Chest Pain: When Symptoms Are and Aren’t Heart-Related

Chest pain is a potentially serious symptom of a cardiovascular problem, but many other causes aren't cause for concern. Discomfort in the chest can be related to heart, blood vessel, lung, digestive, musculoskeletal, and even psychiatric conditions. This article will review the various causes and features of chest pain.

Read on to learn about when to be concerned.

Causes of Chest Pain That Could Be Heart- or Vascular-Related Pain

There are several organs in the chest, but one of the more concerning types of chest pain is related to the heart or its major blood vessels. These conditions may be life-threatening and require emergency attention.

Heart Attack Pain

Perhaps the most worrisome cause of chest pain is a heart attack. A sudden blockage of blood flow in the coronary arteries that supply blood to the heart causes the injury and death of the heart muscle. Abnormal heart rhythms (arrhythmias) in a heart attack can cause sudden death, which is why seeking immediate medical care in an emergency room is essential if you are experiencing heart attack symptoms.

People experience heart attacks differently, but the most common symptom is chest discomfort. It's often in the center or left side of the chest. It's typically a vague discomfort over a wide area rather than pinpoint pain. The discomfort may radiate to the neck, jaw, or arms. Other symptoms of a heart attack include:

• Shortness of breath
• Nausea and vomiting
• Palpitations (feeling of rapid or irregular heartbeats)
• Fatigue

Chronic Angina

Blockages in the coronary arteries (coronary artery disease) build up gradually over time and can limit blood flow to the heart, especially during activity. This condition causes a type of chest pain known as chronic angina.

Angina is usually a dull pressure in the chest that happens with exercise and goes away with rest. Any angina that is new, changing, or worsening is serious and should be evaluated promptly.

Pericarditis

Pericarditis, which is the inflammation of the sac that lines the heart, is another potentially serious cause of chest pain. Typically, pain in pericarditis is sharp and gets worse with taking a breath or lying flat.

Pericarditis can cause a buildup of fluid within the sac surrounding the heart, known as a pericardial effusion. A large or sudden buildup of fluid can be potentially life-threatening as it impairs the heart's ability to fill and pump blood to the body. This condition is known as cardiac tamponade. The following signs and symptoms can happen with tamponade:

• Low blood pressure
• Lightheadedness or dizziness
• Shortness of breath
• Palpitations or racing heart
• Pale, cool skin
• Feeling anxious

Aortic Stenosis

Aortic stenosis is a narrowing of the heart valve that allows blood to pass out of the heart into the aorta. With severe narrowing, there may be chest pain, shortness of breath, fatigue, lightheadedness and dizziness, and even fainting, particularly with exertion or physical activity. Similarly, hypertrophic obstructive cardiomyopathy (HCM), a condition in which there the heart muscle thickens, can cause similar symptoms due to the impairment of blood flow out of the heart.

Aortic Dissection

Aortic dissection is a tearing within the wall of the aorta, the main blood vessel that brings blood from the heart to the rest of the body. Aortic dissection is a serious condition that can lead to death if not treated. Some types of aortic dissection require immediate surgery.

The location of pain with aortic dissection depends on where the tear is. The pain is usually sudden and severe ripping, sharp, or stabbing pain in the center of the chest or upper abdomen that radiates to the back. Other signs and symptoms of aortic aneurysm include:

• Low blood pressure
• Fast heart rate
• Lightheadedness or dizziness
• Shortness of breath
• Loss of consciousness
• Neurologic symptoms like slurred speech, weakness
• Feeling very anxious
• Pale, cool, and clammy skin

People with aortic aneurysms (bulging of the aorta due to weakening of the walls) are at higher risk of aortic dissection, so if you have a known aneurysm in the aorta and experience these symptoms, seek medical attention right away. Aortic dissection is also more common with smoking, high blood pressure, and certain connective tissue disorders like Marfan syndrome.

Pulmonary Embolism

Pulmonary embolism (PE) is a blood clot in the arteries in the lungs. It often comes from a clot from the deep veins in the legs. PE can happen to anyone, but certain risk factors like cancer, recent surgery, and blood clotting disorders increase the risk of having a PE.

Pain with PE varies but can typically occur anywhere in the chest or back and get worse when taking a deep breath. Other signs and symptoms of PE include:

• Shortness of breath
• Increased heart rate
• Cough
• Low oxygen levels
  

Causes of Chest Pain That Are Not Heart- or Vascular-Related

In addition to heart-related causes of chest pain, many conditions that cause chest pain are related to other organs in the chest.

Respiratory Causes

Problems with the lungs can cause chest pain anywhere in the chest, and even in the back.

Pneumothorax, also known as a collapsed lung, is a potentially life-threatening condition in which air escapes from the lung into the space between the lungs and the chest wall. This may happen due to a traumatic injury but also can occur spontaneously without any obvious trigger. People with certain lung conditions like chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis are more likely to experience a collapsed lung.

Chest pain with pneumothorax is worse with deep breathing and may be located anywhere in the shoulder. Other possible symptoms include:

• Shortness of breath
• Low oxygen levels
• Blueish skin
• Lightheadedness or dizziness
• Low blood pressure

Infections that lead to inflammation in the airways, such as bronchitis and pneumonia, can also cause chest pain. These infections can become severe and life-threatening; however, they are not as immediately life-threatening as the other causes in the sections above. Pain may get worse when taking a breath in, which can make differentiating from pain related to pulmonary embolism or pericarditis difficult in some cases.

