When to Worry About Chest Pain: Causes, Diagnosis, & Treatment

It can be difficult to know when chest pain is serious or not. The cause of chest pain can be difficult to diagnose because symptoms come in many forms, ranging from dull sensations of pressure or squeezing, to sharp pain or swelling that radiates to other regions.

While heart complications are often associated with chest pain, there are many other less serious causes. It’s wise to talk to your doctor about any chest pain you’re experiencing, but more importantly, it’s best to learn when the chest pain you’re experiencing is serious enough for you to seek emergency treatment.

If you can recognize the signs of angina-type chest pain, a common symptom of heart attack, you can better determine how to respond.

Where You Can Experience Chest Pain

People may use the term “chest pain” to refer to pain located across multiple body parts. Chest pain can occur in the following areas of the body:

• Ribs and rib cage, including the muscles and skin surrounding the rib cage
• Spine and back muscles
• Lungs
• Heart, aorta, and surrounding area
• Esophagus (the tube that connects the throat and stomach)
• Diaphragm (muscle located between the chest and abdomen)

In some cases, chest pain can also expand to the jaw, neck, shoulders, arms or abdomen.

Types of Chest Pain

Chest pain can vary in intensity. To help you determine the severity, pay attention to the nature of pain which will likely fall into the following categories:

• Dull chest pain: Dull pain may be described as pressure, squeezing, tightness, or heaviness in the chest. It generally lasts longer than sharp pain, and may also be accompanied by a burning sensation. Dull chest pain can radiate to the shoulders, arm, or jaw. If your pain intensifies significantly over the course of a few minutes, or if you start to experience lightheadedness, shortness of breath, indigestion, or cold sweats, this may indicate heart attack and you should get to a hospital immediately.
• Sharp chest pain: Sharp pain in the chest generally comes and goes quickly, and with more intensity than dull pain. It may be described as stabbing, shooting, or piercing pain. This type of pain is usually focused in one particular area or muscle group. Sharp chest pain may occur when taking deep breaths, turning the torso, coughing, or making a particular movement.
• One-sided chest pain: Sometimes, chest pain is isolated to one side of the chest. Chest pain on the left side is generally associated with heart attack, while right side chest pain is normally not a sign of heart attack. However, this is not a hard-set rule, so if you are experiencing right side chest pain with other symptoms of heart attack, you should still treat it as an emergency.
• Gas chest pain: After eating, some people may experience gas pain in the chest, which may feel like a stabbing or tightness. Gas pain may be accompanied by belching, passing of gas, and bloating. It’s common for this type of pain to spread to or from the abdomen.
• Anxiety-related chest pain: People who suffer from anxiety or panic disorder may experience anxiety-related chest pain during or immediately before a panic attack. This type of pain is generally felt as a sharp stabbing pain that comes and goes. It may be accompanied by abdominal cramps, shortness of breath, muscular pain, or diarrhea.

Common Causes of Chest Pain

Common causes of chest pain include:

• Heart-related causes: Dull, heavy chest pain that lasts for more than three minutes or intensifies quickly can be a symptom of heart attack. In the case of heart attack, you may also experience nausea, lightheadedness, cold sweats, or shortness of breath. If the pain only comes when exercising and subsides when resting, it may be angina, caused by a lack of oxygen reaching the heart. Angina is not the same as heart attack—but people with angina can have a heart attack, so it is important to seek immediate care for these symptoms.
• Digestive causes: Tightness in the chest, especially after eating, may be caused by indigestion and a build up of gas. This pain tends to spread around the abdomen and chest region and patients may also belch, feel bloated, or pass excess gas. A sense of burning in the chest after eating, especially if accompanied by a bitter or acidic taste, may be caused by heartburn—a condition in which stomach acid flows back up into the esophagus.
• Rib injuries: Sharp intense chest pain may be caused by broken or bruised ribs. In this case, it will generally hurt to take deep breaths or move the upper body, and patients may feel short of breath. Less serious chest wall injury, including muscle strain, can cause similar symptoms.
• Panic attack: People experiencing a panic attack may feel anxiety-related chest pain, which occurs in 20-70% of panic attacks. It’s thought that this is caused by muscle contractions in the chest wall.
• Shingles: This virus causes a painful, burning sensation that can spread from the back to the front of the chest, often marked by a recognizable rash which may not appear until after the pain.
• Costochondritis: Costochondritis is a condition in which the joints and cartilage between the ribs and chest become inflamed. Pain may be felt when taking a deep breath, and the area may be tender when touched.

How Chest Pain Is Diagnosed

To diagnose chest pain, your doctor will take into account the frequency and intensity of your pain, as well as your medical history. In some cases, your doctor may conduct a blood test, an electrocardiogram (ECG), an x-ray or CT scan to help with diagnosis.

The best way for your doctor to diagnose causes of chest pain is to get as accurate an understanding as possible of what you are feeling, which is why they are likely to ask you a host of questions to help you describe your pain.

Your doctor should also closely review your medical record and family history to understand your risk factors for certain conditions.

Treatments for Chest Pain

Treatments for chest pain may include mild pain relievers, heart medication, or even emergency hospitalization.

