause

The doctor will ask exactly where it hurts, what makes it worse, whether it changes with breathing, position or pressure, and about recent illness, travel, surgery and risk factors. They examine your chest wall, listen to your lungs and heart (a scratching "friction rub" suggests pericarditis), and check oxygen levels.

Common tests include an ECG, a chest X-ray, troponin for heart damage, D-dimer and a CT pulmonary angiogram if a clot is possible, and an echocardiogram for pericarditis.

Treatment

• Chest wall pain: reduce activities that trigger it, apply heat or ice, and take acetaminophen (paracetamol) or an NSAID such as ibuprofen at the label dose. Gentle stretching helps costochondritis.
• Pleurisy: treat the cause, and NSAIDs for pain.
• Pericarditis: NSAIDs or aspirin with colchicine, prescribed and monitored by a doctor, and rest from strenuous exercise.
• Pulmonary embolism: anticoagulant medicine, and hospital care in serious cases.
• Pneumothorax: small ones may be observed; larger ones need air removed with a needle or chest drain.
• Pneumonia: antibiotics if bacterial.

Frequently asked questions

Is sharp chest pain a heart attack?

Usually not. Sharp, stabbing pain that changes with breathing or pressing is more often from the chest wall, lungs or pericardium. Heart attacks usually cause pressure or squeezing. But some heart attacks feel sharp, so seek emergency care if pain comes with breathlessness, sweating, nausea or fainting.

Why do I get sharp chest pain when I breathe in?

Pain on breathing in is called pleuritic pain. It is caused by irritation of the lung or heart lining, or of the chest wall. Common causes are pleurisy, costochondritis, strained muscles and precordial catch. Pulmonary embolism, pneumonia, pneumothorax and pericarditis also cause it and need urgent checks.

What is a sudden sharp pain in the chest that lasts a few seconds?

In children and young adults, this is often precordial catch syndrome: a harmless pinpoint pain on the left side, often at rest, that worsens with breathing in and disappears within seconds to minutes. It needs no treatment. Pain that keeps recurring or comes with other symptoms should be checked.

Can anxiety cause sharp chest pain?

Yes. Anxiety and panic attacks can cause sharp, stabbing chest pains, often with a racing heart, fast breathing, tingling and dizziness. Tense chest muscles and hyperventilation contribute. Because the symptoms overlap with heart and lung problems, get a first episode checked.

When should I go to the ER for sharp chest pain?

Go to the ER, or call 911, if sharp pain is sudden and severe, comes with shortness of breath, fainting, coughing blood or a fast heartbeat, follows surgery or long travel, or tears through to the back. Pain after a chest injury also needs prompt assessment.