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What causes chest pain?

 What causes chest pain?
 

Chest pain is pain that is experienced anywhere from your shoulders down to your lower ribs. This pain often sparks concerns about heart issues. While heart problems are possible, chest pain can have numerous other causes, with about 16% considered non-specific chest pain (i). Some causes can be life-threatening.
 

Cardiac or non-cardiac chest pain


According to the National Institute for Health and Care Excellence (NICE), chest pain is commonly classified as having either cardiac or non-cardiac causes (ii). The non-cardiac causes are numerous, including pneumonia, asthma, cracked ribs, heartburn and anxiety, to name just a few. Indeed, because there are so many causes it can be difficult to make a diagnosis of what’s causing chest pain. The only way to find out for certain is to see a medical professional.
 
Chest pain is also common. Every year, one to two per cent of adults in the UK see their GP about having chest pain for the first time. Meanwhile, chest pain accounts for five per cent of visits to UK A&E departments (iii).
 
Chest pain's sensation varies, ranging from sharp or dull to tightness, aching, squeezing, burning, stabbing or feeling like someone is sitting on your chest. It can occur in different chest areas, last briefly or for extended periods, and may happen during physical activity or at rest.      
 

How to know if your chest pain is serious 


However and whenever you feel it, chest pain should never be ignored, especially if it’s the first time you’re having it or it’s sudden or particularly severe. Most importantly, if you experience chest pain with any of the following, see a doctor or call 999 for an ambulance straight away:
 

  • Pain that radiates to your arms, back, neck or jaw

  • Pain that’s severe and lasts 15 minutes or longer

  • Tightness or heaviness

  • Pain that started with nausea, vomiting or sweating

  • Breathing difficulties or changes in your breathing rate

  • An irregular or rapid heartbeat

  • Lightheadedness or fainting 

  • Confusion

  • Blue lips or nail beds


It’s also important to see your GP if you have any type of chest pain, including chest pain that comes and goes or pain that goes away quickly. Some causes of chest pain can have severe consequences, so it’s always best to get a check-up to make sure it’s not anything serious.
 
In the meantime, here’s a rundown of some of the most common causes of chest pain – including those caused by heart problems, lung problems, gastrointestinal problems and others.
 

How to tell if chest pain is muscular or heart-related 


Muscular chest pains can cause a sharp shooting pain when taking deep breaths, whereas, heart-related chest pains will not change during deep breathing.
 
According to US experts, acute coronary syndrome – a range of conditions caused by a sudden reduced blood flow to the heart, including heart attack and unstable angina – is the most common cause in people who go to A&E for chest pain (31 per cent) (iv).
 
There are several things that can increase your risk of having chest pain caused by heart problems, including:
 

 
The following are among some of the most common heart-related causes of chest pain:
 

 

Heart attack  

 
Known in the medical world as a myocardial infarction, a heart attack is caused by a blockage or reduction in the blood flow through the blood vessels in the heart. If you think you may be having a heart attack you need emergency medical help, as getting treatment to remove the blockage quickly can increase your chances of surviving and reduce the damage to your heart.
 
Severe chest pain that sometimes spreads to the jaw, neck or arms is the most common heart attack symptom, with other major symptoms including:
 

  • Nausea and sweating

  • Feeling faint or lightheaded

  • Pale skin

  • Rapid and weak pulse

  • Shortness of breath

 
Some people, however, experience other symptoms – with or even without chest pain – including fatigue, chest pressure, abdominal pain and dizziness. Women, for instance, are often likely to have other, less common symptoms that later turn out to be caused by a heart condition. If you have any of these symptoms or you think you may be having a heart attack for any reason, call 999 for an ambulance immediately and – if you have one – take one 300mg aspirin by chewing it slowly.
 
Meanwhile symptoms accompanying chest pain that are not likely to be caused by a problem with your heart include flu-like symptoms, pain that only happens after you swallow or eat, having an acidic or sour taste in your mouth, pain caused by coughing or breathing deeply, pain with a rash, feelings of anxiety or panic, and swallowing difficulties.
 
