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, 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 indicate a serious problem, it's important to seek immediate medical help.

Symptoms

Chest pain can cause many different sensations 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

Although chest pain is often associated with heart disease, many people with heart disease say they have a vague discomfort that isn't necessarily identified as pain. In general, chest discomfort related to a heart attack or another heart problem may be described by or associated with one or more of the following:

• Pressure, fullness, burning or tightness in your chest
• Crushing or searing pain that spreads to your 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 or weakness
• Nausea or vomiting

Other types of chest pain

It can be difficult to distinguish heart-related chest pain from other types of chest pain. However, chest pain that is less likely due to a heart problem is more often associated with:

• A sour taste or a sensation of food reentering your mouth
• Trouble swallowing
• Pain that gets better or worse when you change your body position
• Pain that gets worse when you breathe deeply or cough
• Tenderness when you push on your chest
• Pain that persists 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 assistance 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 attention.

Heart-related causes

Examples of heart-related causes of chest pain include:

• Heart attack. A heart attack results from blocked blood flow, often from a blood clot, to the heart muscle.
• Angina. Angina is the term for 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.
• Aortic dissection. This life-threatening condition involves the main artery leading from the heart (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 (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 painful, burning sensation behind the breastbone occurs when stomach acid washes up from the stomach into the tube that connects the throat to the stomach (esophagus).
• Swallowing disorders. Disorders of the esophagus can make swallowing difficult and even painful.
• Gallbladder or pancreas problems. Gallstones or inflammation of the gallbladder or pancreas can cause abdominal 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, including:

• 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, can cause persistent muscle-related chest pain.
• Injured ribs. A bruised or broken rib can cause chest pain.

Lung-related causes

Many lung disorders can cause chest pain, including:

• Blood clot in the lung (pulmonary embolism). A blood clot that gets stuck in a lung (pulmonary) artery can block blood flow to lung tissue.
• Inflammation of the membrane covering the lungs (pleurisy). This condition can cause chest pain that worsens when you inhale or cough.
• Collapsed lung. The chest pain associated with a collapsed lung typically begins suddenly and can last for hours and is generally associated with 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 (pulmonary hypertension). This condition affects the arteries carrying blood to the lungs and can produce chest pain.

Other causes

Chest pain can also be caused by:

• Panic attack. If you have periods of intense fear accompanied by chest pain, a rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness and a fear of dying, you may be having a panic attack.
• Shingles. Caused by a reactivation of the chickenpox virus, shingles can produce pain and a band of blisters from the back around to the chest wall.

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 may also 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 evaluating chest pain include:

• Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An ECG can show if the heart is beating too fast, too slow or not at all. Because injured heart muscle doesn't conduct electrical signals in a typical pattern, the ECG may show that you have had or are having a heart attack.
• Blood tests. Blood tests may be done to check for increased levels of certain proteins or enzymes typically found in heart muscle. Damage to heart cells from a heart attack may allow these proteins or enzymes to leak, over a period of hours, into the blood.
• Chest X-ray. An X-ray of the chest can show the condition of the lungs and the size and shape of the heart and major blood vessels. A chest X-ray can also reveal lung problems such as pneumonia or a collapsed lung.
• Computerized tomography (CT) scan. CT scans can spot a blood clot in the lung (pulmonary embolism) or detect an aortic dissection.

Follow-up testing

Depending on the results from the initial tests for chest pain, you may need follow-up testing, which may include:

• Echocardiogram. An echocardiogram uses sound waves to produce a video image of the heart in motion. 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 can also be done with dye to check the heart and lung arteries for blockages and other problems.
• Stress tests. These measure how the heart and blood vessels respond to exertion, which may indicate if chest pain is heart related. There are many kinds of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while connected to an ECG. Or you may be given an IV drug to stimulate the heart in a way similar to exercise.
• Coronary catheterization (angiogram) . This test helps health care providers see blockages in the heart arteries. A long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter 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 your pain.

Medications

Drugs 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.
• Thrombolytic drugs. If you are having a heart attack, you may receive these clot-busting drugs. 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 feeding your heart or lungs, you'll likely be given drugs that interfere with blood clotting to prevent more clots from forming.
• Acid-suppressing medications. If chest pain is caused by stomach acid splashing into the esophagus, a health care provider may suggest medications that 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

Procedures to treat some of the most dangerous causes of chest pain include:

• Angioplasty and stent placement. Chest pain that is caused by a blockage in an artery feeding the heart is typically treated with angioplasty. The doctor inserts a catheter with a balloon on the end into a large blood vessel, usually in the groin, and guides the catheter to the blockage. The doctor inflates the balloon to widen the artery, then deflates it and removes the catheter. A small wire mesh tube (stent) is often placed on the outside of the balloon tip of the catheter. When expanded, the stent locks into place to keep the artery open.
• Bypass surgery. During this procedure, surgeons take a blood vessel from another part of the body and use it to create an alternative route for blood to go around the blocked artery.
• Emergency dissection repair. You may need emergency surgery to repair an aortic dissection — a life-threatening condition in which the artery that carries blood from the heart to the rest of the body ruptures.
• Lung reinflation. If you have a collapsed lung, a health care provider may insert a tube in the chest to reinflate 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 signs and symptoms in detail, noting when they started and anything that makes the pain better or worse.
• Medical history. Have you ever had chest pain before? What caused it? Do you or any close family members have a history of heart disease or diabetes?
• Medications. Having a list of all the medications and supplements you regularly take will be helpful to the emergency workers. You might want to prepare such a list in advance to carry in your wallet or purse.

Once you're at the hospital, it's likely that your medical evaluation will move quickly. Based on results from an electrocardiogram (ECG) and blood tests, your health care provider may be able to quickly determine if you are having a heart attack — or give you another explanation for your symptoms. You'll probably have a number of questions at this point. 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 be hospitalized?
• 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 additional questions that occur to you during your medical evaluation.

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 signs and symptoms other than chest pain, such as 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?