Chest pain
DEFINITION
Chest pain comes in many varieties, ranging from a sharp stab to a dull ache. Some chest pain is described as crushing or burning. In certain cases, the pain travels up the neck, into the jaw, and then radiates through to the back or down one or both arms.
Many different problems can cause chest pain. The most life-threatening ones involve the heart or lungs. Because it can be difficult to determine the exact cause of chest pain, it’s best to seek immediate medical help.
CAUSES
Chest pain has many possible causes, all of which deserve medical attention.
Heart-related causes
Examples of heart-related causes of chest pain include:
- Heart attack. A heart attack is a result of a blood clot that’s blocking blood flow to your heart muscle.
- Angina. Thick plaques can gradually build up on the inner walls of the arteries that carry blood to your heart. These plaques narrow the arteries and restrict the heart’s blood supply, particularly during exertion.
- Aortic dissection. This life-threatening condition involves the main artery leading from your heart — your aorta. If the inner layers of this blood vessel separate, blood will be forced between the layers and can cause the aorta to rupture.
- Pericarditis. This condition, an inflammation of the sac surrounding your heart, usually causes sharp pain that gets worse when you breathe in or when you lay down.
Digestive causes
Chest pain can be caused by disorders of the digestive system, including:
- Heartburn. This painful, burning sensation behind your breastbone occurs when stomach acid washes up from your stomach into the esophagus — the tube that connects your throat to your stomach.
- Swallowing disorders. Disorders of the esophagus can make swallowing difficult and even painful.
- Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder or pancreas can cause abdominal pain that radiates to your chest.
Muscle and bone causes
Some types of chest pain are associated with injuries and other problems affecting the structures that make up the chest wall. Examples include:
- Costochondritis. In this condition, the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed and painful.
- Sore muscles. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.
- Injured ribs. A bruised or broken rib can cause chest pain.
Lung-related causes
Many lung disorders can cause chest pain, including:
- Pulmonary embolism. This cause of chest pain occurs when a blood clot becomes lodged in a lung (pulmonary) artery, blocking blood flow to lung tissue.
- Pleurisy. If the membrane that covers your lungs becomes inflamed, it can cause chest pain that’s made worse when you inhale or cough.
- Collapsed lung. The chest pain associated with a collapsed lung typically begins suddenly and can last for hours. A collapsed lung occurs when air leaks into the space between the lung and the ribs.
- Pulmonary hypertension. High blood pressure in the arteries carrying blood to the lungs (pulmonary hypertension) also can produce chest pain.
Other causes
Chest pain can also be caused by:
- Panic attack. If you have periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness and a fear of dying, you may be experiencing a panic attack.
- Shingles. Caused by a reactivation of the chickenpox virus, shingles can produce pain and a band of blisters from your back around to your chest wall.
SYMPTOMS
A wide range of health problems can cause chest pain. In many cases, the underlying cause has nothing to do with your heart — though there’s no easy way to tell without seeing a doctor.
Heart-related chest pain
Although chest pain is commonly attributed to heart disease, many people with heart disease say they experience a vague discomfort for which “pain” doesn’t seem to be an adequate description. In general, chest discomfort related to a heart attack or another heart problem may be described by or associated with one or more of the following:
- Pressure, fullness or tightness in your chest
- Crushing or searing pain that radiates to your back, neck, jaw, shoulders and arms — particularly your left arm
- Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back or varies in intensity
- Shortness of breath
- Cold sweats
- Dizziness or weakness
- Nausea or vomiting
Other types of chest pain
It can be difficult to distinguish chest pain due to a heart problem from other types of chest pain. However, chest pain that is less likely due to a heart problem is more often associated with:
A sour taste or a sensation of food re-entering your mouth
- Trouble swallowing
- Pain that gets better or worse when you change your body position
- Pain that intensifies when you breathe deeply or cough
- Tenderness when you push on your chest
- The classic symptoms of heartburn — a painful, burning sensation behind your breastbone — can be caused by problems with your heart or your stomach.
When to see a doctor
If you have new or unexplained chest pain or suspect you’re having a heart attack, call for emergency medical help immediately.
