Chest pain

Chest pain occurs in the chest area, which covers anywhere from the bottom of your ribs up to your shoulders. It can have multiple causes and most often needs further investigations to identify the cause. If you have chest pain, you should seek treatment immediately as it can be the result of a serious underlying health problem, which needs urgent medical treatment.

Sudden pain in your chest, particularly pain that lasts more than 15 minutes, can be a symptom of a life-threatening condition such as a heart attack. Other heart attack symptoms include:

• Pain in other parts of your body — sometimes it feels as if the pain is travelling from your chest elsewhere, such as down your back or arms, or up to your neck or jaw 
• A tight or heavy feeling in your chest
• Feeling dizzy and anxious
• Sweating
• Breathlessness, coughing or wheezing
• Nausea or vomiting

Call 999 immediately if you think you’re having a heart attack.

You’re at a higher risk of heart problems if you’re older and you:

• Smoke
• Are overweight or obese
• Have high blood pressure, diabetes or high cholesterol
• Have a family history of coronary heart disease, heart attacks or angina, particularly in those under the age of 60

You should see your GP urgently if you have chest pain, even if it comes and goes or if it has passed but you are worried. Any underlying conditions can then be diagnosed and treated. 

While chest pain can be a sign of a serious underlying health condition, it can also be caused by a minor or easily treatable condition.

There are many different reasons for chest pain and heart problems are not usually the cause. 

Digestive causes

Burning pain in your chest after eating might be heartburn. Heartburn can be a symptom of GORD (gastro-oesophageal reflux disease) or a peptic ulcer, which is caused by stomach acid. The pain usually starts after eating. You may also feel bloated and bring up some of your food or bitter-tasting fluids. 

Muscle, joint and bone causes

If your chest pain improves when relaxed and you’ve been exercising or lifting, you might have strained a chest muscle.

If your chest pain occurs at the front of your chest and feels sharp and stabbing, you might have costochondritis. This is caused by inflammation of the joints between the ribs and the cartilage at the front of the ribcage. Exercise, movement and deep breathing usually make the pain worse.

Chest pain can also be a symptom of ankylosing spondylitis.

Lung-related causes

Sharp, stabbing chest pain can be the result of several different conditions. 

If the pain is on one side of your chest and gets worse when breathing in, you might have a pneumothorax. This is caused by air trapped between your chest wall and lung. 

If the pain occurs alongside other symptoms including coughing up blood, a racing heartbeat and a mild fever, you might have a pulmonary embolism. This is caused by one of the blood vessels supplying the lungs being blocked, usually by a blood clot. 

If the pain gets worse when breathing in, coughing or sneezing, you might have pleurisy. You may also feel pain in your shoulders. Pleurisy is caused by inflammation of the linings of your lungs and the inner surface of your chest. 

If the pain gets worse when breathing in and out, you are coughing up yellow or green mucus and have a high fever, you might have pneumonia. This is caused by inflammation of the lungs due to an infection. 

Heart-related causes

Sudden, severe chest pain could be the sign of a heart attack, with other symptoms including:

• Pain in other parts of your body — sometimes it feels as if the pain is travelling from your chest elsewhere, such as down your back or arms, or up to your neck or jaw 
• A tight or heavy feeling in your chest
• Feeling dizzy and anxious
• Sweating
• Breathlessness, coughing or wheezing
• Nausea or vomiting

A heart attack occurs because one of the blood vessels supplying the heart is blocked. This damages the heart tissue and needs urgent medical attention. If you think you’re having a heart attack, call 999 immediately. 

Severe or tight chest pain can be a symptom of angina, which can be successfully treated. This chest pain can also feel like an ache or discomfort. It is caused by the narrowing of blood vessels that supply the heart. This may not result in any problems when resting but when exercising can result in chest pain. 

Sharp chest pain when breathing can be a sign of pericarditis, which isn’t usually serious but must be checked.

Other causes

Chest pain can be a panic attack triggered by feeling stressed or worried, along with:

• Sweating
• Dizziness
• A racing heartbeat
• Hiatus hernia

Chest pain can also be caused by shingles. Shingles is a viral infection that results in a tingling or painful feeling in your skin and later, a skin rash which blisters.