Read our guide for more information about heart attack symptoms, treatment and prevention.
 

Angina

 
Angina, often caused by narrowed heart arteries (coronary heart disease), leads to chest pain, which can be described as discomfort, aching or tightness in the chest. This pain may radiate to the arm, jaw, shoulder, or back. Typically, it occurs during physical activity and not at rest. While angina doesn't harm the heart directly, it serves as a warning sign for potential future heart issues.    
 
Angina is more common in men than in women, with eight per cent of men and three per cent of women aged 55 - 64 years old having had angina or living with angina (v). Read more about it in our angina guide,  including what causes it and how it’s treated.
 

Myocarditis  

 
Several things can cause myocarditis – which is when the heart muscle (myocardium) becomes inflamed – but the most common is a viral infection. Chest pain is a common symptom, along with fatigue, shortness of breath and a rapid and/or irregular pulse, along with a high temperature. Because of these symptoms, people with myocarditis can often think they’re having a heart attack.
 
Treatments for myocarditis include bed rest and avoiding exercise to prevent the heart muscle becoming strained, while the viral infection usually clears on its own. Some people may have mild or even no symptoms, but for others it can lead to serious complications such as heart failure.
 

Pericarditis

 
When the sac that surrounds the heart and keeps it in place inside the chest wall – the pericardium – becomes inflamed, the condition is called pericarditis. This can also feel like a heart attack, causing a sudden, sharp or stabbing chest pain, often in the middle or left side of your chest. The pain can also radiate to the neck, jaw, arms or shoulders, and it can feel worse when you lie down or take deep breaths. Indeed, according to the NHS, pericarditis is one of the most common heart problems that causes chest pain (vi).
 
Pericarditis also causes other symptoms including weakness, fatigue, heart palpitations and breathing difficulties (often when you’re lying down). Viruses are the main causes, though pericarditis can be caused by other infections too. The good news is that pericarditis tends to clear up on its own within about three weeks, though you may have to rest while you recover and take anti-inflammatory medicines if needed.
 

Aortic dissection 

 
A condition caused by a tear in the aorta – the main artery that carries blood away from the heart to the rest of the body – aortic dissection is thankfully rare. However, it has symptoms similar to those of a heart attack, including severe sudden chest pain, pain in the jaw, neck, back and shoulder; fainting, dizziness, shortness of breath; as well as nausea. Other symptoms can include abdominal pain, sudden weakness, clammy skin and vomiting.
 
If you experience a sudden tearing pain in your chest, neck, jaw, stomach or shoulder along with feeling faint, breathing difficulties and sudden weakness, call 999 for an ambulance immediately, as aortic dissection is a medical emergency.
 

How do you know if chest pain is lung-related?    

 
Some of the main lung-related conditions that cause chest pain and discomfort include the following:
 

Pneumonia  

 
This is a potentially serious type of lung infection where the air sacs (alveoli) in the lungs fill up with fluid, making it harder for you to breathe. Pneumonia can also cause sharp or stabbing chest pain, especially when you cough or breathe deeply. Find out more about it in our pneumonia guide.
 
Bronchitis is another type of chest infection that can cause a sore, aching chest as well as a heavy or tight sensation in your chest.
 

Pleurisy  

 
Causing a sharp, stabbing chest pain particularly when you inhale or cough, pleurisy is inflammation of the pleura, the membrane that surrounds the lungs. The inflammation is usually caused by a viral infection. Other symptoms include shortness of breath and coughing up blood. If a virus is the cause, the symptoms usually settle within a few days.
 

Pulmonary embolism  

 
This is caused by a blockage – usually a blood clot such as a deep vein thrombosis (DVT) – in one of the artery blood vessels in the lungs. A pulmonary embolism is a medical emergency and potentially life threatening, so prompt treatment is essential.
 
