Chest pain can be a sign of a heart attack or other cardiac condition, but it can also be a symptom of problems related to:
- bones and muscles
- other aspects of physical and mental health
Chest pain should always be taken seriously, even if it’s mild or you don’t suspect a life-threatening condition.
Learning to recognize when chest pain should be treated as a medical emergency and when it should be reported to your doctor at your next appointment could help you prevent major medical complications down the road.
Signs of a medical emergency
A heart attack doesn’t always include chest pain. You may be having a heart attack if you have sudden chest pain along with any of the following symptoms:
If these symptoms last for five minutes or more, you should call your local emergency services. You may be having a heart attack. Heart attack can also cause pain in the jaw, neck, back, or arms.
Chest pain related to your heart is often accompanied by shortness of breath or other breathing difficulties. You may also experience heart palpitations or a racing heart.
Chest pain associated with angina: described as pressure, or a feeling like your heart is being squeezed
Angina refers to a type of chest pain that occurs when blood is still flowing to the heart muscle, but the supply is dramatically reduced. It’s a fairly common condition, affecting about 9 million Americans.
Symptoms of angina include:
- feeling of pressure in your chest or like your heart is being squeezed
- pain elsewhere in your upper body
Angina is sometimes confused with a heart attack. Unlike a heart attack, angina doesn’t cause permanent damage to heart tissue.
There are two main types of angina: stable and unstable. Stable angina is predictable. It comes on when you’re physically active and the heart is pumping harder than usual. It tends to disappear when you rest.
Unstable angina can appear at any time, even when you’re sitting down and relaxed. Unstable angina is a more serious concern because it strongly indicates you’re at a greater risk of a heart attack.
If you aren’t sure whether you’re experiencing angina or a heart attack, err on the side of caution and call your local emergency services. If you experience either type of angina, you should make an appointment to see your doctor soon.
2. Heart attack
Chest pain associated with heart attack: sharp, stabbing pain, or tightness or pressure
A heart attack occurs when there is blockage in one or more of the arteries supplying blood to the heart muscle. When any muscle in the body is starved of oxygen-rich blood, it can cause considerable pain. The heart muscle is no different.
The chest pain that comes with a heart attack may feel like a sharp, stabbing sensation, or it may seem more like tightness or pressure in your chest. Other heart attack symptoms may include:
- shortness of breath
- a cold sweat
- a fast or irregular pulse
- a lump in your throat or a feeling of choking
- signs of shock, such as sudden and severe weakness
- numbness in an arm or hand
- vague feeling that something is wrong
A heart attack is always a medical emergency. The sooner you respond to heart attack symptoms and receive treatment, the less damage this cardiac event will cause. A heart attack may require bypass surgery or placement of a stent in one or more of your blocked coronary arteries.
Chest pain associated with myocarditis: mild pain or feeling of pressure
In some cases, heart-related chest pain is caused by inflammation of the heart muscle most frequently caused by a viral infection. This condition is known as myocarditis. About cases of myocarditis are reported across the globe every year.
Symptoms of myocarditis include:
- mild chest pain
- chest pressure
- shortness of breath (the most common symptom)
- swelling in the legs
- heart palpitations
If your symptoms are mild, make a doctor’s appointment soon. If chest pain, shortness of breath, and other signs are more severe, call your local emergency services.
Chest pain associated with pericarditis: sharp or dull pain that usually starts in the center or left side of the chest
Another type of heart inflammation is called pericarditis. It’s specifically an inflammation of the thin, watery sac that surrounds the heart, and it may be caused by viral or bacterial infections. Heart surgery can also lead to pericarditis. In most cases of pericarditis, the cause is unknown.
The condition isn’t very common, affecting only about 0.1 percent of hospital admissions.
Pericarditis can cause chest pain that feels like a heart attack. The pain may be sharp or dull, and it usually starts in the center or left side of the chest. The pain sometimes radiates to your back. Other symptoms may include:
Symptoms often disappear after a week or two with rest or medications.
If you think you may be having a heart attack, call your local emergency services. If the chest pain is mild, make a doctor’s appointment. Take note if you’ve had any type of infection, as it may have triggered pericarditis.
