Chest pain appears in many forms, ranging from a sharp stab to a dull ache. Sometimes chest pain feels crushing or burning. In certain cases, the pain travels up the neck, into the jaw, and then radiates to the back or down one or both arms. Many different problems can cause chest pain. The most life-threatening causes involve the heart or lungs. Because chest pain can indicate a serious problem, it's important to seek immediate medical help.

Symptoms

Chest pain can cause many different sensations depending on what's triggering the symptom.

Heart-related chest pain

Although chest pain is often associated with heart disease, many people with heart disease say they experience a vague discomfort that isn't necessarily identified as pain. In general, chest discomfort related to a heart attack or another heart problem may be described by or associated with one or more of the following:

Pressure, fullness, burning or tightness in your chest

Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms

Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity

Shortness of breath

Cold sweats

Dizziness or weakness

Nausea or vomiting

Other types of chest pain

It can be difficult to distinguish heart-related chest pain from other types of chest pain. However, chest pain that is less likely due to a heart problem is more often associated with:

A sour taste or a sensation of food re-entering your mouth

Trouble swallowing

Pain that gets better or worse when you change your body position

Pain that intensifies when you breathe deeply or cough

Tenderness when you push on your chest

Pain that is persistently present for many hours

When to see a doctor

If you have new or unexplained chest pain or suspect you're having a heart attack

Causes

Chest pain has many possible causes, all of which need medical attention.

Heart-related causes

Examples of heart-related causes of chest pain include:

Heart attack: A heart attack results from blocked blood flow, often from a blood clot, to your heart muscle.

Angina: Angina is the term for chest pain caused by poor blood flow to the heart. This is often caused by the buildup of thick plaques on the inner walls of the arteries that carry blood to your heart. These plaques narrow the arteries and restrict the heart's blood supply, particularly during exertion.

Aortic dissection: This life-threatening condition involves the main artery leading from your heart (aorta). If the inner layers of this blood vessel separate, blood is forced between the layers and can cause the aorta to rupture.

Pericarditis: This is the inflammation of the sac surrounding your heart. It usually causes sharp pain that gets worse when you breathe in or when you lie down.

Digestive causes

Chest pain can be caused by disorders of the digestive system, including:

Heartburn: This painful, burning sensation behind your breastbone occurs when stomach acid washes up from your stomach into the tube that connects your throat to your stomach (esophagus).

Swallowing disorders: Disorders of the esophagus can make swallowing difficult and even painful.

Gallbladder or pancreas problems: Gallstones or inflammation of your gallbladder or pancreas can cause abdominal pain that radiates to your chest.

Muscle and bone causes

Some types of chest pain are associated with injuries and other problems affecting the structures that make up the chest wall, including:

Costochondritis: In this condition, the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed and painful.

Sore muscles: Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.

Injured ribs: A bruised or broken rib can cause chest pain.

Lung-related causes

Many lung disorders can cause chest pain, including:

Pulmonary embolism: This occurs when a blood clot becomes lodged in a lung (pulmonary) artery, blocking blood flow to lung tissue.

Pleurisy: If the membrane that covers your lungs becomes inflamed, it can cause chest pain that worsens when you inhale or cough.

Collapsed lung: The chest pain associated with a collapsed lung typically begins suddenly and can last for hours, and is generally associated with shortness of breath. A collapsed lung occurs when air leaks into the space between the lung and the ribs.

Pulmonary hypertension: This condition occurs when you have high blood pressure in the arteries carrying blood to the lungs, which can produce chest pain.

Other causes

Chest pain can also be caused by:

Panic attack: If you have periods of intense fear accompanied by chest pain, a rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness and a fear of dying, you may be experiencing a panic attack.

Shingles: Caused by a reactivation of the chickenpox virus, shingles can produce pain and a band of blisters from your back around to your chest wall.

Immediate tests

Some of the first tests your doctor may order include:

Electrocardiogram (ECG): This test records the electrical activity of your heart through electrodes attached to your skin. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that you have had or are having a heart attack.

Blood tests: Your doctor may order blood tests to check for increased levels of certain proteins or enzymes normally found in heart muscle. Damage to heart cells from a heart attack may allow these proteins or enzymes to leak, over a period of hours, into your blood

Chest X-ray: An X-ray of your chest allows doctors to check the condition of your lungs and the size and shape of your heart and major blood vessels. A chest X-ray can also reveal lung problems such as pneumonia or a collapsed lung

Computerized tomography (CT scan): CT scans can spot a blood clot in your lung (pulmonary embolism) or make sure you're not having aortic dissection

Follow-up testing

Depending upon the results from these initial tests, you may need follow-up testing, which may include:

Echocardiogram: An echocardiogram uses sound waves to produce a video image of your heart in motion.

Computerized tomography (CT scan): Different types of CT scans can be used to check your heart arteries for blockages. A CT coronary angiogram can also be done with dye to check your heart and lung arteries for blockages and other problems.

Stress tests: These measure how your heart and blood vessels respond to exertion, which may indicate if your chest pain is heart-related. There are many kinds of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while hooked up to an ECG. Or you may be given a drug intravenously to stimulate your heart in a way similar to exercise.

Coronary catheterization (angiogram): This test helps doctors identify individual arteries to your heart that may be narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, either through your wrist or your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-rays and video.