Symptoms of a small pulmonary embolism include sharp chest pain while inhaling, coughing up blood, a rapid pulse and a mildly raised temperature. Your risk of having a pulmonary embolism is higher if you’re pregnant, immobile or have had major surgery, or if you have one of certain medical conditions or are taking certain medicines.
 

Pneumothorax   

 
When air becomes trapped between your lung and your chest wall, it’s known as a pneumothorax (also often called a collapsed lung). This often causes a sudden sharp, stabbing pain in your chest on one side, especially when you inhale. Breathlessness is the other main symptoms.
 
Causes of a pneumothorax include lung conditions such as chronic obstructive pulmonary disease (COPD), pneumonia, tuberculosis, cystic fibrosis and lung cancer. However it can also develop for no obvious reason, even in people who are otherwise healthy (primary spontaneous pneumothorax). In fact, most cases develop in healthy young adults who do not have a lung condition, with around three times more men affected than women (vii). Smoking also increases your risk of developing a spontaneous pneumothorax.
 

Asthma  

 
Caused by inflammation and irritation in the airways, asthma typically causes shortness of breath, tightness in the chest, coughing and wheezing, but it can cause chest pain too. Read all about it in our guide to asthma symptoms and treatments.
 

Gastrointestinal problems and chest pain

 
Chest pain can also be a common symptom of some gastrointestinal and digestive disorders, such as the following:
 

Gastro-oesophageal reflux disease  

 
A study has found 30 per cent of people going to A&E with chest pain have gastro-oesophageal reflux disease (GORD) (iv), making it the second-most common cause of chest pain in A&E patients after acute coronary syndrome.
 
GORD is a common condition that causes the burning chest pain known as heartburn when acid from the stomach travels up into the oesophagus (this is known as acid reflux). Many people have severe heartburn pain – indeed, in one survey four out of 10 heartburn sufferers said their symptoms were so painful they thought they were having a heart attack (viii).
 
Other symptoms of heartburn and GORD include nausea, vomiting, bloating, belching, pain while swallowing and an unpleasant, acidic taste in your mouth. Read more about it, including how to treat it, in our guide to indigestion and heartburn
 

Peptic ulcer  

 
Sores in the lining of the stomach or the upper part of the small intestines, peptic ulcers commonly cause chest pain, just below the breastbone. Caused by stomach acid, they often affect people who smoke or drink a lot of alcohol, and can even develop if you take high doses of anti-inflammatory medicines for a long period of time, including pain relief medicines such as aspirin, ibuprofen and naproxen. Other symptoms can include bloating, nausea, vomiting, feeling very full after eating and heartburn.
 
If you’re diagnosed with a peptic ulcer, you may need medication to reduce the amount of acid your stomach produces.
 

Hiatus hernia  

 
There are several different types of hernias. A hiatus hernia is when part of the stomach protrudes into the lower chest through a weak spot in the diaphragm, the muscle that separates your lungs from your abdomen. One of the things you may experience if you have a hiatus hernia is heartburn.
 
Find out more about hiatus hernias and other types of hernias by reading our article What is a hernia? 
 

Acute cholecystitis  

 
This is the medical term for inflammation of the gallbladder, the main symptom of which is a sudden sharp pain in the right side of your chest that can spread towards your right shoulder. The pain is constant and tends to be worse when you breathe in deeply. Other symptoms include nausea, vomiting, sweating, a high temperature and yellowing of the skin and eyes (jaundice).
 
Most cases are the result of a blockage in the opening to your gallbladder (the cystic duct), often caused by a gallstone. If you think you may have acute cholecystitis you need prompt medical treatment, so see your GP or call NHS 111 for advice.
 

Other causes of chest pain

 
Chest pain has many other potential causes too, including the following:
 

Costochondritis  

 
Sharp, stabbing chest pain that develops gradually or suddenly is the main symptom of costochondritis – inflammation of the cartilage that connects your ribs to your sternum (the costochondral joint). It’s not clear what causes costochondritis in many cases, but it has been linked to having a chest injury, severe coughing, physical straining and infections (including respiratory infections or infections caused by wounds).
 