5. Aortic aneurysm
Chest pain associated with aortic aneurysm: may not cause noticeable symptoms, or your chest may feel tender to the touch
The aorta is the largest artery in your body, and it’s responsible for transporting blood from the heart and to the vast network of blood vessels that supply most of the body. All that blood flow can cause a bulge to form in the wall of the aorta. This balloon-like bulge is called an aortic aneurysm.
You could have an aortic aneurysm without knowing it. The bulge itself may not cause any symptoms. If you do notice any signs, they may include:
- tenderness in the chest, back, or abdomen
- shortness of breath
See your doctor as soon as you can if you notice a change in your breathing accompanied by chest discomfort.
6. Aortic dissection or rupture
Chest pain associated with aortic dissection or rupture: sudden sharp pain in chest and upper back
An aortic aneurysm can lead to an aortic dissection, which is a tear within the layers of the aortic wall that allows blood to leak out. An aortic aneurysm can also rupture, which means it bursts, causing blood to gush from the aorta.
Symptoms of a dissection or a rupture include:
- a sudden, sharp, and constant pain in your chest and upper back
- pain in your arms, neck, or jaw
- trouble breathing
These symptoms should be treated as an emergency, and you should seek immediate emergency medical care. An aortic dissection or rupture can be fatal if not treated promptly.
Chest pain associated with cardiomyopathy: may experience moderate pain after eating or exercise
Cardiomyopathy refers to several heart muscle diseases. They can cause the heart muscle to thicken, thin, or experience other complications that affect its pumping ability. You may develop a cardiomyopathy following another disease, or you may inherit the condition.
Symptoms may include:
- shortness of breath, especially after physical activity
- swelling in your legs and ankles
- chest pain in some cases, which may be more intense with exertion or after eating a heavy meal
- heart palpitations
- irregular heart rhythm
Make an appointment to see your doctor if you have these symptoms. If shortness of breath or chest pain become severe, call your local emergency services.
8. Valve disease
Chest pain associated with valve disease: pain, pressure, or tightness, usually with exertion
Your heart has four valves that control the flow of blood in and out of the heart. As you age, your risk of valve problems increases.
Symptoms of valve disease depend on the particular type of valve disorder, and may include:
- chest pain, pressure, or tightness when you’re very active
- shortness of breath
- heart murmur, which is an unusual heartbeat that your doctor can detect with a stethoscope
If you notice chest pain or pressure with exertion, make an appointment to see your doctor. It may not be an emergency, but the sooner you get a diagnosis, the sooner you and your doctor can start a treatment plan.
Most respiratory causes of chest pain are due to injuries to the lungs, or problems within the airways leading to and coming from your lungs.
Chest pain associated with a breathing disorder or other respiratory condition may feel like a heart attack or heart-related condition. The pain will like increase with exertion and heavy breathing, and decrease with rest, and stable or slow breathing. Items 9–16 describe causes of respiratory-related chest pain.
9. Pulmonary embolism
Chest pain associated with pulmonary embolism: gradual or sudden, sharp pain, similar to a heart attack, that gets worse with exertion
A pulmonary embolism (PE) is a blood clot that gets lodged in an artery in one of your lungs. A PE makes it difficult to breathe. This sensation can form suddenly, and breathing gets harder with exertion.
The chest pain and tightness from a PE feels like a heart attack. It also gets more severe with physical activity. Other symptoms include swelling in the lower leg and a cough that may include blood mixed with mucus.
If any of these symptoms develop suddenly, seek immediate emergency medical help. A pulmonary embolism can stop blood flow to the heart, causing immediate death.
10. Collapsed lung
Chest pain associated with collapsed lung: pain occurs when you inhale
A collapsed lung, also called pneumothorax, occurs when air gets in between the chest wall (the rib cage, and several layers of muscle and tissue) and the lungs. This buildup of air can put pressure on a lung and keep it from expanding when you inhale.
If you have a collapsed lung, breathing in will hurt and ultimately become difficult. It may feel like the pain is in your chest due to the location of the lung. Seek immediate medical attention if you suspect you have a collapsed lung.
Chest pain associated with pneumonia: sharp or stabbing pain that increases when you inhale
Pneumonia isn’t a stand-alone disease, but a complication from the flu or other respiratory infection. The chest pain with pneumonia usually starts as a sharp or stabbing pain that is worse when you inhale.
