Chest Pain

Chest pain often occurs with other symptoms, which vary depending on the underlying disease, disorder or condition. For example, with chest pain from an infection, you may also experience a fever and body aches. Problems with organs and tissues in your chest or abdomen, such as the lungs, stomach, esophagus, ribs, pancreas, gallbladder, muscles and nerves, can result in chest pain as well.

Pain can also travel from the neck, back and belly area to your chest. Coexisting symptoms can also be related to the digestive tract. Some signs or symptoms, such as low oxygen levels and high carbon dioxide levels, may be evident only through medical testing, so always seek medical care if you are experiencing chest pain.

Chest pain may accompany other heart and lung symptoms including:

• Cough (may be a productive cough with phlegm)

• Flared nostrils

• Wheezing

Chest pain can accompany symptoms related to the digestive system including:

• Abdominal pain

• Difficulty swallowing, possibly with a sore throat

• Feeling that food is stuck in your chest

• Food regurgitation

• Nausea and vomiting

Other symptoms that may accompany chest pain include:

• Anxiety and feelings of panic or fear

• Racing thoughts

• Stress

• Sweating palms

Chest pain may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) for symptoms including:

• Change in level of consciousness or alertness, such as passing out or unresponsiveness

• Chest pain that spreads to the left arm, jaw, or shoulder, or to the back

• Chest pain when breathing or coughing

• Cold, clammy skin or cyanosis, a bluish color of the skin, lips or nails

• Coughing up yellow-green phlegm (mucus) with shortness of breath or wheezing

• Dizziness or disorientation

• Heart palpitations or a fluttering feeling in the chest

• High fever (higher than 101°F)

• Pressure, cramping, tightness, or tearing sensation in the chest

• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

• Sweating

A variety of mild to serious disorders, diseases or conditions can cause chest pain. This includes infection, heart attack, inflammation, trauma, malignancy, and other abnormal processes. People often think of problems with the heart causing chest pain. While heart problems are a possible cause, chest pain can also be due to lung diseases, problems with digestion, anxiety disorders, or a pulled muscle or tendon.

Chest pain can arise from problems with the structures surrounding the heart and the heart itself including:

• Aortic dissection

• Cardiac arrhythmias (irregular heart rhythms)

• Congenital cardiac anomalies and disorders and birth defects, such as coarctation of the aorta and aortic valve stenosis

• Congestive heart failure

• Coronary artery disease (heart disease), including coronary artery spasm or angina due to atherosclerosis (hardening and narrowing of the arteries)

• Endocarditis (inflammation or infection of the inner lining of the heart)

• Heart attack

• Mitral valve prolapse and other heart valve problems

• Pericarditis (inflammation or infection of the lining that covers the heart)

Chest pain can also be caused by serious problems with the respiratory system including:

• Asthma

• Bronchitis

• Chronic obstructive pulmonary disease (COPD)

• Pleurisy (inflammation of the lung lining)

• Pneumonia

• Pneumothorax or hemothorax (collapsed lung or blood around the lung)

• Pulmonary edema

• Pulmonary embolism

• Pulmonary hypertension

Chest pain can arise from gastrointestinal problems including:

• Achalasia (disorder of the esophagus)

• Barrett’s esophagus (abnormal lining of the esophagus caused by stomach acid)

• Heartburn

• Esophageal spasm

• Gallbladder conditions, such as cholecystitis (inflammation of the gallbladder) and gallstones

• Gastritis

• Gastroesophageal reflux disease (GERD)

• Hiatal hernia (abnormal movement of the stomach into the chest)

• Pancreatitis and other pancreas conditions

• Peptic ulcer

Other causes of chest pain include psychological and inflammatory conditions:

• Anxiety attack

• Chest injury or trauma, such as rib fracture or a bruised chest

• Costochondritis (inflammation of the ribs and breastbone)

• Pulled chest wall muscle (muscle strain)

• Shingles

Chest pain can be a sign of an emergency. It is best to see a doctor for new, sudden or unexplained chest pain.

Call 911 or go to your nearest emergency room for chest pain when:

• You have sharp pain or a crushing or squeezing sensation in your chest.

• You have fast or irregular heartbeat or pain or discomfort in the jaw, neck, shoulder, back or arm.

• You have other symptoms, including cold sweat, anxiety, shortness of breath, dizziness, lightheadedness, weakness, nausea or vomiting.

• You know you have angina and your chest pain is more intense, lasts longer, or occurs at rest.

See a doctor promptly for chest pain when:

• You have chest pain that changes with your body position.

• You have chest pain that occurs when you push on your chest.

