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Having chest pain can be a frightening experience that causes much unwanted anxiety. Of course, there’s no way to have a “relaxed” episode of chest pain. Chest pain scares everyone and it's helpful to be as informed as well. If you have time, besides the comprehensive list below, please also check out our interview with a renowned Harvard professor on ways to differentiate heart attack or normal tightness in chest.
The good news is that most causes of chest pain are not nearly as serious as the pain might suggest. Often, chest pains are a cause of an unresolved anxiety or panic attack disorder, heartburn or gastric distress, GERD, IBS, and other issues.
However, sudden chest pain that comes out of nowhere, when you haven’t eaten recently and have not experienced some type of great physical or mental trauma—especially if the pain is sudden, sharp, recurring and fading, or is accompanied by any numbing of the limbs—then, please, take no chances! Get help!
The following list of chest pain and its possible causes will explain what’s normal and what’s not in terms of chest pain.
First, we’ll look at the more non-life-threatening sources of chest pain, such as heartburn and muscle strains, and we’ll lead up to the more serious sources of chest pain and the symptoms they present that mean “get to a hospital quickly.”
Chest Pain Left Side vs Right Side
The term chest pain can describe pain anywhere in the chest, but one common question with chest pain is if there is a difference between pain in the left side of the chest and the right side of the chest. This is because people typically associate only left side chest pain with a heart attack, as most people known that is where the heart is located.
However, left side chest pain doesn’t always indicate a heart issue. Nor should right side chest pain be ignored. Heart attacks cause pain all over the body—from the right side of the chest, to the left side of the chest and other places on the body, like the jaw.
Chest pain on the right side of the chest rarely signifies a heart issue--but that doesn’t mean that right side chest pain isn’t serious. There are several reasons behind chest pains on right side, some serious and others not as serious such as:
- a bruised or broken rib
- a torn muscle in the chest
- a viral infection
- gall bladder, liver, pancreas, spleen, and lung issues
- pleuritic pain, or inflammation around the lung
- a blood clot in the lung
- digestive issues such as IBS, GERD, or heartburn
But knowing where the pain in your chest is located and explaining this to any doctor or nurse is important because the location of your pain, like upper chest pain, left side chest pain, or right side chest pain, can greatly help your doctor to determine the exact cause behind your chest pain and to resolve your problem quickly, before it becomes a serious health issue.
Low-Risk Causes of Chest Pain
Easily managed with over-the-counter (OTC) medications
1. Anxiety chest pain
Whether you’ve dealt with anxiety most of your life or only have an occasional panic attack, periods of great stress and anxiety can often present in chest pain symptoms.
Anxiety often causes pain and discomfort in the chest as well as a general speeding of the heartbeat. In fact, nearly 25% of patients who report chest pain to their doctors are diagnosed with a panic disorder, which can cause pain in the middle of the chest area.
Of course, this doesn’t mean any chest discomfort should be ignored, as patients with panic disorder and chest pain from stress have higher rates of cardiovascular disease. In fact, if you’ve suffered with panic attacks and/ or an anxiety disorder for many years, your heart could have suffered some trauma or cumulative damage along the way.
As always with chest pain – especially for people with anxiety disorders -- get to a hospital and make sure you’re not having a serious heart event. Often, with serious panic disorders, doctors and/or psychiatrists have the patient keep medicine on hand which may help with symptoms like chest pain with panic attacks.
Fortunately, anxiety and panic disorders are treatable with prescribed medication and therapy, which are both highly effective ways of easing and fully preventing panic attacks as well as making the accompanying chest pain much less frequent.
Sometimes chest pain is caused by inflammation around the ribs. When the cartilage surrounding your ribs becomes inflamed, this can cause chest pain. This condition is called costochondritis and is a fairly normal occurrence of chest pain for many people.
With costochondritis, the pain will feel the same way as it would if you were pressing very hard on your sternum (the bone that runs down the middle of your ribcage).
Costochondritis can be caused by all kinds of daily activities, such as accidents or falls, coughing excessively, vomiting, pulling muscles in the chest during strenuous exercises or sports activities, a car accident (often the air bag inflating hits the sternum and bruises it, causing inflammation there), or some types of arthritis or bursitis.