Other symptoms of pneumonia include:
- severe cough, usually with green, yellow, or sometimes bloody phlegm
If you have chest pain when inhaling, see a doctor soon. If you have chest pain and are coughing up blood, call your local emergency services.
Chest pain associated with asthma: tightness in the chest
Asthma is a condition that causes inflammation of your airways. They tighten and produce more mucus. Asthma’s main symptoms include wheezing and difficulty breathing during a flare-up. You may feel an uncomfortable tightness in your chest when having as asthma attack.
Asthma can usually be controlled with inhaled medications. But if your medications aren’t working as well as they have in the past, or you develop asthma symptoms without having been diagnosed with a respiratory problem, make a doctor’s appointment soon.
13. Chronic obstructive lung disease (COPD)
Chest pain associated with COPD: tightness in the chest, often worse with exertion
COPD refers to a few different conditions in which your airways become inflamed, restricting the flow of air in and out of your lungs. The two main examples are chronic bronchitis and emphysema. Symptoms of COPD include:
- chest tightness
Physical activity makes most COPD symptoms worse.
Seek immediate medical help if you have chest tightness and difficulty breathing.
Chest pain associated with pleurisy: sharp chest pain that worsens with breathing or coughing
The pleura is a membrane that includes the tissue lining the inner wall of your chest cavity and the layer of tissue that surrounds the lungs. When the pleura becomes inflamed, the condition is called pleurisy or pleural disease. There are several types of pleurisy with a variety of causes, including cancer.
Symptoms of pleurisy include:
- shortness of breath
- a sharp chest pain that worsens when you breathe or cough
Chest pain may spread throughout your upper body, and may also turn into a constant ache.
If you have unexplained chest pain when breathing or coughing, make a doctor’s appointment to determine the cause.
15. Lung cancer
Chest pain associated with lung cancer: unexplained chest pain, including pain that’s unrelated to coughing
Lung cancer is the growth of abnormal cells in your lungs that interfere with healthy lung function. Symptoms of lung cancer include:
- coughing that produces phlegm
- shortness of breath
- chest pain unrelated to coughing that may also extend to your back or shoulders
- chest pain that worsens when you breathe deeply, laugh, or cough.
Unexplained chest and back pain should prompt a visit to your doctor soon, especially if your cough is getting worse or more frequent. If you cough up blood or phlegm tinged with blood, which is common with lung cancer, seek immediate emergency medical help.
16. Pulmonary hypertension
Chest pain associated with pulmonary hypertension: tightness or pressure
Your blood pressure is the force of blood against the inner walls of your arteries as it circulates through your body. When the force is too great, it’s called high blood pressure or hypertension. When the pressure is high in the arteries serving your lungs, the condition is known as pulmonary hypertension. It can lead to serious consequences, such as heart failure.
In the early stages of pulmonary hypertension, you’ll likely experience shortness of breath when physically active. Eventually, pulmonary hypertension causes you to be tired, even at rest. You will also feel:
- a tightness or pressure in your chest
- a racing heartbeat
- swelling in your legs
These are signs of a medical emergency.
Pulmonary hypertension can often be treated with medications and lifestyle changes. You should be evaluated by a physician if pulmonary hypertension symptoms emerge.
While most heart- and lung-related causes of chest pain get worse with exercise, chest discomfort triggered by a digestive issue may actually improve with exertion and get worse when you lie down. That’s because you digest food more effectively when you aren’t lying flat.
Most digestive causes of chest pain are related to problems with your esophagus. The esophagus is the tube that carries food and liquids down your throat and into your stomach. Items 17–24 are digestion-related causes for chest pain.
17. Gastroesophageal reflux disease (GERD)
Chest pain associated with GERD: burning sensation
Acid reflux is a common condition that results when stomach acid moves back up the esophagus and irritates the lining of the esophagus. GERD is a more serious, persistent form of this condition.
The resulting chest pain is known by a more common term: heartburn. That’s because it causes a burning sensation in the chest. It’s sometimes worse when you lie down.
GERD can also cause difficulty swallowing and a feeling that there is something caught in your throat.
