Chest pain

Chest pain is pain or discomfort in the area between the neck and belly. Chest pain may be sharp or dull. It might come and go, or you might always feel the pain. The exact symptoms depend on the cause.

Many different things can cause chest pain. The most life-threatening causes involve the heart or lungs. So it's important to get medical help for an accurate diagnosis.

If you think your chest pain is due to a heart attack, call 911 or your local emergency number right away.

Chest pain symptoms depend on the cause.

Heart-related chest pain

Chest pain is often related to heart disease. Chest pain symptoms due to a heart attack or another heart condition may include:

• Pressure, tightness, pain, squeezing or aching in the chest.
• Pain that spreads to the shoulder, arm, back, neck, jaw, teeth or upper belly.
• Shortness of breath.
• Fatigue.
• Heartburn or indigestion.
• Cold sweats.
• Lightheadedness.
• Fast heartbeat.
• Nausea.

Other types of chest pain

It can be hard to tell if chest pain is due to a heart condition or something else. Usually, chest pain is less likely due to a heart condition if it happens with:

• A sour taste or a feeling of food coming back up into 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 or days.

The classic symptoms of heartburn — a painful, burning sensation behind the breastbone — can be due to a health condition affecting 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 right away. Never ignore the symptoms of a heart attack.

If you can't get an ambulance or emergency vehicle to come to you, have someone drive you to the nearest hospital. Drive yourself only if you have no other way to get there.

Chest pain has many possible causes.

Heart and blood vessel causes

Some heart-related causes of chest pain are:

• Angina. This is any chest pain due to reduced blood flow to the heart muscle. It is often described as squeezing, pressure, heaviness, tightness or pain in the chest. Angina is a symptom of coronary artery disease. Unstable angina can cause a heart attack or near heart attack.
• Heart attack. A heart attack happens when blood flow to the heart muscle is blocked. It can cause angina chest pain. Emergency treatment is needed for a heart attack to prevent death.
• Aortic dissection. This life-threatening condition involves the body's main artery, called the aorta. If the inner layers of the aorta separate, blood is forced between the layers. This 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 taking a breath or lying down.

Digestive causes

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

• Gastroesophageal reflux disease (GERD). In this condition, stomach acid washes up from the stomach into the tube that connects the throat to the stomach. That tube is called the esophagus. GERD can cause a burning feeling in the chest, called heartburn.
• Swallowing disorders. Diseases that affect the esophagus can make swallowing difficult and even painful. This may lead to chest pain.
• Gallbladder or pancreas disease. Gallstones or inflammation of the gallbladder or pancreas can cause stomach pain that spreads to the chest.

Lung-related causes

Many lung conditions 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. Symptoms of a pulmonary embolism may feel like a heart attack.
• Irritation of the thin layers of tissue that separate your lungs from your chest wall, called pleurisy. This condition causes sharp chest pain that gets worse when you breathe in or cough.
• Collapsed lung. A collapsed lung happens when air leaks into the space between the lung and the ribs. It also is called a pneumothorax. Chest pain due a collapsed lung typically starts suddenly. It can last for hours. It usually causes shortness of breath.
• 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 or pressure.

Muscle and bone causes

Some types of chest pain are due to injury or damage to the structures that make up the chest wall. These conditions include:

• Costochondritis. This is inflammation of the cartilage that connects a rib to the breastbone. It can cause chest pain that might feel like a heart attack. The pain is most commonly felt on the left-hand side of the body.
• Injured ribs. A bruised or broken rib can cause chest pain.
• Long-term pain syndromes. Conditions such as fibromyalgia, which can make muscles sore, may cause long-term pain that affects the chest area.

Other causes

Chest pain also can be caused by:

• Panic attack. If you feel intense fear with chest pain, you may be having a panic attack. Panic attack symptoms also include a fast, pounding heartbeat, fast breathing, a lot of sweating, shortness of breath, nausea and dizziness. It can be hard to tell the difference between a heart attack and a panic attack. Always get medical help if you aren't sure of the cause of chest pain.
• Shingles. This is an infection caused by the varicella-zoster virus — the same virus that causes chickenpox. It can cause very bad pain and a band of blisters from the back around to the chest area.
• Nerve pain. Some people with pinched nerves in the middle back may feel chest pain.