The main symptom of costochondritis is a sharp pain in the chest wall and ribs that comes and goes. Heavy breathing intensifies the pain typically, along with coughing or sneezing. Most cases of tenderness near the chest bone are diagnosed as costochondritis.
Treatment typically includes hot or cold compresses, a prescription of anti-inflammatory drugs, bed rest and time to heal. Although the condition usually goes away on its own, some severe cases of costochondritis may take several months to fully recover from.
3. Pulled muscle
When a muscle is pulled, over-stressed, or torn, it’s commonly described as a pulled muscle. However, a pulled muscle in the chest area will cause chest pain that some people might mistake for a cardiac event or heart attack.
Pulled muscles can be caused by improper form during exercise, strenuous weight lifting or cardiovascular exercise, or simply moving the wrong way suddenly or sleep in the wrong position all night. Car accidents, falls, and other mishaps can also cause pulled chest muscles.
Often, people in car accidents will pull a muscle in the chest from the pressure of the seat belt or the air bag as their body lurches forward from the force of the accident. This is often not felt till the day or two after the accident and is a common reason people will seek care, even if they did not think they needed to go to the hospital right away.
Weight lifters and athletes can also pull chest muscles, whether they’re boxing, swinging a bat, playing soccer, or throwing a javelin.
Depending on the exact location of the pulled muscle in the body, such as the back or abdominal area, chest pain can sometimes be a symptom of a pulled muscle in the upper body area, which is typically accompanied by stiffness, bruising, and a limited range of movement that causes chest pain when stretching.
If you believe an incident or activity could have caused a chest muscle strain or a pulled chest muscle, and you’re experiencing chest pain because of it, apply ice to minimize swelling and reduce the pain of the strain, and rest as much as possible. If the discomfort hasn’t improved within two days, schedule an appointment with your doctor.
4. Rib bruise
Like a pulled muscle, a bruised rib can cause chest pain. A bruised rib is usually caused by a direct blow to the chest, and although the pain can be quite severe, the condition usually heals on its own. Car accidents, falls, or sports injuries are common culprits of rib bruises.
Symptoms of a rib bruise include pain and tenderness near the injured rib along with chest pain that increases when you breathe deeply, move, or cough. Chest pain after sneezing or coughing can also increase in intensity the more one coughs or sneezes and aggravates the bruise.
Often, rib bruise pain can be relieved with over-the-counter pain medications and ice compresses, but patience is the best treatment, as it typically takes a month for rib cage pain to heal. If this does not improve, especially if you had a trauma that caused the pain and/or are short of breath, be sure to get checked out, as sometimes this indicates an injury to the underlying lung.
Usually managed as an outpatient by your doctor with prescription medication
The same viruses that spread colds can also cause acute bronchitis, but it can also be caused by a bacterial infection or exposure to harsh pollutants, such as smoke, smog, fumes, and vapors from harsh toxins, like industrial cleaning products.
The symptoms of bronchitis include a dry, hacking cough, fatigue, and expelling yellowish, whitish, or greenish sputum (that can be streaked with blood). Bronchitis can also cause shortness of breath, fever, and a feeling of tightness in the chest. This chest tightness combined with a strenuous cough can lead to chest pain.
The chest pain associated with bronchitis is usually mild but coughing will often worsen the pain. Bronchitis can clear up on its own after a few days of rest, but if you’re finding that your cough and other symptoms are getting worse instead of better with time, you need to see a doctor.
If your infection is viral, your doctor can provide you with supportive care to make you feel better as your body fights the infection. If it’s bacterial, antibiotics can help quickly relieve the symptoms of the infection. If your bronchitis continues to return, you might have chronic bronchitis, which requires serious medical attention and monitoring.
Bronchial asthma affects 24.6 million Americans. For most individuals, asthma symptoms are mild and manageable. But often, especially when aggravated by allergies, the event of an asthma exacerbation can be serious.
Asthma attacks can cause wheezing, shortness of breath, coughing, and chest tightness.
If you’ve been diagnosed with asthma and are experiencing chest pain, it could be a symptom of a mild asthma attack. There is no cure for asthma, so it’s important to avoid triggers such as allergens, pollutants, and excessive physical activity.
