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What's Causing My Chest Pain?

Reviewed by James Beckerman, MD, FACC on March 08, 2021

Chest pain is not something to ignore. But you should know that it has many possible causes. In many cases, it's related to the heart. But chest pain may also be caused by problems in your lungsesophagus, muscles, ribs, or nerves, for example. Some of these conditions are serious and life threatening. Others are not. If you have unexplained chest pain, the only way to confirm its cause is to have a doctor evaluate you.

You may feel chest pain anywhere from your neck to your upper abdomen. Depending on its cause, chest pain may be:

  • Sharp
  • Dull
  • Burning
  • Aching
  • Stabbing
  • A tight, squeezing, or crushing sensation

Here are some of the more common causes of chest pain.

Heart Problems

These heart problems are common causes:

Coronary artery disease, or CAD. This is a blockage in the heart's blood vessels that reduces blood flow and oxygen to the heart muscle. This can cause pain known as angina. It's a symptom of heart disease but typically does not cause permanent damage to the heart. It is, though, a sign that you are at risk for a heart attack in the future. The chest pain may spread to your arm, shoulder, jaw, or back. It may feel like a pressure or squeezing sensation. Angina can be triggered by exercise, excitement, or emotional distress and is relieved by rest.

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Myocardial infarction (heart attack). This reduction in blood flow through heart blood vessels causes the death of heart muscle cells. Though similar to angina chest pain, a heart attack is usually a more severe, crushing pain usually in the center or left side of the chest and is not relieved by rest. Sweatingnausea, shortness of breath, or severe weakness may accompany the pain.

Myocarditis. In addition to chest pain, this heart muscle inflammation may cause fever, fatigue, fast heart beat, and trouble breathing. Although no blockage exists, myocarditis symptoms can resemble those of a heart attack.

Pericarditis. This is an inflammation or infection of the sac around the heart. It can cause pain similar to that caused by angina. But it often causes a sharp, steady pain along the upper neck and shoulder muscle. Sometimes it gets worse when you breathe, swallow food, or lie on your back.

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Hypertrophic cardiomyopathyThis genetic disease causes the heart muscle to grow abnormally thick. Sometimes this leads to problems with blood flow out of the heart. Chest pain and shortness of breath often occur with exercise. Over time, heart failure may occur when the heart muscle becomes very thickened. This makes the heart work harder to pump blood. Along with chest pain, this type of cardiomyopathy may cause dizziness, lightheadedness, fainting, and other symptoms.

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Mitral valve prolapse. Mitral valve prolapse is a condition in which a valve in the heart fails to close properly. A variety of symptoms have been associated with mitral valve prolapse, including chest pain, palpitations, and dizziness, although it can also have no symptoms, especially if the prolapse is mild.

Coronary artery dissection. Many things can cause this rare but deadly condition, which results when a tear develops in the coronary artery. It may cause a sudden, severe pain with a tearing or ripping sensation that goes up into the neck, back, or abdomen.

Lung Problems

These are common causes of chest pain:

Pleuritis. Also known as pleurisy, this is an inflammation or irritation of the lining of the lungs and chest. You likely feel a sharp pain when you breathe, cough, or sneeze. The most common causes of pleuritic chest pain are bacterial or viral infectionspulmonary embolism, and pneumothorax. Other less common causes include rheumatoid arthritis, lupus, and cancer.

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Pneumonia or lung abscess. These lung infections can cause pleuritic and other types of chest pain, such as a deep chest ache. Pneumonia often comes on suddenly, causing fever, chills, cough, and pus coughed up from the respiratory tract.

Pulmonary embolism. When a blood clot travels through the bloodstream and lodges in the lungs, this can cause acute pleuritis, trouble breathing, and a rapid heartbeat. It may also cause fever and shock. Pulmonary embolism is more likely following deep vein thrombosis or after being immobile for several days following surgery or as a complication of cancer.

Pneumothorax. Often caused by an injury to the chest, pneumothorax happens when a part of the lung collapses, releasing air into the chest cavity. This can also cause pain that gets worse when you breathe as well as other symptoms, such as low blood pressure.

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Pulmonary hypertension. With chest pain resembling that of angina, this abnormally high blood pressure in the lung arteries makes the right side of the heart work too hard.

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Asthma. Causing shortness of breath, wheezingcoughing, and sometimes chest pain, asthma is an inflammatory disorder of the airways.

