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arWhat Causes Chest Pain?
Chest pain is a common issue that many people experience at some point in their lives and is often a serious source of concern. Although serious conditions like heart attacks first come to mind when chest pain is felt, there can be many different underlying causes. It is a complex symptom that must be evaluated across a wide range of possibilities from cardiovascular diseases to digestive system issues, musculoskeletal problems, and psychological factors. Therefore, every episode of chest pain should be taken seriously, and a professional medical assessment is crucial to correctly understand the underlying cause.
There is no single answer to the question of why chest pain occurs because this symptom can reflect many conditions originating from different systems in the body. The causes can be generally grouped into a few main categories. The most significant among these are cardiovascular causes. Heart attack and angina pectoris are the most serious and emergency-related causes of chest pain. Such pains are usually described as a pressure, tightness, or heaviness. Myocarditis and pericarditis, which are inflammations of the heart muscle or pericardium, can also cause sharp and stabbing chest pain. The tearing of the main artery, the aorta, manifests as a sudden, intense chest and back pain spreading toward the back.
The lungs are another common source of chest pain. A pulmonary embolism, which is a blockage of the lung artery by a clot, can cause sudden pain that worsens with breathing. Infections such as pleurisy and pneumonia, as well as lung collapse, are also among the causes of chest pain. Especially after viral infections such as COVID, sensitivity in the lungs or pericardium can also lead to this complaint.
Digestive system problems can surprisingly cause chest pain that mimics heart-related pain. Gastroesophageal reflux disease causes a burning sensation in the middle of the chest due to stomach acid flowing back into the esophagus, commonly known as heartburn. Esophageal spasms, gallstones, or gallbladder inflammation can also cause pain that radiates to the chest, back, and shoulders. These causes of chest pain often vary depending on meals or body position.
When we talk about chest wall pain, it generally refers to the structures forming the chest wall, such as muscles, bones, and cartilages. These pains are typically considered less dangerous than heart or lung-related pain, though they are still bothersome and should be evaluated by a doctor. One of the most common causes is costochondritis, which is inflammation of the cartilage connecting the ribs to the breastbone. This condition causes sharp, stabbing pain in the middle or sides of the chest and becomes more sensitive to touch.
Chest muscle pain is another common cause of chest wall pain. Unusual physical activity, lifting heavy objects, intense and prolonged coughing, or sudden movements can strain or tear the intercostal muscles of the chest wall. This pain usually intensifies with movement, deep breathing, coughing, or sneezing. Its location can typically be pinpointed and tends to improve with rest, heat application, or anti-inflammatory medication.
Pain felt in the exact center of the chest, behind the sternum bone, is one of the most common and worrisome types. Since this area is near vital organs such as the heart, esophagus, and main airways, any pain originating here should never be ignored. The most serious potential cause is a heart attack, typically described as a pressure, tightness, or heaviness—as if an elephant is sitting on the chest. This pain can radiate to the left arm, jaw, shoulder, or back and is often accompanied by shortness of breath, cold sweating, and nausea.
Previously mentioned costochondritis often presents with tenderness and pain around the sternum area. The rare but serious aortic dissection, which involves tearing the inner wall of the aorta, causes a sudden, severe pain starting in the center of the chest and spreading to the back. Panic attacks can also cause a feeling of tightness and pain in the center of the chest, leading individuals to fear they are having a heart attack. Hence, all these possibilities must be carefully evaluated by a physician for a proper diagnosis of central chest pain.
Pain in the left side of the chest causes significant fear among people as it is classically associated with heart attacks. Indeed, because the heart is anatomically closer to the left side of the body, pain originating from the heart is commonly felt in this region. Myocardial infarction or angina pectoris is the first suspicion when there is pressure or tightness-type pain on the left side. This pain often radiates to the left arm, shoulder, and jaw. Pericarditis, an inflammation of the pericardium, is also usually felt on the left or central chest and causes sharp, stabbing pain that lessens when leaning forward.
However, the only cause of left-sided chest pain is not the heart. As with general chest pain, other systems can also lead to pain in this area. Conditions affecting the left lung, such as pneumonia, pleurisy, or lung collapse, can cause sharp, stabbing pain that worsens with breathing. Gastrointestinal issues may also cause pain on the left side. Trapped gas in the stomach can compress the part of the colon beneath the spleen, causing pain radiating from the upper left abdomen to the left chest—known as splenic flexure syndrome. Similarly, reflux and esophageal spasms can cause pain on the left side.
Musculoskeletal problems are also significant causes of left-sided chest pain. Strain in the left pectoral muscle, intercostal muscle strain, or injury to a left-side rib can cause localized pain that worsens with movement or touch. These pains are typically sharper and more precisely located than heart-related pain. Ultimately, all left-sided chest pain should be taken seriously, and medical help must be sought until a heart attack is ruled out. On the other hand, pain in the right chest is more commonly related to the right lung, liver, or gallbladder.