• You have chest pain with trouble swallowing or a sour taste in your mouth.

• You have pain that intensifies when you breathe deeply, laugh or cough.

• You have symptoms of an infection, such as fever or a productive cough.

When you go to an emergency room for chest pain, a heart attack is the most immediate threat to your life. So, doctors will test for it first, along with other life-threatening causes like PE. This testing may include:

• Blood tests, which can detect enzymes that the heart muscle releases when a heart attack damages it

• Chest X-ray to look at your lungs, heart, and major vessels

• EKG (electrocardiogram) to measure your heart’s electrical activity, which will be abnormal during or following a heart attack

• Other imaging exams, such as CT (computerized tomography), which can find a PE

Follow-up testing after these immediate tests may include:

• Echocardiogram, which makes moving images of your heart

• Stress test, which checks your heart’s response during exertion

• Coronary catheterization, which can show whether you have blocked blood vessels that supply the heart and treat them if necessary

Diagnosing the cause of chest pain will also involve a physical exam and medical history. For less urgent causes, the process may start with these components.

To diagnose the causes of chest pain, your doctor may ask you several questions related to your chest pain including:

• When did you first notice chest pain or discomfort? Did it start suddenly or gradually?

• Where exactly is the pain? Is it always there or does it move or radiate to other areas?

• How would you describe the pain, such as sharp, dull, achy, burning, or heavy?

• On a scale of 1 to 10 with 10 being the worst pain imaginable, how would you rate your pain? Has it changed with time?

• What, if anything, makes the pain better or worse, such as changing positions, breathing deeply, exercising or resting?

• Have you taken any medicines for the pain, including pain relievers or heartburn remedies?

• Do you have any other symptoms, such as coughing or trouble breathing?

• What other medical conditions do you have?

• What medications are you taking?

• Do you smoke, drink caffeine, or use alcohol or drugs?

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

Treatments for chest pain depend entirely on the underlying cause. The goal is to correct or remedy the root cause of chest pain. Medications are often useful for many of the common causes of chest pain, including heart problems. Depending on the cause, these medicines may include:

• Acid reducing drugs, such as H2 blockers and PPIs (proton pump inhibitors), to treat reflux and heartburn

• Antibiotics to treat bacterial infections

• Antidepressants or anti-anxiety medicines for panic attacks and other mental health-related causes

• Aspirin or blood thinners to prevent blood clots

• Nitroglycerin or other blood vessel relaxants to treat angina

• Thrombolytic drugs to bust up blood clots during a heart attack

Sometimes, procedures are necessary to treat serious causes of chest pain. These procedures may include:

• Angioplasty and stenting, which is a catheter-based procedure to open blocked coronary arteries and keep them open

• Coronary artery bypass grafting surgery (CABG), which uses a blood vessel from somewhere else in your body to create an alternate route around a blocked coronary artery

• Lung reinflation for collapsed lung

• Repair of the aorta for aortic dissection

Home remedies cannot treat chest pain. And only a doctor is qualified to diagnose the cause of chest pain and treat it. However, some causes of chest pain can benefit from lifestyle changes you can make at home.

For heart-related causes of chest pain, living a heart-healthy lifestyle is an important part of treatment. This includes:

• Eating a heart-healthy diet, including whole grains, low-fat dairy, lean meats, and fresh fruits and vegetables

• Getting regular physical activity on most days of the week

• Maintaining a healthy weight

• Not smoking

• Taking medication as your doctor prescribes

Talk with your doctor and ask about safe goals for you before changing or starting a diet and exercise plan.

For GERD and acid reflux, helpful habits include:

• Avoiding or limiting alcohol, caffeine, and foods that trigger your symptoms

• Eating small, frequent meals and remaining upright for 2 to 3 hours afterwards

• Losing weight if you are overweight and maintaining a healthy body weight

• Not smoking

• Raising the head of your bed 6 to 8 inches with blocks under the feet, a wedge between the mattress and box springs, or with an adjustable bed

• Wearing clothing that fits loosely around your abdomen

The complications of untreated or poorly controlled chest pain vary depending on the underlying disease, disorder or condition. Any kind of chest pain, whether it occurs alone or is accompanied by other symptoms, should be evaluated by your doctor or healthcare provider.

Once the underlying cause is identified, following the treatment plan you and your healthcare provider develop specifically for you will minimize the risk of complications of serious or life-threatening underlying causes of chest pain including:

• Cardiac arrest

• Cardiac arrhythmias (abnormal heart rhythm)

• High carbon dioxide levels and acidosis

• Low oxygen levels

• Respiratory failure and respiratory arrest

• Sepsis

• Shock