Activities like lying down, deep breathing, coughing, sneezing, physical exertion, and even pressure on the chest from things like seatbelts or hugs can exacerbate costochondritis pain. Fortunately, it typically resolves on its own over time. However, since its main symptom mirrors that of a heart attack, seeking prompt medical advice is essential.    
 

Does anxiety cause chest pain?

 
It’s quite common for anxiety to cause chest pain, usually when you’re faced with a stressful situation or when you’re very worried. In fact many people with anxiety think they’re having a heart attack or angina, such is the severity of the pain it can cause.
 
If you have chest pain caused by anxiety it’s known as Da Costa’s syndrome. Other symptoms you may experience include a rapid heart rate, sweating and dizziness. Similarly, people who have panic attacks can also have chest pain, with many of the symptoms of panic attacks often mistaken for a heart attack.
 
You can read more about these conditions in our guides to anxiety symptoms and dealing with panic attacks
 

Shingles 

 
If you've had chickenpox, you're at risk of shingles, a condition caused by the reactivation of the varicella-zoster virus. Shingles typically begins with pain in various body parts, including the chest, before the rash appears. The location of pain depends on the affected nerve and can range from mild to severe, accompanied by tenderness. A rash with blisters typically follows in about two to three days.    
 
Shingles is very common, developing in about one in four people at some time or other (ix). But while it can affect anyone who has previously had chickenpox, it’s most common in people aged 50 or older. Read more about it, including what you can do to make yourself feel more comfortable, in our guide to chickenpox and shingles
 

Chest injury 

 
Physical injuries can cause chest pain as well. In fact, research indicates that 28% of individuals seeking A&E care for chest pain are diagnosed with musculoskeletal issues, such as strained or torn chest muscles, or bruised or broken ribs.
 
Various activities, from severe coughing to poor posture and lifting heavy objects, can lead to these injuries. However, even a muscle strain or rib fracture can mimic more severe conditions, like heart or lung problems. Seeking medical attention is crucial for accurate diagnosis and peace of mind.     
 

Chest pain treatment      

 
Treatment for chest pain depends on its underlying cause and may involve medication or surgery. To reduce the risk of these conditions, try to prioritise a healthy lifestyle: maintain a nutritious diet with five daily portions of fruits and vegetables, manage a healthy weight, stay physically active, avoid smoking, drink alcohol moderately, and diligently follow your doctor's advice and prescribed medications for any existing health conditions.      
 
Some of the other things you can do include:
 

  • Avoiding foods that you know make your stomach produce too much acid

  • Wearing compression socks or stockings if you’re immobile for a long time (during a long journey, for instance, or if you’re recovering from an operation) to prevent the development of a DVT

  • Getting a shingles jab and a pneumococcal jab (ask your GP about this if you’re aged 70 or older for the shingles jab and 65 or older for the pnemococcal vaccine)

  • Treating respiratory infections quickly

  • Learning to avoid your triggers if you have asthma

  • Practising relaxation techniques such as deep breathing or mindful meditation

 
There are also many nutritional supplements that could give you some extra support and help boost your wellbeing. A multivitamin and mineral supplement, for instance, can help make sure you’re getting all the nutrients your body needs – this may be especially important if you don’t always eat as healthily as you should.
 
Find out more about multivitamin supplements, including the many different types that are available, by reading our guide to multivitamins and daily requirements
 
Meanwhile here are just a few of the other supplements you may want to consider trying:
 

  • CoQ10 to support heart health (researchers claim coQ10 supplements may have several benefits for the heart, including reducing vascular stiffness and high blood pressure, and reducing mortality from cardiovascular causes (x))

  • Omega-3 for heart health and inflammation reduction (may lower heart disease risk, including heart attacks).    

