Chest Pain: Causes, and When It Is an Emergency

When to stop reading and get help

The features that should send you in immediately, rather than to an appointment:

• Pain that is severe, crushing, or feels like a heavy band across the chest
• Pain lasting more than a few minutes, or coming on at rest
• Sweating, nausea or vomiting alongside the pain
• Breathlessness, or feeling faint
• Pain radiating to the arm, jaw, neck, back or upper abdomen
• Chest pain in anyone with diabetes, known heart disease, or several risk factors

Cardiac causes

Angina is chest pressure caused by narrowed coronary arteries. It classically comes on with exertion — walking uphill, climbing stairs, hurrying — and eases within minutes of stopping. Angina that is new, or now occurs at rest, needs prompt assessment.

Heart attack pain is usually more severe, lasts longer, and does not settle with rest. See heart attack symptoms.

Other cardiac causes include inflammation around the heart and problems with the aorta, which can cause sudden severe pain radiating to the back.

Acidity and digestive causes

Reflux is genuinely one of the commonest causes of chest pain, and it can be indistinguishable from cardiac pain without testing. It tends to be burning, worse lying flat or after a heavy meal, and sometimes comes with an acid taste.

Gallstones, spasm of the food pipe and stomach ulcers also cause upper chest and abdominal pain. Our gastroenterology department assesses these.

The trap: acidity and cardiac pain overlap heavily, and plenty of heart attacks have been treated at home with an antacid.

Muscular and skeletal causes

Pain from the chest wall — muscles, ribs, the joints where ribs meet the breastbone — is common and usually harmless. Distinguishing features:

• It is reproducible when you press on the spot
• It is worse with particular movements, twisting or deep breathing
• It often follows unusual exertion, coughing, or an awkward night's sleep
• It is sharp and well-localised rather than a diffuse heaviness

Lung causes

Pneumonia, pleurisy and other lung problems typically cause pain that is sharper on breathing in, often with cough or fever. A clot in the lung causes sudden breathlessness with chest pain and is a medical emergency. Our pulmonology department covers respiratory causes.

Anxiety and panic

Panic attacks cause genuine, frightening chest tightness, along with palpitations, breathlessness, tingling in the hands and a sense of impending doom. The symptoms are real, not imagined.

But anxiety is a diagnosis to reach after considering the alternatives, particularly in anyone with cardiac risk factors. Being told "it is just stress" without an examination is not a diagnosis.

Why "just gas" is a dangerous assumption

It is the most common self-diagnosis for chest pain in India, and it is often right. The problem is what happens on the occasions it is wrong: hours lost, heart muscle lost.

An ECG takes a few minutes and is inexpensive. If your chest pain has any of the features in the box at the top of this page, get one — and let a doctor tell you it was acidity.