COPD. This includes one or more of three disease: Emphysema, chronic bronchitis, and chronic obstructive asthma. The disease blocks airflow by shrinking and damaging both the airways that bring gases and air to and from your lungs and the tiny air sacs (alveoli) that transfer oxygen to your bloodstream and remove carbon dioxide. Smoking is the most common cause.

Gastrointestinal Problems

Gastrointestinal problems can also cause chest pain and include:

Gastroesophageal reflux disease (GERD). Also known as acid reflux, GERD occurs when stomach contents move back into the throat. This may cause a sour taste in the mouth and a burning sensation in the chest or throat, known as heartburn. Things that may trigger acid reflux include obesity, smoking, pregnancy, and spicy or fatty foods. Heart pain and heartburn from acid reflux feel similar partly because the heart and esophagus are located close to each other and share a nerve network.

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Esophageal contraction disorders. Uncoordinated muscle contractions (spasms) and high-pressure contractions (nutcracker esophagus) are problems in the esophagus that can cause chest pain.

Esophageal hypersensitivity. This occurs when the esophagus becomes very painful at the smallest change in pressure or exposure to acid. The cause of this sensitivity is unknown.

Esophageal rupture or perforation. A sudden, severe chest pain following vomiting or a procedure involving the esophagus may be the sign of a rupture in the esophagus.

Peptic ulcers. A vague, recurring discomfort may be the result of these painful sores in the lining of the stomach or first part of the small intestine. More common in people who smoke, drink a lot of alcohol, or take painkillers such as aspirin or NSAIDs, the pain often gets better when you eat or take antacids.

Hiatal hernia. This common problem occurs when the top of the stomach pushes into the lower chest after eating. This often causes reflux symptoms, including heartburn or chest pain. The pain tends to get worse when you lie down.

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Pancreatitis. You may have pancreatitis if you have pain in the lower chest that is often worse when you lie flat and better when you lean forward.

Gallbladder problems. After eating a fatty meal, do you have a sensation of fullness or pain in your right lower chest area or the right upper side of your abdomen? If so, your chest pain may due to a gallbladder problem.

Bone, Muscle, or Nerve Problems

Sometimes chest pain may result from overuse or an injury to the chest area from a fall or accident. Viruses can also cause pain in the chest area. Other causes of chest pain include:

Rib problems. Pain from a broken rib may worsen with deep breathing or coughing. It is often confined to one area and may feel sore when you press on it. The area where the ribs join the breastbone may also become inflamed.

Muscle strain. Even really hard coughing can injure or inflame the muscles and tendons between the ribs and cause chest pain. The pain tends to persist and it worsens with activity.

Shingles. Caused by the varicella zoster virus, shingles may prompt a sharp, band-like pain before a telltale rash appears several days later.

Other Potential Causes of Chest Pain

Another potential cause of chest pain is anxiety and panic attacks. Some associated symptoms can include dizziness, sensation of shortness of breath, palpitations, tingling sensations, and trembling.

When to See the Doctor for Chest Pain

When in doubt, call your doctor about any chest pain you have, especially if it comes on suddenly or is not relieved by anti-inflammatory medications or other self-care steps, such as changing your diet.

Call 911 if you have any of these symptoms along with chest pain:

  • A sudden feeling of pressure, squeezing, tightness, or crushing under your breastbone
  • Chest pain that spreads to your jaw, left arm, or back
  • Sudden, sharp chest pain with shortness of breath, especially after a long period of inactivity
  • Nausea, dizziness, rapid heart rate or rapid breathing, confusion, ashen color, or excessive sweating
  • Very low blood pressure or very low heart rate

Call your doctor if you have any of these symptoms:

  • Fever, chills, or coughing up yellow-green mucus
  • Problems swallowing
  • Severe chest pain that does not go away
WebMD Medical Reference

Sources

SOURCES:

American College of Gastroenterology: "Non-Cardiac Chest Pain."

Merck Manuals Online Medical Library: "Lung and Airway Disorders: Symptoms" and "Chest Pain."

National Lung Health Education Program: "Chest Pain."

American Academy of Family Physicians: "Chest Pain, Chronic."

National Digestive Diseases Information Clearinghouse: "Heartburn, Gastroesophageal Reflux (GER, and Gastroesophageal Reflux Disease (GERD))."

CDC: “Smoking and COPD.”

UpToDate: “Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging.”

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