Chest Pain

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Introduction

What is chest pain?

Chest pain includes any type of pain or discomfort that occurs between your upper belly area and your lower neck. Chest pain can occur in any age group or population and may be described as chest tightness, chest pressure, or a feeling of burning or fullness in the chest. Chest pain may also be sharp, dull, throbbing, crushing, tearing, cramping or achy.

Chest pain can be a serious, life-threatening symptom and is the classic symptom of a heart attack. Chest pain is often associated with a heart attack and other types of heart and cardiovascular disease, but it can also occur with a wide variety of other diseases, disorders and conditions. For example, chest pain can result from a relatively mild to moderate condition that is relatively easy to treat, such as drinking too much coffee, occasional indigestion, hyperventilation, or an anxiety attack.

Chest pain can also be a symptom of more serious conditions of the gastrointestinal tract, such as acid reflux and GERD, or serious respiratory conditions. These include pneumothorax, acute bronchitis, bronchiolitis, asthma, chronic obstructive pulmonary disease (COPD), pulmonary embolism, pulmonary edema, and lung cancer. In children, chest pain is usually not caused by a heart attack, but may be caused by a congenital heart condition, pneumonia, pleuritis, or birth defect.

Depending on the cause, chest pain can be last briefly and disappear quickly, such as during hyperventilation or when breathing in very cold air. Sharp chest pain that occurs in a sudden, severe episode may be due to a heart attack or pulmonary embolism. Chronic and ongoing chest pain may be due to COPD or lung cancer.

It is not possible to accurately identify the precise cause at home. Seek immediate emergency care (call 911) if you have unexplained chest pain or a crushing feeling in your chest, if the pain is radiating to your shoulder blades, jaw, or left arm, or if you have shortness of breath, sweating, or chest pain at rest. In addition, sudden chest pain with shortness of breath after a long period of inactivity, such as prolonged bed rest, may be a sign of a pulmonary embolism and is a life-threatening emergency.

Symptoms

What other symptoms might occur with chest pain?

Chest pain often occurs in conjunction with other symptoms, which vary depending on the underlying disease, disorder or condition. For example, if chest pain is related to an infection, you may experience a fever and body aches. Diseases and conditions of 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.

Other chest symptoms that may occur along with chest pain

Chest pain may accompany other heart and lung symptoms including:

  • Cough (may be a productive cough with phlegm)

  • Flared nostrils

  • Wheezing

Digestive symptoms that may occur along with chest pain

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

Other symptoms may occur along with chest pain

Other symptoms that may accompany chest pain include:

  • Anxiety and feelings of panic or fear

  • Racing thoughts

  • Stress

  • Sweating palms

Serious symptoms that might indicate a life-threatening condition

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 degrees Fahrenheit)

  • 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

Causes

What causes chest pain?

Chest pain is caused by a variety of mild to serious disorders, diseases or conditions. Chest pain can result from infection, infarction, inflammation, trauma, malignancy, and other abnormal processes. While many cases of chest pain are due to problems with the heart, chest pain can also be due to respiratory diseases, problems with digestion, anxiety disorders, or a pulled muscle or tendon. In children, chest pain is usually not caused by a heart attack, but may be caused by a serious congenital heart condition or birth defect.

Life-threatening cardiovascular causes of chest pain

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

Serious or life-threatening lung-related causes of chest pain

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

Digestive system-related causes of chest pain

Chest pain can arise from gastrointestinal problems including:

Other causes of chest pain

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

What are the potential complications of chest pain?

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

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 26
  1. Chest pain. Medline Plus, a service of the National Library of Medicine National Institutes of Health. www.nlm.nih.gov/medlineplus/ency/article/003079.htm
  2. Heart Disease, Conditions. Centers for Disease Control and Prevention. http://www.cdc.gov/heartdisease/signs_symptoms.htm
  3. Barrett’s Esophagus. National Digestive Diseases Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. www.digestive.niddk.nih.gov/ddiseases/pubs/barretts/
  4. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012
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