GERD symptoms don’t require an emergency room trip, but you should tell your doctor soon. The stomach acid irritating your esophagus can lead to serious health problems if not treated.
Chest pain associated with esophagitis: burning sensation and discomfort when swallowing
Esophagitis is an inflammation of the tissue in the esophagus. It can be caused by GERD or other conditions, such as allergies or an infection. Esophagitis can make swallowing painful and difficult, while also causing chest pain. In many cases, the pain is like the heartburn brought on by GERD.
19. Esophageal rupture
Chest pain associated with esophageal rupture: mild to severe, and comes on quickly
The lining of the esophagus can sometimes tear. When a tear occurs, it’s called an esophageal rupture or Boerhaave syndrome. Food and liquids are able to escape through the tear into the chest cavity.
This condition can cause mild or severe pain in the chest, depending on the size and location of the tear. The pain usually comes on quickly and is often accompanied by:
- vomiting, sometimes with blood
- rapid breathing
- a fever
Treat these symptoms as a medical emergency.
A doctor can use an endoscopy to diagnose this condition. Endoscopy is a procedure in which a very thin tube carrying a tiny camera is guided down the throat and into the esophagus to provide pictures of the esophagus wall.
In many cases, a surgeon can clean up the affected area and repair the tear.
20. Primary esophageal motility disorders (PEMDs)
Chest pain associated with PEMDs: mild, and may feel like heartburn
PEMDs include several different disorders of the esophagus.
With a PEMD, you could experience:
- mild chest pain or heartburn
- trouble swallowing
- the sensation that food is sticking in your esophagus
See a doctor soon if you have these symptoms.
Treatment options include medications to help relax the muscles to ease swallowing, as well as minimally invasive surgical procedures.
Chest pain associated with dysphagia: discomfort that occurs when swallowing
Dysphagia is the clinical term for a swallowing disorder. You may have a problem at the top of the throat or farther down the esophagus. A swallowing disorder that affects the esophagus can cause chest pain, as well as coughing.
If you start to have swallowing problems, make an appointment to see your doctor. There are many potential causes of dysphagia. It’s often treatable with medication or a type of physical therapy.
Chest pain associated with gallstones: intense pain that radiates from the upper abdomen to the chest area
Gallstones are hardened little clusters of cholesterol or bilirubin. Bilirubin is a compound created when red blood cells break down.
Gallstones form in your gallbladder. The gallbladder is an organ that contains a chemical called bile, which is used to help with digestion.
When gallstones block the bile duct, you can experience intense pain in your upper abdomen. This is called a gallbladder attack. You may feel pain radiating up to your chest, too. Symptoms usually develop after a large meal.
See a doctor right away if abdominal pain lingers for more than an hour or two and you have symptoms that include:
- changes in the color of your urine or stools
If you have occasional abdominal or chest pains after a heavy meal, report those symptoms to your doctor at your next appointment.
Chest pain associated with pancreatitis: pain that radiates from the upper abdomen to the chest and back
Pancreatitis is inflammation of the pancreas. Your pancreas is a large gland near your stomach.
Pancreatitis can be acute or chronic. Acute pancreatitis is sudden, but temporary. Chronic pancreatitis is a lifetime condition that can cause permanent damage to your pancreas.
Symptoms of acute and chronic pancreatitis include pain in the upper abdomen that may spread to your chest and back. With an acute pancreatitis attack, you may experience pain for several days and have other symptoms, such as fever, vomiting, and a swollen belly.
Chronic pancreatitis pain may become constant and worsen after meals. Vomiting and diarrhea are also common signs of chronic pancreatitis. They can lead to weight loss, too. In some cases, the pain associated with chronic pancreatitis fades over time, but the condition persists.
24. Hiatal hernia
Chest pain associated with hiatal hernia: heartburn or pain in both the chest and abdomen
There are several types of hernias, but the one that can cause chest pain is called a hiatal hernia. It occurs when your stomach starts to bulge into the opening in the diaphragm (hiatus) through which the esophagus passes before meeting the stomach. Symptoms may include:
- pain in your chest and abdomen
- vomiting up blood or having black stools, which means you have some internal bleeding
Make an appointment soon if you have any of these symptoms. A hiatal hernia can often be treated with medications or surgery.