Everyone with asthma should carry an over-the-counter inhaler with them at all times. If you are having an asthma attack and notice that your chest pain is accompanied by severe difficulty breathing, seek medical attention immediately and use your inhalers as directed by your doctor.
7. A hiatal hernia
A hiatal hernia occurs when some of the stomach pushes through an opening of the diaphragm, which is a muscle that separates the abdomen from the chest. While the exact cause of hiatal hernias isn’t known, it is suspected that weak supporting tissue is the typical cause.
The risk of developing a hiatal hernia increases with age and weight gain. Symptoms are mild for most, but pain in the chest after eating can occur, along with heartburn, esophagus problems, regurgitation, or trouble swallowing.
Various tests are required to diagnose the condition, and treatment may include surgery, medications to control stomach acid, a change in diet, and eating smaller meals – all of which can help ease the pain and discomfort of a hiatal hernia. If these measures fail, surgery can usually correct this.
8. Shingles and chest pain
Shingles is caused by the same virus that causes chickenpox. If you’ve had chickenpox in the past, you’re at risk for developing shingles.
Early symptoms of shingles include burning, tingling, and a numbness in nerve distribution that the varicella virus has been dormant in. If the rash is going to involve one of the dermatomes of the chest, this will often be painful, burn or tingle.
A painful, blistering rash typically follows, This is a red rash with blisters on it, whch ultimately pop, scab and heal. If you feel chest pain that seems to be nerve-related instead of muscle or internally-related, have had chickenpox in the past, and have not been vaccinated against shingles, call your doctor to discuss your options or get to a hospital immediately. Shingles can be very painful if it’s not caught quickly. Luckily, there is a vaccine for adults over age 65 and anti-virals can shorten the duration of symptoms, if caught early enough.
9. GERD /acid reflux and heartburn
Heartburn or GERD can be described as a burning sensation in the chest and behind the breastbone. The sensation can move up and down the throat and often is accompanied by a taste of food or a feeling of burning acid in the throat. This often happens after eating, especially if you eat large meals, consume alcohol with them/smoke and lie down too soon after eating.
Many people confuse this sensation with having a heart attack, since this can be uncomfortable and cause pain in the middle of the chest.
GERD is a common kind of chest pain during pregnancy, so if you’re pregnant and you feel like your heart hurts, speak with your doctor to see if you have GERD.
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Medium-Risk Causes of Chest Pain
May require an ED visit or hospitalization. Precription medication needed usually.
10. Peptic ulcers
A peptic ulcer is a raw area or open sore located in the stomach lining or the first part of the small intestine. When the stomach or intestines can’t protect themselves against strong stomach acids, these ulcers can occur.
The most common symptom of a peptic ulcer is abdominal or chest pain, along with mild nausea, improvement in your pain with eating food/taking anti-acids and heartburn. Weight loss, dark or tarry stools can also occur, but mandate being checked out by a doctor.
A gastroenterologist can perform a test called an upper endoscopy to see if you have a peptic ulcer. This is a common procedure and is usually done with mild sedation to make you comfortable.
Persons diagnosed with peptic ulcers and stomach ulcers are typically advised to avoid drinking alcohol, which greatly irritates the stomach lining, to stop smoking (as nicotine is a toxin which irritates the stomach and gut lining), and to avoid any regular use of NSAIDs, which are known to aggravate ulcers of all kinds. There are powerful anti-acid medications which can allow these to heal as well.
Pneumonia is classified as a respiratory condition. Bacteria, viruses, and fungi can cause an infection in the lung which can progress into pneumonia.
The main symptom of pneumonia is a cough, which is often accompanied by a thick and yellow-colored mucus. Fever typically accompanies pneumonia, along with chills and shortness of breath. Headaches are not uncommon along with a general loss of appetite. A sharp chest pain that gets worse with coughing or when taking a deep breath may also be present.
If pneumonia is caught early on enough, it can be managed and treated with antibiotics.
If you are elderly, have a weak immune system, or have any serious medical conditions, seek medical attention immediately, as pneumonia in the elderly is often fatal and can quickly become a serious, life-or-death situation.
If the heart muscle becomes infected and inflamed, myocarditis could be the cause. Although rare, myocarditis can often lead to severe cardiac issues and even require some people to need a heart transplant.
