When Should You Be Concerned About Chest Pain?

You should be concerned about chest pain if you have severe pain, pressure, crushing, or squeezing in the chest that lasts more than a few minutes, pain that moves into the neck, left shoulder, arm, or jaw, or pain associated with breaking out in a sweat or feeling like you are going to pass out. Call 911 right away if this describes your chest pain.

Chest pain is a symptom of many different conditions, some of which can be life-threatening. Chest pain may be felt in any part of the chest, including the heart, lungs, muscle, bone, esophagus, and skin. In some cases, chest pain may originate in another part of the body such as the stomach or other abdominal organs and radiate to the chest.

Symptoms of chest pain may vary depending on the cause. 

Symptoms of chest pain caused by a heart attack include: 

• Pain on the mid to left side of the chest that may also extend to the left shoulder or arm, jaw, stomach, or back
• Other symptoms that may accompany a heart attack include shortness of breath, increased sweating, nausea, and vomiting
• Women may also experience abdominal pain or discomfort, heartburn, lightheadedness, dizziness, or unusual fatigue 

Symptoms of chest pain caused by angina include: 

• Symptoms similar to heart attack pain
• Symptoms occur with physical exertion and are relieved by rest
• May be life-threatening if pain occurs at rest or increases in frequency or intensity

Symptoms of chest pain caused by aortic dissection include: 

• Pain occurs suddenly and is described as "ripping" or "tearing"
• Pain may radiate to the back or between the shoulder blades
• Other symptoms that may accompany aortic dissection include shortness of breath, fainting, abdominal pain, or symptoms of stroke

Symptoms of chest pain caused by pulmonary embolism (PE) include: 

• Sudden onset of shortness of breath, fast breathing, and sharp pain in the middle of the chest, which increases with deep breaths

Symptoms of chest pain caused by pneumothorax include: 

• Sudden onset of shortness of breath, sharp chest pain, fast heart rate, and dizziness, light-headedness, or faintness

Symptoms of chest pain caused by pericarditis include: 

• Sharp or stabbing pain in the middle of the chest, that is worsened by deep breaths
• Pain may resemble the pain of a heart attack, and may radiate to the left side of the back or shoulder
• Pain is worsened by lying flat and gets better when leaning forward
• A recent cold, fever, shortness of breath, or pain when swallowing may occur just before developing pericarditis

Symptoms of chest pain caused by mitral valve prolapse include: 

• Often there are no symptoms
• When they do occur, symptoms may include palpitations and chest pain
• Pain is sharp, does not radiate, and is not related to physical exertion
• Other symptoms that may accompany mitral valve prolapse include fatigue, light-headedness, and shortness of breath

Symptoms of chest pain caused by pneumonia include: 

• Pain occurs during prolonged or forceful coughing
• Other symptoms that may accompany pneumonia include fever, coughing up sputum, and shortness of breath

Symptoms of chest pain originating from the esophagus include: 

• Symptoms of gastroesophageal reflux disease (GERD) include heartburn, painful swallowing, excessive salivation, dull chest discomfort, chest pressure, severe squeezing pain across the mid chest, sore throat, sour or bitter taste in the mouth or throat, hoarseness, and persistent dry cough
• Symptoms of esophagitis include chest pain that comes on suddenly, difficulty swallowing, painful swallowing, or symptoms of GERD
• Symptoms of esophageal spasm usually include intermittent and dull pain in the mid-chest that may radiate to the back, neck, or shoulders

Potentially life-threatening causes of chest pain include:

• Heart attack (acute myocardial infarction)
• Angina
• Aortic dissection
• Blood clot in the lungs (pulmonary embolism)
• Collapsed lung (pneumothorax)
• Perforated viscus
• Cocaine-induced chest pain

Causes of chest pain that are not immediately life threatening include:

• Inflammation of the lining of the heart (acute pericarditis)
• Mitral valve prolapse
• Pneumonia
• Disorders of the esophagus
  • Gastroesophageal reflux disease, or GERD) 
  • Esophagitis 
  • Esophageal spasm 
• Costochondritis
• Shingles (herpes zoster)

You should be concerned about chest pain if you have severe pain, pressure, crushing, or squeezing in the chest that lasts more than a few minutes, pain that moves into the neck, left shoulder, arm, or jaw, or pain associated with breaking out in a sweat or feeling like you are going to pass out. This can be a medical emergency. Call 911 and go immediately to a hospital’s emergency department. Do not drive yourself. 

In a hospital’s emergency department, doctors will take a history and do a physical exam. 

Tests used to diagnose the cause of chest pain include: 

• Electrocardiogram (ECG or EKG)
• Echocardiogram (“echo”)
• Blood tests 
• Cardiac enzymes
• Oxygen levels and other blood gases
• Stress test
• Cardiac catheterization 
• Chest X-ray
• Transesophageal echocardiography 
• Ventilation-perfusion scan (V/Q scan) 
• Computerized tomography (CT) scan of the lungs 

Treatment for chest pain depends on the cause. 

• Heart attack (acute myocardial infarction)
  • Medicines such as aspirin, heparin, and thrombolytic drugs to increase blood flow by opening arteries blocked or narrowed by a blood clot
  • Other medications may be used to slow the heart rate
  • Surgery: angioplasty or cardiac bypass
• Angina
  • Nitroglycerin to dilate coronary arteries
• Aortic dissection
  • Medications to reduce blood pressure
  • Surgical repair for dissections that involve the ascending (upward) portion of the aorta
• Blood clot in the lungs (pulmonary embolism)
  • If a pulmonary embolism is known or suspected, patients are admitted to the hospital
  • Supplemental oxygen and medication to prevent blood clots (anticoagulants)
  • Surgery may be required to place a filter in a blood vessel to prevent blood clots in the lower extremities from moving to the lungs
• Collapsed lung (pneumothorax)
  • If there are no symptoms: patients usually need six hours of hospital observation and repeat chest X-rays
  • If there are symptoms: catheter aspiration or chest tube insertion is performed 
• Inflammation of the lining of the heart (acute pericarditis)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin)
• Pneumonia
  • Antibiotics
  • Pain medications 
• Disorders of the esophagus
  • Antacid therapy
  • Antibiotics, antivirals, or antifungals 
  • Medications to relax the muscles of the esophagus
• Costochondritis
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin)