Chest Pain

Important: chest pain can be an emergency

Chest pain should always be taken seriously, because while many causes are harmless, some are life-threatening — most importantly a heart attack. If you or someone else has chest pain that is severe, crushing or tight, spreads to the arm, jaw, neck or back, or comes with breathlessness, sweating, nausea or a feeling of dread, call emergency services immediately. It is always better to be checked and reassured than to delay treatment for a heart attack.

This article explains the range of possible causes for general understanding, but it cannot diagnose your chest pain. When in doubt, seek urgent medical help.

Possible causes of chest pain

Chest pain can come from the heart, but also from many other structures in the chest and upper body. Causes include:

• •Heart problems — such as a heart attack or angina (reduced blood flow to the heart)
• •Muscle or rib strain — often sharp and worse with movement or pressing on the area
• •Indigestion or acid reflux — a burning pain, sometimes with a sour taste
• •Lung conditions — such as a chest infection or, more seriously, a blood clot
• •Anxiety or panic attacks — which can cause real chest tightness and a racing heart
• •Costochondritis — inflammation of the cartilage joining the ribs

Heart-related versus other chest pain

Although only a doctor can tell for sure, some patterns are more concerning for the heart. Heart-related chest pain is often felt as pressure, tightness or heaviness rather than a sharp stab, may spread to the arm, jaw, neck or back, and can come with breathlessness, sweating or nausea. It may be brought on by exertion and eased by rest (a pattern called angina).

Pain that is sharp, very localised, changes with breathing or movement, or can be reproduced by pressing on the chest is more often muscular or related to the chest wall. However, these patterns are not reliable enough to rule out a heart problem on your own — which is why medical assessment is so important when there is any doubt.

What to do

For any severe, sudden or worrying chest pain, especially with the emergency signs described, call emergency services without delay — do not drive yourself. For milder, clearly non-cardiac chest discomfort, such as obvious indigestion or a pulled muscle, self-care and over-the-counter remedies may be appropriate, but if you are unsure, get medical advice.

If you have known heart disease and have been given medication such as a GTN spray for angina, follow the plan your doctor gave you, and seek emergency help if the pain does not settle as expected. New, unexplained or recurring chest pain should always be assessed by a doctor.

Common non-cardiac causes of chest pain

While the priority with any chest pain is to rule out a heart problem, it is worth knowing that many cases of chest pain are not caused by the heart at all. Understanding these common, less serious causes can help put milder symptoms in context — though it never replaces medical assessment when there is any doubt.

Musculoskeletal causes are very common: strained chest muscles, rib injuries, and inflammation of the cartilage joining the ribs to the breastbone (costochondritis) can all cause chest pain that is typically sharp, localised, and worse with movement, breathing deeply or pressing on the area. Digestive causes are also frequent, with acid reflux and heartburn producing a burning chest discomfort that can sometimes be mistaken for heart pain.

Anxiety and panic attacks can cause genuine chest tightness, a racing heart and breathlessness, which can be frightening and hard to distinguish from a heart problem. Lung-related causes, such as a chest infection or inflammation of the lining of the lungs, can cause chest pain that worsens with breathing. Because these causes overlap in their symptoms with more serious conditions, medical assessment remains important whenever chest pain is new, unexplained or concerning.

Reducing your risk of heart-related chest pain

For chest pain related to the heart, much of the underlying risk can be reduced through the same measures that protect cardiovascular health overall. Since conditions like angina and heart attacks stem largely from narrowed, hardened arteries, looking after your heart and blood vessels lowers both your risk of these problems and of the chest pain they cause.

The key measures are well established: not smoking, eating a balanced diet low in saturated fat and salt, staying physically active, maintaining a healthy weight, and limiting alcohol. Keeping blood pressure, cholesterol and blood sugar within healthy ranges is particularly important, as all three damage arteries over time when raised. Many of the tools and guides on this site can help you understand and track these factors.

For people who already have a heart condition such as angina, following the treatment plan agreed with their doctor — including any prescribed medication — helps control symptoms and reduce risk. Knowing your personal risk factors and acting on them is one of the most effective things you can do, both to reduce heart-related chest pain and to protect your long-term health.