Clues that your chest pain may be related to a respiratory infection include:

• Cough, especially a productive cough with sputum
• Fevers and chills
• Having recently been around other people who were sick

Note that some of these symptoms overlap with those of pericarditis, which can also happen due to a viral infection. Evaluation by a healthcare provider and imaging tests of the chest and heart can help tell these causes of chest pain apart.

Additionally, masses or tumors in the lungs can also cause chest pain. Lung cancer can cause chest pain anywhere in the chest, which often gets worse when taking a breath. Pain due to a mass in the lungs most often develops gradually and may come with a chronic cough as well as blood in the sputum, weight loss, and fatigue.

Gastrointestinal Causes

Problems with the esophagus (the tube connecting the mouth and stomach) and the stomach can cause chest pain.

Acid reflux and gastrointestinal esophageal reflux disease (GERD) are both common causes of chest pain that can be difficult to tell apart from heart attack pain. Acid reflux is when the acid from the stomach goes up into the esophagus. GERD is a condition in which there is frequent acid reflux.

The pain from acid reflux and GERD is known as heartburn. Heartburn is typically described as a burning sensation located in the upper abdomen or central chest. It may go up to the throat, and you may experience belching, a bitter taste in the mouth, bad breath, and coughing after meals. It can get worse after eating certain foods like spicy foods, peppermint, citrus, and chocolate.

Musculoskeletal Causes

Another common cause of chest pain is related to the bones, cartilage, and muscles that make up the chest wall.

Costochondritis is inflammation of the cartilage that attaches the ribs to the breastbone. Pain from costochondritis can mimic a heart attack, but unlike pain from a heart attack, it's usually worse when you press on the affected area. Though there's often no clearly identified cause, there may the pain may result from some activity, such as a new exercise, repeated movements, or coughing.

Other musculoskeletal causes of chest pain include muscle strain and bruising or rib fractures such as those from trauma. These types of pain are also typically worse when pressing on the area, taking a deep breath, or rotating the rib cage.

Skin Causes

Shingles are another cause of chest pain that can be difficult to recognize initially. Also known as herpes zoster, this condition is related to the reactivation of the chicken pox virus. It causes pain in one half of the body.

When involving the chest, it can occur either on the left or the right side of the chest and along the side of the rib cage to the back, but the pain generally won't cross over the middle of the chest to the other side. Pain from shingles is a burning pain that may itch or tingle. Discomfort from shingles can get quite severe and make the skin feel very sensitive. A few days later, the characteristic fluid-filled blisters appear on the affected area.

Psychiatric Causes

Panic attacks related to an anxiety disorder can cause chest pain. These episodes start suddenly and can include a racing heart, anxious feelings, tingling in the hands, and nausea. Though panic attacks can make you feel like you are having a serious event or even dying, a panic attack itself is not considered life-threatening.

It's best not to diagnose yourself with a panic attack, however. Before writing off your chest pain as a panic attack, you should have an evaluation to rule out a heart attack because the two are easily confused.

Chest Pain Causes by Timing and Duration of Pain

Chest pain can occur suddenly, be constant, or come and go, and certain activities can make the pain worse or better. These can all be clues about the cause of the pain.

Sudden Chest Pain

Many of the serious causes of chest pain come on suddenly or "acutely." These include heart- and blood vessel-related conditions as well as problems with the lungs or gastrointestinal tract:

• Heart attack
• Aortic dissection
• Pulmonary embolism
• Pneumothorax
• Rupture or tear of the esophagus

Though some other less serious causes of chest pain (such as GERD or a musculoskeletal problem) may also come on suddenly, any acute chest pain without an obvious cause (such as an injury to the chest) should undergo immediate evaluation to rule out life-threatening causes.

Constant Chest Pain

Chest pain that comes on and lasts for minutes to hours could be due to a number of causes, some of which are serious, including:

• Heart attack
• Aortic dissection
• Muscle, connective tissue, or bone injury
• Lung mass
• Shingles

Have any chest pain that lasts more than a few minutes checked out by a healthcare professional.

Fleeting Chest Pain

Fleeting chest pain that lasts only a few seconds and goes away is not usually a sign of something very serious. Fleeting chest pain might be musculoskeletal or nerve-related. On the other hand, chest pain that lasts for minutes at a time or longer can signal a potentially serious cause, such as angina.

Intermittent Chest Pain

Intermittent chest pain, or discomfort that comes and goes, may result from a serious heart-related condition or something unrelated to the heart. Paying attention to any triggers can help narrow down the possibilities. For example, chest discomfort that comes and goes with physical exertion is concerning for angina, a heart-related pain due to blockages in the coronary arteries.

Chest pain that comes with certain movements of muscles, on the other hand, might be related to a musculoskeletal cause. And pain that gets worse after a spicy or heavy meal might be related to GERD.

An Important Note on Chest Pain

It's very difficult to tease out the exact cause of chest pain because there is a lot of overlap of symptoms between the various causes. Writing off less severe chest pain as nothing serious may be tempting, but awareness of symptoms that may be due to a heart attack and seeking medical attention for them immediately (preferably by calling 911 and reaching emergency personnel who can treat any potentially dangerous arrhythmias) are essential.

Healthcare providers can run various tests including blood tests, electrocardiogram, and chest imaging studies to determine the most likely cause of chest pain and rule out serious conditions.

Summary

There are many causes of chest pain, some of which are potentially life-threatening causes related to heart or blood vessel problems. Though chest pain duration and timing can provide clues to its cause, determining the cause without testing is difficult. Seeking immediate medical care for possible life-threatening situations—like new chest pain that could be a sign of a heart attack—is essential.