The diagnostic process for chest pain must be conducted quickly and systematically due to its potentially serious nature. When a patient presents with chest pain, the first step for the doctor is to take a detailed medical history and perform a physical examination. The doctor will ask about the onset, location, character, duration, frequency, triggers, and relieving factors of the pain. Connections to exertion, food, stress, or posture can provide important diagnostic clues. Risk factors such as age, smoking, diabetes, high blood pressure, high cholesterol, and family history of heart disease should also be considered. In the physical exam, the doctor listens to the heart and lungs, checks blood pressure, and looks for tenderness in the chest wall.
Following the medical history and physical exam, various tests are performed based on the suspected cause. If a heart-related issue is suspected, an electrocardiogram (ECG) is one of the first tests to be done. The ECG records the heart's electrical activity and provides immediate information about heart attacks or arrhythmias. Blood tests are also crucial, especially for cardiac enzymes like troponin, which indicate heart muscle damage.
Imaging techniques are essential for diagnosis. Chest X-rays help detect lung infections, lung collapse, heart enlargement, or rib fractures. CT angiography is the gold standard for diagnosing emergencies like pulmonary embolism or aortic dissection. An echocardiogram (ECHO), which is an ultrasound of the heart, allows for detailed evaluation of the heart's structure, valves, and pumping function. A stress ECG is used to assess the relationship between exercise and pain, and to investigate coronary artery disease. If digestive system problems are suspected, an endoscopy may be used to examine the esophagus and stomach.
Treatment for chest pain is entirely planned based on the underlying cause. The goal is not just to eliminate the symptom—pain—but to treat the actual disease causing the pain. Therefore, an accurate diagnosis is the first and most critical step in effective treatment. Treatment approaches vary widely, ranging from emergency interventions to simple lifestyle changes, depending on the seriousness of the cause. If a heart attack is the reason for the chest pain, treatment begins immediately, and the goal is to reopen the blocked coronary artery as quickly as possible. This is typically achieved with blood thinners, clot-dissolving medications, and emergency angioplasty. For pain caused by coronary artery disease, such as angina pectoris, medications like sublingual nitroglycerin sprays, beta blockers, and calcium channel blockers, along with lifestyle changes, form the foundation of treatment.
Treatment for chest pain caused by digestive system issues is different. For reflux-related pain, medications like antacids to neutralize stomach acid and proton pump inhibitors to reduce acid production are prescribed. Additionally, patients are advised to avoid fatty and spicy foods, refrain from eating right before bedtime, and elevate the head of the bed—among other dietary and lifestyle recommendations. For musculoskeletal chest pain or conditions like costochondritis, the treatment is usually simpler. Pain relievers and anti-inflammatory drugs, rest, and applying heat or cold to the affected area are generally sufficient. Physical therapy can also help strengthen muscles and improve flexibility.
No, not every chest pain indicates a heart attack. In fact, many patients who present to the emergency department with chest pain are found to have musculoskeletal, digestive, or psychological causes. However, because a heart attack is the most serious potential cause, any new, severe, pressure-like chest pain that radiates to the arm or jaw and is accompanied by shortness of breath or cold sweats should be evaluated urgently at a medical facility.
Yes, stress and anxiety are major causes of chest pain. Intense stress can trigger panic attacks. During a panic attack, a person may experience severe chest pain, palpitations, difficulty breathing, trembling, and fear of death—symptoms that mimic a heart attack. Chronic stress can also lead to muscle tension and chest muscle pain or exacerbate conditions like reflux, indirectly causing chest pain.
Right-sided chest pain is more often associated with non-cardiac causes. Pneumonia or pleurisy affecting the right lung, liver issues, gallstones or gallbladder inflammation, musculoskeletal problems, or even shingles can cause pain on the right side. While rare, serious conditions like right-heart involvement or pulmonary embolism can also cause right-sided pain. Whether it's dangerous depends on the underlying cause, and right-sided chest pain should also be investigated by a physician.
Chest pain is very common in children, but unlike adults, it rarely stems from heart problems. Most pediatric chest pain cases are caused by costochondritis, muscle strain, severe coughing, or asthma. Sometimes stress or reflux can also be responsible. However, it is still important for the child to be evaluated by a pediatrician just in case.
Simultaneous chest and back pain can indicate serious conditions. Aortic dissection causes tearing-type pain that starts in the chest and spreads between the shoulder blades. Heart attack pain can also radiate to the back. Additionally, digestive issues like esophageal problems, pancreatitis, or gallbladder disorders can cause both chest and back pain. A more benign cause could be muscle strain involving both the chest and back muscles. In any case, this combination should be taken seriously and assessed medically.
Chest pain after COVID-19, during or following infection, is a known occurrence. It can result from inflammation in the lungs or as part of long COVID syndrome. More rarely, COVID-19 may cause inflammation of the heart muscle or pericardium, both of which can manifest as chest pain. Therefore, if you experience persistent or new chest pain after recovering from COVID-19, it is essential to consult a doctor to check for possible heart or lung complications. Sometimes chest swelling and pain may accompany this inflammatory process.
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