The symptoms of myocarditis resemble the flu, including fatigue, fever, joint pain, and muscle aches. Chest pain, rapid breathing, fainting, and low urine output are other symptoms of myocarditis. Because of its difficulty to diagnose, a chest x-ray is often necessary to diagnose this uncommon condition.
If you feel as if you have the flu but also have intense, unexplainable chest pain, seek medical care. Treatment could involve antibiotics, steroids, and or NSAID's.
13. Rib fracture
A fractured rib can be the result of an accident, such as a fall or a motor vehicle collision. Prolonged coughing can also fracture a rib, along with repetitive movements or overly intense exercise.
Like other rib injuries, symptoms of a rib fracture include discomfort when breathing deeply, pain while bending or twisting, or a feeling of pressure in the chest or rib area.
Chest pain that is consistent and worsens when breathing or moving could be a sign of a rib fracture. Fractured or broken ribs can heal on their own, but the process can take several months. Pain medication can be used as prescribed or on an as-needed basis.
14. Atrial fibrillation
Atrial fibrillation is a rapid and irregular heart rate that occurs when the heart’s upper chambers beat out of coordination or out of sync with the lower chambers of the heart.
If diagnosed with atrial fibrillation, several treatment options will need to be determined on an individual basis to prevent serious health problems, including lifestyle changes, medications, and possible surgical intervention.
More often than not, those with atrial fibrillation experience no symptoms and only discover their condition during a routine physical exam. But symptoms of atrial fibrillation, sometimes called a-fib, are common and include feelings of lethargy, overall weakness, heart palpitations, dizziness, confusion, difficulty breathing, and sometimes chest pain. This can be easily diagnosed with an EKG by your doctor.
Hospitilization needed, usually not life threatening but could be
15. Coronary artery disease / Angina pectoris
Coronary artery disease, more commonly known as heart disease, is a condition that develops as a result of plaque buildup in the arteries. Symptoms are often mistaken for heartburn or indigestion and include a feeling of heaviness in the chest area, numbness, burning, aching, and pain in the chest. Discomfort is usually felt mostly in the chest area, but it is also common in the left shoulder or arm, neck, or back.
A physical exam is required for diagnosis of coronary heart disease, along with stress tests or heart monitoring. Treatment usually involves lifestyle changes, such as quitting smoking and avoiding high-fat foods, avoiding stressful situations and people, taking prescribed medications, and sometimes surgical procedures.
Chest pain from angina pectoris is due to poor blood flow to the heart. Often this is accompanied by nausea, feeling unwell, sweating, and tightness in the chest and pain in the left arm/jaw. These symptoms indicate poor blood flow to the heart. If you have had this before and been evaluated by your doctor, you should rest and take the nitroglycerin that you have been given. If this is a new sensation, then you need immediate medical care, as this could be a heart attack.
16. Hypertrophic cardiomyopathy
When part of the heart becomes thicker than the rest, the condition is called hypertrophic cardiomyopathy. The condition makes it harder for the heart to pump blood throughout the body. It is usually inherited, and while the condition can affect persons of any age, younger patients typically have more severe forms of the condition. Often this is familial or noted when an athlete suddenly collapses and has a cardiac arrest. Some municipalities now screen athletes for this with echocardiography.
While some people with hypertrophic cardiomyopathy experience no symptoms, others may experience dizziness, fainting during strenuous activities, chest pain while running or exercising, palpitations, and shortness of breath upon waking.
Medications are often used to regulate the heart’s rhythm, and blood thinners are used to lower the risk for blood clots. Pacemakers are sometimes inserted to treat the condition as well.
Hypertrophic cardiomyopathy can develop suddenly in any location of heart tissue, so it’s best to seek medical attention if you experience fainting after exercise or unexplained symptoms.
17. Lung abscess
A lung abscess is a very rare condition, thanks to today’s medical treatments, as it is typically a result of a severe infection from pneumonia or tuberculosis.
With a lung abscess, a cavity develops in the lungs and fills with pus. Symptoms include a fever, loss of appetite, an overall sick feeling for several weeks or months, clubbing of the fingers, a bluish skin color, and chest pain. If diagnosed through cultures, scans, or chest x-rays, a lung infection and abscess are treated with antibiotics, mucus draining, and, if the abscess doesn’t respond, surgery.
