Chest pain

Chest pain can be caused by a wide range of conditions, from relatively harmless muscle strain to life-threatening heart attack or pulmonary embolism. Because it is impossible for a person to know the exact cause on their own, chest pain should never be ignored. It is always safest to seek immediate medical help, especially if you have other symptoms. 

Signs and symptoms

The location, duration, and feeling of chest pain can vary widely, depending on the cause. 

Signs of a heart-related issue

  • Pressure, tightness, squeezing, or a feeling of fullness in the center or left side of the chest that lasts for more than a few minutes, or comes and goes.

  • Pain that spreads to the jaw, neck, back, or one or both arms.

  • Shortness of breath, often but not always accompanied by chest discomfort.

  • Cold sweats, nausea, lightheadedness, or sudden dizziness.

  • Women often experience less severe chest pain and are more likely to have vague symptoms like unusual fatigue, nausea, or back or jaw pain. 

Signs of a non-heart-related issue

  • Heartburn: A burning sensation that is often worse after eating, lying down, or bending over. It may also leave a sour or bitter taste in your mouth.

  • Musculoskeletal pain (e.g., costochondritis): Sharp, localized pain that worsens when you press on the area, move, or take a deep breath. It is often caused by muscle strain or inflammation of the cartilage connecting the ribs to the breastbone.

  • Anxiety or panic attack: Chest tightness or pressure accompanied by a fast heart rate, sweating, shortness of breath, and a feeling of intense fear.

  • Pulmonary embolism (PE): A blood clot in the lung that can cause sudden, sharp chest pain and shortness of breath that worsens with deep breathing.

  • Pneumonia: An infection of the lungs that can cause fever, a cough with phlegm, and chest pain. 

Diagnosis

Because chest pain can have so many different causes, diagnosis often involves a combination of tests to rule out life-threatening conditions first. 

Initial tests in the hospital include:

  • Electrocardiogram (ECG): This quick test records your heart's electrical activity and can help detect a heart attack.

  • Blood tests: These can check for elevated heart proteins that may be released into the blood after heart damage.

  • Chest X-ray: This can reveal problems in the lungs, like pneumonia, or changes in the heart's size or shape.

  • CT scan: This imaging can be used to look for a blood clot in the lung (pulmonary embolism) or a tear in the aorta (aortic dissection). 

Follow-up tests may include:

  • Echocardiogram: An ultrasound that creates a moving image of your heart to assess its structure and function.

  • Stress test: Exercise or chemical, helps evaluate your heart's performance during stress

  • Coronary catheterization: In this procedure, a thin tube is guided to your heart arteries, and a dye is injected to highlight any blockages. 

Treatment

Treatment for chest pain depends entirely on the underlying cause. 

For life-threatening conditions:

  • Heart attack: Requires immediate treatment in the hospital, which may involve medications like aspirin or nitroglycerin, or procedures like placing a stent or bypass surgery.

  • Pulmonary embolism: Treated with blood thinners to prevent the clot from getting bigger, or with clot-busting medications in severe cases.

  • Other emergencies (e.g., aortic dissection): Require specialized medical or surgical procedures. 

For non-emergency conditions:

  • Heartburn/GERD: Often managed with lifestyle changes (avoiding trigger foods, eating smaller meals) and over-the-counter or prescription antacids.

  • Musculoskeletal pain: Treated with rest, over-the-counter anti-inflammatory medications (like ibuprofen), ice, and warm compresses.

  • Pneumonia: Treated with antibiotics for bacterial infections or supportive care for viral infections.

  • Anxiety: Managed with therapy (like Cognitive Behavioral Therapy), stress reduction techniques, and sometimes medication. 

When to call 911

You should call 911 or your local emergency number immediately for any unexplained chest pain, especially if it is accompanied by the following: 

  • Sudden pressure, squeezing, or fullness in the chest.

  • Pain spreading to the arm, jaw, neck, or back.

  • Shortness of breath, cold sweats, or nausea.

  • Feeling lightheaded or dizzy.

  • Pain that lasts more than a few minutes or worsens with exertion. 

When it comes to chest pain, it is always better to be safe and seek medical help to rule out a serious condition.

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