Causes of chest pain can vary from minor problems, such as indigestion or stress, to serious medical emergencies, such as a heart attack or pulmonary embolism. The specific cause of chest pain is often difficult to interpret.
Finding the cause of your chest pain can be challenging, especially if you've never had symptoms in the past. Even doctors may have a difficult time deciding if chest pain is a sign of a heart attack or something less serious, such as indigestion. If you have unexplained chest pain lasting more than a few minutes, you should seek emergency medical assistance rather than trying to diagnose the cause yourself.
As with other sudden, unexplained pains, chest pain may be a signal for you to get medical help. Use the following information to help you determine whether your chest pain is a medical emergency.
A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack may cause chest pain that lasts 15 minutes or longer. But a heart attack can also be silent and produce no signs or symptoms.
Many people who experience a heart attack have warning symptoms hours, days or weeks in advance. The earliest warning sign of an attack may be ongoing episodes of chest pain that start when you're physically active, but are relieved by rest.
Someone having a heart attack may experience any or all of the following:
- Uncomfortable pressure, fullness or squeezing pain in the center of the chest lasting more than a few minutes
- Pain spreading to the shoulders, neck or arms
- Lightheadedness, fainting, sweating, nausea or shortness of breath
If you or someone else may be having a heart attack:
- Call 911 or emergency medical assistance. Don't "tough out" the symptoms of a heart attack for more than five minutes. If you don't have access to emergency medical services, have someone, such as a neighbor or friend, drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.
- Chew a regular-strength aspirin. Aspirin reduces blood clotting, which can help blood flow through a narrowed artery that's caused a heart attack. However, don't take aspirin if you are allergic to aspirin, have bleeding problems or take another blood-thinning medication, or if your doctor previously told you not to do so.
- Take nitroglycerin, if prescribed. If you think you're having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Don't take anyone else's nitroglycerin.
- Begin CPR on the person having a heart attack, if directed. If the person suspected of having a heart attack is unconscious, a 911 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR). Even if you're not trained, a dispatcher can instruct you in CPR until help arrives. If help from a 911 dispatcher or emergency medical specialist is unavailable, begin CPR. If you don't know CPR, begin pushing hard and fast on the person's chest over the heart — about 100 compressions a minute.
Angina is a type of chest pain or discomfort caused by reduced blood flow to your heart muscle. Angina may be stable or unstable:
- Stable angina — persistent, recurring chest pain that usually occurs with exertion
- Unstable angina — sudden, new chest pain, or a change in the pattern of previously stable angina, that may signal an impending heart attack
Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion.
Angina signs and symptoms may include:
- Chest pain or discomfort
- Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
- Shortness of breath
The severity, duration and type of angina can vary. If you have new or changing chest pain, these new or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. If your angina gets worse or changes, becoming unstable, seek medical attention immediately.
Pulmonary embolism occurs when a clot — usually from the veins of your leg or pelvis — lodges in a pulmonary artery of your lung. The lung tissue served by the artery doesn't get enough blood flow, causing tissue death. This makes it more difficult for your lungs to provide oxygen to the rest of your body.
Signs and symptoms of pulmonary embolism may include:
- Sudden, sharp chest pain often accompanied by shortness of breath
- Sudden, unexplained shortness of breath, even without pain
- Cough that may produce blood-streaked sputum
- Rapid heartbeat associated with shortness of breath
- Severe anxiety
- Unexplained sweating
Pulmonary embolism can be life-threatening. As with a suspected heart attack, call 911 or emergency medical assistance immediately.
An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is usually fatal.
If you think aortic dissection is the cause of your chest pain, seek emergency medical assistance immediately. Typical signs and symptoms include:
- Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates to the neck or down the back
- Loss of consciousness (fainting)
- Shortness of breath
- Sudden difficulty speaking, loss of vision, weakness, or paralysis of one side of your body, such as having a stroke
- Weak pulse in one arm compared with the other
Pneumonia with pleurisy
Frequent signs and symptoms of pneumonia are chest pain accompanied by chills, fever and a cough that may produce bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes that surround the lung (pleura), you may have considerable chest discomfort when taking a breath or coughing. This condition is called pleurisy.
One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This isn't usually true of a heart attack. If you've recently been diagnosed with pneumonia and then start having symptoms of pleurisy, contact your doctor or seek immediate medical attention to determine the cause of your chest pain. Pleurisy alone isn't a medical emergency, but you shouldn't try to make the diagnosis yourself.
Chest wall pain
One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It causes pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).
In costochondritis, pressing on a few points along the edge of your sternum often results in considerable tenderness in those small areas. If the pressure of a finger causes similar chest pain, it's unlikely that a serious condition, such as a heart attack, is the cause of your chest pain.
Other causes of chest pain include:
- Strained chest muscles from overuse or excessive coughing
- Chest muscle bruising from minor injury
- Short-term, sudden anxiety with rapid breathing
- Peptic ulcer disease
- Pain from the digestive tract, such as esophageal reflux, peptic ulcer pain or gallbladder pain that may feel similar to heart attack symptoms
- Brown JE, et al. Chest pain. In: Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05472-0..X0001-1--TOP&isbn=978-0-323-05472-0&uniqId=230100505-57. Accessed Nov. 10, 2011.
- ACC/AHA management of patients with unstable angina/non-ST-elevation myocardial infarction — Pocket guideline. American College of Cardiology and the American Heart Association. http://content.onlinejacc.org/cgi/data/57/19/e215/DC2/1. Accessed Nov. 10, 2011.
- Heart attack. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/. Accessed Nov. 10, 2011.
- Pulmonary embolism. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/pe/. Accessed Nov. 10, 2011.
- Pleurisy and other pleural disorders. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/pleurisy/. Accessed Nov. 10, 2011.
- Manning WJ. Clinical manifestations and diagnosis of aortic dissection. http://www.uptodate.com/home/index.html. Accessed Nov. 10, 2011.