  • Magnesium for healthy heart muscle functioning (magnesium supplements may also help treat high blood pressure, say scientists writing in the journal Hypertension (xii))

  • Garlic for immune and heart support (may reduce cholesterol and protect against viral infections; consult your doctor if on blood thinners).    

  • Vitamin K2 for heart health (researchers believe this may be a safe and promising option for improving cardiovascular health thanks to the way it reduces arterial stiffness caused by calcium deposits (xv))

  • Vitamin D to boost your resistance to infections (studies show vitamin D supplements may have beneficial effects on immune function (xvi))

  • B-complex for heart health (B6, B12, folate lower heart disease risk; a convenient source of various B vitamins).

  • Pomegranate concentrate for heart health (contains vitamin C, potassium, and polyphenols; may reduce blood pressure).

  • Anthocyanidins for blood vessel health (found in dark-skinned fruits and veggies; promotes collagen production for strong connective tissues).

     

Need more information?

 
There’s lots more information on a range of conditions that cause pain in all parts of the body in the pain section of our pharmacy health library. Also take a look at the articles in our heart health section, which provide details of several heart conditions (many of which cause chest pain).
 

 

References:

  1. Available online: https://cks.nice.org.uk/topics/chest-pain/background-information/causes/

  2. Available online: https://cks.nice.org.uk/topics/chest-pain/background-information/definition/

  3. Available online: https://cks.nice.org.uk/topics/chest-pain/background-information/prevalence/

  4. Available online: https://www.ncbi.nlm.nih.gov/books/NBK470557/

  5. Available online: https://patient.info/doctor/stable-angina-2

  6. Available online: https://www.nhs.uk/conditions/chest-pain/

  7. Available online: https://patient.info/signs-symptoms/chest-pain-leaflet/pneumothorax

  8. Zantac 75 Relief online survey with Opinion Health. 501 Heartburn and Indigestion adult sufferers. March 2010.

  9. Available online: https://patient.info/skin-conditions/shingles-herpes-zoster-leaflet

  10. , The Use of Coenzyme Q10 in Cardiovascular Diseases. Antioxidants (Basel) ; 10(5): 755. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151454/

  11. , Marine Omega-3 Supplementation and Cardiovascular Disease: An Updated Meta-Analysis of 13 Randomized Controlled Trials Involving 127 477 Participants. Journal of the American Heart Association ; 8(19). Available online: https://www.ahajournals.org/doi/10.1161/JAHA.119.013543

  12. , Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials. Hypertension ; 68(2): 324-33. Available online: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.116.07664

  13. , Garlic as a lipid lowering agent – a meta-analysis. JR Coll Physicians Lond. ; 28(1): 39-45. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400934/

  14. , Antiviral potential of garlic (Allium sativum) and its organosulfur compounds: A systematic update of pre-clinical and clinical data. Trends Food Sci Tehnol. ; 104: 209-234. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434784/

  15. , Vitamin K2—a neglected player in cardiovascular health: a narrative review. Open Heart ; 8(2): e001715. Available online: https://openheart.bmj.com/content/8/2/e001715#

  16. , Vitamin D and Immune Function. Nutrients ; 5(7): 2502-2521. Available online: https://www.mdpi.com/2072-6643/5/7/2502/htm

  17. , Dietary Vitamin B6 Intake Associated with a Decreased Risk of Cardiovascular Disease: A Prospective Cohort Study. Nutrients ; 11(7): 1484. Available online: https://www.mdpi.com/2072-6643/11/7/1484

    , Intake of vitamin B6, folate, and vitamin B12 and risk of coronary heart disease: a systematic review and dose-response meta-analysis of prospective cohort studies. Crit Rev Food Sci Nutr. ; 59(16): 2697-2702. Available online: https://www.tandfonline.com/doi/abs/10.1080/10408398.2018.1511967?journalCode=bfsn20

     





 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 
 
Our Author - Christine Morgan

Christine

Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.

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