Everyone at some point in their lives experiences some form of chest pain. However, it is easy to become worried about chest pain when it is common knowledge that some of the causes of chest pain have serious implications, and these causes are fairly common. Whether it’s from sleeping funny, a muscular issue, or a more seriou reason such as an underlying heart disease, it can be very difficult to determine the cause of someone’s chest pain. If you’re reading this, you may be someone who has experienced chest pain and want more information to understand what you are experiencing. To find out more about the different causes of chest pain, continue reading below.
What is chest pain?
Chest pain describes an unpleasant sensation you primarily feel around your chest. This definition covers a range of different sensations that might come the umbrella term, “chest pain”.1 One person with chest pain may describe a feeling of tightness or heaviness in the chest, whilst another may describe a sharp pain. Others might describe a feeling of discomfort that isn’t necessarily “painful”.1 This provides a bit of a conundrum, as different causes of chest pain trigger variable sensations and accurately describing your pain can be a challenge. Chest pain can be divided into Cardiac and Non-Cardiac chest pain. Cardiac chest pain, as it sounds, has to do with your heart. Non-Cardiac chest pain, however, describes every other possible cause of chest pain.
Possible causes of chest pain
As I mentioned before, the causes of chest pain can be divided into two categories. A very common cause of non-cardiac chest pain is skeletal (bone) and muscular pain.2 This can be a muscular strain, tear, or a result of some form of trauma to the chest. This type of chest pain typically comes on very suddenly and might be worse when you move. Another common cause is acid reflux, which can give you a chest pain-like sensation. Problems with the lungs such as infections, conditions like asthma or COPD, a collapsed lung, and lung cancer can also cause chest pain.1 A very serious lung-related condition is a pulmonary embolism where a blood clot gets stuck in an artery in your lungs. This is a medical emergency.
Cardiac chest pain is the type of chest pain that affects most poeple, and can be the most worrying as cardiac disease is one of the leading causes of mortality around the world.3, 4 There are a range of conditions that fall under the umbrella term “ ischaemic/coronary heart disease: They all follow the same pattern of varying severity, where the blood vessels that supply the heart muscle with oxygen and nutrients become obstructed by fatty plaques.5 This means that the heart cannot get enough nutrients to create the energy it needs to carry out its function of pumping blood around the body. You can think of coronary heart disease as being on a spectrum, with stable angina at the ‘less severe’ end and a myocardial infarction (heart attack) at the ‘most severe’ end.5 In stable angina the coronary arteries are obstructed, however, not to the extent it interferes with your daily functioning. However, in situations where you need to exert yourself (vigorous exercise),5 your heart needs to pump faster to supply your muscles with energy to perform the task required. However, if you suffer from stable angina, your heart cannot keep up with the additional demand, because it needs more blood to supply it with oxygen. This is what causes chest pain in those with stable angina, where they are perfectly fine at rest but experience chest pain on exertion. This can progress into unstable angina, where the blockage in the coronary arteries is worse and the patient experiences chest pain all the time. This can progress onto a myocardial infarction (MI) if your coronary arteries become fully blocked. An MI is a medical emergency and would require immediate intervention.
There are other causes of cardiac chest pain too, including:
- Aortic dissection, where the inner part of the main artery in the body has a tear.