If you notice sudden, unexpected or new chest pain, call 999 immediately. It’s vital that the cause of your chest pain is diagnosed and treated as soon as possible.

If you’ve had chest pain for some time or chest pain that comes and goes, see your GP. They will ask about your symptoms, any medications you are taking or treatments you are having, as well as any other medical conditions you have. They may also examine your chest and listen to your heart.

Your GP may refer you for further investigations, including:

• Blood tests – to check for signs of heart problems
• Chest X-ray – to look for lung conditions, including pneumonia
• Electrocardiogram (ECG) – to measure your heart’s rhythm and electrical activity
• Endoscopy – to check for digestive problems
• MRI scan/CT scan – to provide a detailed view of your heart
• Myocardial perfusion scintigraphy – to assist with a diagnosis of angina
• Coronary angiography — to check for narrowed or blocked blood vessels to your heart 
• Isotope and CTPA (computed tomography pulmonary angiography) scan — to check for narrowed or blocked blood vessels from your heart to your lungs

Your GP may also refer you to a consultant for further assessment, diagnosis and treatment.

Treatments for heart-related chest pain 

You can reduce your risk of heart problems, including having a heart attack, by:

• Losing any excess weight
• Adopting a healthy lifestyle — eat a healthy, balanced diet and take regular exercise
• Stopping smoking
• Keeping your blood pressure at a healthy level — cut down on caffeine, limit salt intake, keep within the recommended limits for alcohol and aim for at least six hours of sleep every night

Your treatment will depend on the underlying cause of your chest pain and further investigations, such as cardiac catheterisation, may be needed to diagnose the cause. 

Treatments include medications, such as nitroglycerine or blood thinners, and/or surgery, such as a heart bypass or coronary angioplasty. 

Your doctor will discuss your treatment options with you and, after considering your health and preferences, decide which is best.

Treatments for other causes of chest pain

As with heart-related chest pain, your treatment will depend on the specific cause of your chest pain.

For a pneumothorax, your lung can be reinflated. For heartburn, medications such as antacids can be taken. For panic attacks, anti-anxiety medications can be taken. 

Your doctor will recommend the most appropriate treatment options to you based on your health and preferences.

When should you be concerned about chest pain?

Chest pain should always be taken seriously. You should seek urgent medical treatment by calling 999 if your chest pain: 

• Is sudden and severe
• Feels heavy, tight or pressing
• Last for more than 15 minutes
• Spreads to other parts of your body, such as your arms, neck, jaw and back
• Occurs with other symptoms, such as breathlessness, coughing up blood, nausea or sweating

If your chest pain comes and goes, or you’ve had chest pain for some time, you should see your GP. 

Why am I feeling pain in my chest?

Chest pain has many different causes. It can be related to a problem with your heart, lungs, gut, muscles, joints and bones, as well as infection and stress or anxiety. It is therefore important to seek immediate treatment so the cause can be identified and the appropriate treatment given. 

How can I relieve chest pain?

Finding relief from your chest pain depends on the cause. Adopting a healthy lifestyle can help but medication or surgery may also be needed. It is therefore important to seek immediate treatment so the cause can be identified and the appropriate treatment given. 

What does a mini heart attack feel like?

A mini heart attack occurs when a blood vessel supplying the heart is temporarily blocked. The symptoms can be milder and shorter-lived when compared to a classic heart attack. Symptoms include: 

• Chest pain or discomfort that comes and goes or lasts only a few minutes
• A tight, heavy or pressing feeling in the middle of your chest
• Mild pain in your throat, similar to acid reflux or indigestion

You may feel normal immediately after these symptoms. However, it is important to seek urgent medical treatment.

How do I know if chest pain is muscular?

Muscular chest pain can be sharp or dull. Sharp pain can be due to suddenly pulling a muscle while a dull pain can be due to long-term strain. Other symptoms of muscular chest pain include: 

• Bruising
• Muscle spasms
• Swelling
• Pain while breathing or moving your chest area

How do I know if my chest pain is anxiety?

Chest pain due to anxiety is usually sharp and stabbing, lasting a few seconds rather than minutes. This pain usually occurs when at rest, unlike chest pain due to a heart attack, which usually occurs when active. It usually stays focused in the chest area, unlike chest pain due to a heart attack, which can spread to other body parts.