High-Risk Causes of Chest Pain
Life threatening and death is possible. Intensive Care Unit (ICU) care often needed.
18. Lung cancer
Lung cancer is a deadly and fast-moving cancer . A persistent and lingering cough is typically the first symptom. Other common symptoms of lung cancer are loss of appetite, trouble breathing, wheezing, weight loss and fatigue.
Chest pain isn’t as common a symptom of lung cancer as the others we have listed here, but if you’re a smoker and you are experiencing chest pain that worsens when you cough or laugh, along with any of the previously mentioned symptoms, schedule an exam with your doctor as soon as possible.
19. Heart attack
This is when blood flow to part of the heart is cut off, usually from a plaque rupture in a coronary artery. This can lead to varying degrees of chest pain or tightness, shortness of breath, nausea, sweating and feeling unwell. Unfortunately, the symptoms can be quite variable and in some cases even mild or ignored!
If you have chest pain and have never had it before, especially with shortness of breath or pain radiating to your arm, back or jaw, you must call 911 and assume you are having a heart attack. The emergency department doctors can figure out what is wrong, but you must immediately seek care.
20. Aortic dissection
An aortic dissection occurs when the large blood vessel coming off from the heart tears. As blood rushes through the tear, other layers of heart tissue can begin to separate. If the blood ruptures through the aortic wall, the condition can become fatal.
Aortic dissections are rare but when they do occur, they most frequently affect men in their 60s and 70s who are smokers and have high blood pressure.
Symptoms of an aortic dissection include chest pain that is severe enough to knock the wind out of you. The pain is sudden and feels like a tearing sensation. The pain radiates down the back, and fainting is common.
If you experience
- severe pain
- pain radiating from the chest and down the back
- a feeling as if the wind has been knocked out of you
- difficulty speaking, seeing, and focusing combined with chest pain
seek medical attention immediately. Surgery is often required, along with medication to prevent additional tearing.
Chest trauma is often the cause of a hemothorax, which is a pooling of blood between the lung and chest wall. This condition can also occur in those with a blood clotting condition, lung cancer, or tuberculosis.
The symptoms of a hemothorax include anxiety, low blood pressure, rapid heart rate, difficulty breathing, and chest pain. It is important you seek medical attention if you are experiencing any kinds of these symptoms, especially after an injury, such as a car accident or fall.
A chest x-ray and CT scan are often needed for diagnosis. Treatment often involves inserting a chest tube to drain the blood and re-expand the lung. Surgery is sometimes required.
The term “pneumothorax” is the medical term for a collapsed lung, which occurs when the amount of air between the lung and chest wall increases. This is usually very painful.
Once collapsed, the lung is unable to expand as you try to breathe, leading to difficulty breathing and severe chest and lung pain. The condition can occur suddenly and without warning and is also known as a spontaneous pneumothorax. More often, this occurs after trauma where a rib is fractured or a direct penetrating chest injury occurs, such as a gunshot wound or stabbing.
A collapsed lung or pneumothorax may result from an injury or can occur because of an illness, such as pneumonia. Pneumothoraxes can vary in severity, with mild cases barely displaying symptoms and severe cases causing debilitating pain, similar to a broken rib or punctured lung. A chest x-ray is needed to diagnose the condition, and treatment includes simple observation, oxygen, to placement of a chest tube. An operation can be done to prevent a future collapse, if this occurs spontaneously.
23. Pulmonary embolism
A pulmonary embolism occurs when there is occlusion of one of the pulmonary veins. Usually this is with a clot, often from the deep veins in the legs and pelvis, but can come from air, fat, amniotic fluid and even surgical devices – the latter are almost always the consequence of a surgical or iatrogenic event.
If you feel short of breath, are experiencing intense chest pain that worsens when you breathe deeply, move, or cough, and have a cough that produces pink, foamy mucus known as bloody sputum, seek immediate medical attention. This is especially true in those with a history of a DVT, recent travel/immobility/trauma/surgery and in those who are pregnant.
Treatment for pulmonary embolisms includes dissolving the blood clot medically or removing it surgically. Follow-up treatment involves the use of blood thinning medication to prevent another episode.
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