- Pericarditis, is inflammation of the sac that your heart is contained within
- Heart Failure
- Any issues with the valves within your heart can cause chest pain
Signs and symptoms of chest pain
There are different signs and symptoms of chest pain that can point towards the underlying cause. In the case of muscular chest pain. people typically describe a sharp pain that is worse when they move. They might also remember a recent incident that caused pain.2 Pain from acid reflux is typically a burning sensation that is worse after eating food. Anxiety, panic attacks, and stress can also cause someone to experience episodes of chest pain, with psychogenic causes being the most common reason.6
Respiratory chest pain has a few distinct features. Conditions affecting the lungs might cause chest pain and have symptoms such as a dry cough, phlegmy cough or coughing up blood. This chest pain can be associated with feeling breathless For example, people with COPD tend to experience chest pain that comes with breathlessness from carrying out day-to-day tasks. Those with asthma experience similar symptoms, such as tightness in the chest. Someone with a pulmonary embolism is likely to have chest pain accompanied by sudden breathlessness. This may be associated with swelling in one leg. Pain when taking a deep breath could also be indicative of a respiratory issue, such as a pulmonary embolism or a musculoskeletal cause.7
Heart disease has a few signs that indicate a cardiac cause for chest pain. The American Heart Association describes angina-associated pain as feeling like an “uncomfortable pressure, fullness, squeezing or pain in the centre of the chest”.8 The difference between stable and unstable angina is whether or not the symptoms of chest pain are present during rest. Stable angina normally occurs when you’re physically exerting yourself. The American Heart Association also outlines a few symptoms that indicate that someone is having a heart attack.9 The chest pain resembles angina-related pain. However, this pain can travel to the neck, jaw, and left arm. This can be accompanied by sweating, nausea, and shortness of breath. The chest pain of an aortic dissection is normally described as a tearing or ripping pain that travels to the back.
Management and treatment for chest pain
The management of chest pain depends t on the underlying cause. Minor muscular issues can be treated with simple rest and over-the-counter painkillers. However, severe skeletal or muscular causes such as a torn chest wall or broken ribs will require immediate medical attention.10
In the case of respiratory chest pains, examples of their treatment include but are not limited to:10
- Antibiotics (for those with chest infections)
- Inhalers and steroids (for those with asthma or COPD)
- Pulmonary Embolisms require treatment with blood thinning medications and imaging called a CTPA
Angina is typically treated with what is known as secondary prevention; this includes medications that help symptoms and decrease mortality. Heart attacks, being a medical emergency, are treated in a hospital.10
How can I prevent chest pain?
Some causes of chest pain are unavoidable such as in conditions like asthma. However, avoiding activities with a high risk for chest trauma can prevent muscular causes. Avoiding smoking can prevent the development of coronary artery disease and COPD. A healthy diet can also prevent heart disease.
What does chest pain feel like
An uncomfortable feeling in your chest. This pain can be sharp, dull, feel like tightness, or induce a significant amount of pressure on your chest.
When should I call my doctor?
You should see your doctor if you have been experiencing chest pain. However, a few symptoms to look out for are:
- Chest pain on exertion
- Pain when at rest
- Increased Breathlessness
- Unexplained weight loss
- Coughing up blood
- Chest pain that travels to your neck, jaw, arm, or back
- Pain with a deep breath
- A general feeling of being unwell
In summary, chest pain is a very common symptom that has many different causes. While many causes might not be serious, it is very important to be vigilant and proactive in seeking medical help when experiencing chest pain.
- Johnson K, Ghassemzadeh S. Chest Pain. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
- Musculoskeletal chest wall pain. Australian Journal for General Practitioners. 2015;44:540-4.
- Ahmad FB, Anderson RN. The Leading Causes of Death in the US for 2020. Jama. 2021;325(18):1829-30.
- Rana JS, Khan SS, Lloyd-Jones DM, Sidney S. Changes in Mortality in Top 10 Causes of Death from 2011 to 2018. Journal of General Internal Medicine. 2021;36(8):2517-8.
- Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. Lancet (London, England). 2022;399(10332):1347-58.
- McDevitt-Petrovic O, Kirby K, Shevlin M. The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study. BMC health services research. 2017;17(1):549.
- Reamy BV, Williams PM, Odom MR. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis. American family physician. 2017;96(5):306-12.
- Association AH. Angina 2021 [cited 2023 26/01/23]. Available from: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain.
- Association AH. Warning Signs of A Heart Attack 2022 [cited 2023 26 Jan]. Available from: https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack.
- NICE. Chest pain: Scenario: Management 2022 [cited 2023 Jan 26]. Available from: https://cks.nice.org.uk/topics/chest-pain/management/management/.