Chest pain doesn't always mean that you're having a heart attack. But that's what emergency medical help usually tests for first because it can be life-threatening. Your healthcare professionals also will 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 done to diagnose the cause of chest pain are:

• Electrocardiogram (ECG or EKG). This quick test shows how the heart is beating. The test can tell if you have had or are having a heart attack. Sticky patches with sensors on them go on the chest and sometimes the arms and legs. Wires connect the sensors to a computer, which prints or displays results.
• Blood tests. Certain heart proteins and other substances slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these.
• Chest X-ray. An X-ray of the chest shows the condition of the lungs and the size and shape of the heart. A chest X-ray can diagnose pneumonia or a collapsed lung.
• Computerized tomography (CT) scan. A CT scan uses X-rays to create cross-sectional images of specific parts of the body. A CT scan of the chest can spot a blood clot in the lung or find an aortic dissection.

Follow-up tests

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

• Echocardiogram. Sound waves create images of the beating heart. This test shows how blood moves through the heart and heart valves.
• CT coronary angiogram. This test looks at the arteries that supply blood to the heart. It uses a powerful X-ray machine to make images of the heart and its blood vessels. The test is used to diagnose many different heart conditions.
• Exercise stress test. For this test, you walk on a treadmill or ride a stationary bike while a healthcare professional watches the heartbeat. Exercise tests help show how the heart reacts to exercise. If you can't exercise, you might get medicines that affect the heart like exercise does.
• Coronary catheterization. This test can find 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.

Chest pain treatment depends on what's causing the pain.

Medications

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

• Nitroglycerin. This medicine is given when your healthcare team thinks your chest pain is due to blocked arteries in the heart. It's often taken as a tablet under the tongue. The medicine relaxes heart arteries so blood can flow more easily.
• Blood pressure medicines. Some blood pressure medicines also relax and widen blood vessels. This can ease chest pain related to the heart.
• Aspirin. If healthcare professionals think that your chest pain is related to your heart, you may be given aspirin. The aspirin does not take away the chest pain. But it's part of the treatment for patients who have or may have blockages in the heart arteries.
• Clot-busting drugs, also called thrombolytics. If you are having a heart attack, you may get these medicines. They 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 may get these medicines to prevent future clots.
• Acid-reducing medicines. These medicines reduce stomach acid. They may be suggested if you have heartburn.
• Anti-anxiety medicines. If you're having panic attacks, your healthcare professional may recommend these medicines. 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 doctor inserts a thin tube with a balloon on the end into a large blood vessel, usually in the groin, and guides it to the heart. 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 graft surgery (CABG). This is a type of open-heart surgery. During CABG, a surgeon takes a vein or artery from somewhere else in the body. The surgeon uses the blood vessel to create a new path for blood to go around a blocked or narrowed heart artery. The surgery increases blood flow to the heart.
• 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 healthcare professional may place a tube in the chest to expand the lung.

You may not have time to prepare. 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 medical help, if possible:

• Symptoms. Describe your symptoms in detail. Note when they started and if anything makes the pain better or worse.
• Medical history. Tell the healthcare team 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 professionals. 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, you're usually examined quickly. Based on results from blood tests and a heart monitor, your healthcare professional can quickly know if you are having a heart attack or not.

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 have to change my activities after I get home?
• Should I see a specialist?

Don't hesitate to ask more questions.

What to expect from the doctor

A healthcare professional 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?
• On a scale of 1 to 10, with 10 being the worst, how bad is your pain?
• Do you have dizziness, lightheadedness or trouble breathing?
• Have you vomited?
• Do you have high blood pressure? If so, do you take medicine for it?
• Do you or did you use to smoke? How much?
• Do you use alcohol or caffeine? How much?
• Do you use illicit drugs, such as cocaine?