Treatment for heart-related causes

A heart attack is caused by reduced blood flow to your heart, often due to a blocked artery or arteries in your heart.

There are two common approaches to treating heart attack: one is to use a drug (such as TPA or TNK) to dissolve the blood clot occluding the artery; the other is to conduct an angioplasty by using a balloon to open the blocked area and then using a stent to hold the area open.

Long-term treatment for heart-related chest pain (angina) can include cardiac procedures, cardiac rehabilitation, medications to help your heart, medications to thin your blood, medications to lower cholesterol, and almost always general changes to lifestyle to help decrease your risk of future heart complications.

Treatment for digestive causes

Gas pain or GERD-related pain in the chest is generally alleviated when you belch, relieving the pressure that’s built up. Heartburn can be treated with over-the-counter medications such as antacids (Tums), famotidine (Pepcid) or ranitidine (Zantac).

Prevention methods for heartburn include cutting down on triggering foods (e.g. tomato sauce, chocolate, spicy foods, caffeine), elevating the head above the body when lying down, and avoiding eating within three hours before going to sleep.

Treatment for rib injuries

In the case of broken or bruised ribs, your doctor may prescribe ibuprofen or a similar anti-inflammatory to help ease pain. Treatment may include applying ice to the area, or taking narcotics to help enable you to take deep breaths.

The biggest concern while healing from injured ribs is the risk of developing pneumonia, in which fluid builds up in the lungs. It’s important to continue breathing deeply, even if it hurts. While it used to be common practice to wrap the injured rib cage area with tape, this method is no longer used because it prevents the lung from expanding fully, thereby increasing your risk of pneumonia.

Treatment for anxiety-related chest pain

Anxiety-induced chest pain that comes and goes, or is experienced infrequently, may be successfully treated with deep breathing and mindfulness techniques. Various psychotherapy methods, such as cognitive behavior therapy (CBT), are commonly used to treat the underlying anxiety or panic disorder and reduce the instances of panic attacks.

In the case of frequently occurring panic attacks, treatment may include prescription medications such as selective serotonin receptor inhibitors (SSRIs) and benzodiazepines.

Treatment for shingles

If you have contracted the shingles virus, your doctor will likely prescribe pain medicine and an antiviral medication such as acyclovir. If your pain persists even after the virus is gone, your doctor may recommend long-term pain medication or, in extreme cases, surgery to treat the inflamed nerve causing the chronic pain.

What to Do About Chest Pain and When to See a Doctor

Here are three important steps to take if you are experiencing chest pain:

Step 1: Recognize heart attack symptoms

Chest pain is less likely to be heart attack if:

• The pain only occurs when you move your body in a specific, reproducible way
• The pain comes and goes very quickly, with no other symptoms

Chest pain is more likely to indicate heart attack if:

• The pain feels like a squeezing, tightening, or pressure spreading through the chest
• The pain lasts for more than three minutes, and/or intensifies quickly
• You experience other symptoms of heart attack including shortness of breath, lightheadedness, cold sweats, sudden extreme fatigue, or nausea

If you suspect that you may be having a heart attack, call 911 or go to the hospital immediately.

Step 2: Make an appointment to see your doctor, if necessary

If you are not experiencing signs of heart attack, but the pain is disturbing to you in any way, make an appointment to see your doctor. For immediate relief from the pain, you may try taking aspirin or a similar pain reliever, lying down either flat or in a slightly upright position, or icing the area if you believe the pain stems from muscle swelling.

Step 3: Prepare to see your doctor

It’s a good idea to prepare for your doctor’s visit by writing down your symptoms to provide as much information as possible. Don’t be surprised if your doctor asks you the same question twice, or asks you to explain your answer in a few ways—everyone describes pain differently, so it’s common for doctors to ask many questions to get the most thorough description of your pain.

Prepare for your doctor to ask you questions like:

• When did the pain begin?
• How would you rate your pain on a scale from 1-10 (one being mild and ten being very intense)?
• What activities provoke or intensify the pain? (e.g. physical activity, movement, breathing, eating)
• What activities relieve the discomfort, if any? (e.g. sitting, lying still, bending)
• How long does the pain last? Does it come and go?
• Does the pain radiate or spread to other parts of your body?
• Has this pain occurred in the past? Have you experienced any recent illnesses, traumas, or injuries?

Related Conditions

Other conditions that are related to chest pain include:

• Fibromyalgia: Chest wall pain is common in those who suffer from fibromyalgia, a disorder that causes widespread musculoskeletal pain and fatigue.
• Arthritis: People with inflammatory arthritis conditions, such as rheumatoid arthritis, may experience chest pain due to inflammation.
• Chronic acid reflux: Gastroesophageal reflux disease (GERD) is a chronic condition marked by long-term, frequent heartburn symptoms. People who are overweight, pregnant, or who smoke regularly may be at higher risk for GERD.
• Asthma: People who suffer from asthma may experience chest pain during asthma attacks. This is due to inflammation in their airways, along with severe coughing and wheezing.
• Lung complications: Pneumonia and other lung infections often cause chest pain. In more extreme cases, sudden sharp chest pain when breathing can be a symptom of a collapsed lung.

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