Mental health-related chest pain may feel similar to a heart attack. You may also have heart palpitations and shortness of breath. Items 25–26 are related to mental health causes of chest pain.
25. Anxiety attack
Chest pain associated with anxiety attack: stabbing or needlelike pain, usually felt in the middle of the chest
Anxiety can cause many physical symptoms, including:
- heart palpitations
- trouble breathing
- chest pain
Many of these are also heart attack symptoms, so people sometimes confuse the two conditions. With an anxiety attack, the pain is usually a stabbing or needle-like sensation right in the middle of your chest. A heart attack often feels more like pressure or tightness in the chest.
An anxiety attack is usually triggered by an upcoming event, such as a doctor appointment, speech, or other cause of nervousness.
26. Panic attack
Chest pain associated with panic attack: stabbing pain, usually accompanied by shortness of breath and a racing heart
Unlike an anxiety attack, a panic attack can occur without any obvious trigger. It’s usually a short-lived event, and it tends to develop quickly based on what’s happening to you in the moment. For example, you may panic being in a large crowd or during a plane flight with a lot of turbulence.
Panic attacks share many symptoms with anxiety attacks, including:
- chest pain
- shortness of breath
- a racing heart
27. Muscle strain
Chest pain associated with muscle strain: tenderness or feeling of stiffness in the chest, usually made worse with movement of the muscle
If you’ve ever lifted something that was too heavy or you didn’t lift it correctly, you may have experienced a strained or bruised chest muscle. The largest chest muscle is the pectoralis major. Straining or injuring the pectoralis major is uncommon, but it can happen, especially when bench-pressing in the weight room.
A chest muscle strain isn’t a medical emergency. If the pain doesn’t get better with rest, see a doctor to make sure there isn’t another cause of discomfort.
If the muscle pain is severe, you may have a muscle tear that could require surgery to repair. If there’s a tear, you may be able to see a change in the appearance of your chest muscles. If this is the case, make a doctor’s appointment as soon as you can.
Chest pain associated with fibromyalgia: dull ache that can last for months, often accompanied by muscular and joint pain in other parts of the body
Fibromyalgia can cause a host of symptoms, including:
- musculoskeletal pain that includes the chest, and muscles and joints throughout the body
- sleep problems
- mood changes
The muscle pain associated with fibromyalgia feels like a dull ache that can last for months.
Fibromyalgia isn’t a medical emergency, but you shouldn’t wait to see a doctor for an evaluation. Make an appointment and be prepared to describe all your symptoms in detail.
The causes of fibromyalgia are unknown, and there is no cure. Instead, treatment focuses on controlling symptoms.
29. Injured rib
Chest pain associated with injured rib: intense pain when you breath or move your upper body, or touch the area
A broken or bruised rib can cause considerable chest pain every time you bend or twist your upper body, take a breath, or press the affected area. See a doctor if you have experienced trauma to your rib area, such as a car accident, fall, or sports injury, and breathing is painful or the area is tender to the touch.
Broken ribs can heal on their own after several weeks, but you should still have a doctor evaluate your injury and get X-rays or an MRI scan. In severe cases, broken ribs can lead to organ damage.
Chest pain associated with costochondritis: sharp, stabbing pain, or tightness or pressure; pain may radiate to the back
Costochondritis occurs when the cartilage that supports your ribs becomes inflamed. It can cause chest pain that feels similar to a heart attack. For this reason, you should call your local emergency services if you have heart attack-like symptoms.
It’s not always clear why costochondritis forms, but a blow to the chest or a strain from heavy lifting may trigger it. A joint infection, arthritis, and a tumor may also cause costochondritis.
Tell your doctor if you’ve experienced undiagnosed chest pain. Be ready to describe the pain and answer other questions, such as:
- What seems to trigger the pain?
- How long does the pain usually last?
- Does anything help to relieve your chest pain?
- What other symptoms, if any, do you have?
- What is your personal and family history of heart disease, respiratory problems, and gastrointestinal health problems?
If you ever have concern about the cause of chest pain, call your local emergency services. It’s better to go to the emergency room and find out that you may have digestive or emotional causes of chest pain than to risk a heart attack without proper care.