Chest pain has many possible causes, all of which deserve medical
attention. The causes of chest pain fall into two major categories
cardiac and noncardiac causes.
A heart attack a blood clot that's blocking blood flow to your
heart muscle can cause pressure, fullness, or a squeezing or
crushing pain in your chest that lasts more than a few minutes. The
pain may radiate to your back, neck, jaw, shoulders and arms,
especially your left arm. Other signs and symptoms may include
shortness of breath, sweating, dizziness and nausea. All, some or
none of these may accompany your chest pain.
Fatty deposits can build up in the arteries that carry blood to your
heart, narrowing them and temporarily restricting blood flow to your
heart, especially during times of exertion. Restricted blood flow to
your heart can cause recurrent episodes of chest pain angina
pectoris, or angina. Angina is often
described as a pressure or tightness in the chest. It's usually
brought on by physical or emotional stress. The pain usually goes
away within minutes after you stop the stressful activity.
Other cardiac causes.
Other problems that can cause chest pain include inflammation of the
sac surrounding your heart (pericarditis), a short-lived condition
often related to a viral infection. Pericarditis causes sharp,
piercing and centralized chest pain. You may also have a fever and
feel sick. A rare, life-threatening cause of chest pain called
aortic dissection involves the main artery leading from your heart
your aorta. If the inner layers of this blood vessel separate,
forcing blood flow between them, the result is sudden and tearing
chest and back pain. Aortic dissection can result from a sharp blow
to your chest or develop as a complication of uncontrolled high
blood pressure. Coronary spasm, also known as Prinzmetal's angina,
can cause varying degrees of chest discomfort. In coronary spasm,
coronary arteries arteries that supply blood to the heart go
into spasm, temporarily closing down blood flow to the heart. Spasm
of the coronary arteries may occur spontaneously or be triggered by
a stimulant, such as nicotine or caffeine. Coronary artery spasm,
which tends to cause episodes of chest pain, can occur with activity
or at rest. A spasm may even wake you from sleep. The condition may
coexist with coronary artery disease the buildup of fatty deposits
in the coronary arteries. Other possible heart-related conditions
that can cause chest pain are syndrome X and endothelial
Many conditions unrelated to your heart can cause chest pain. These
Stomach acid that washes up from your stomach into the tube
(esophagus) that runs from your mouth to your stomach can cause
heartburn a painful, burning sensation behind your breastbone
(sternum). Often this feeling is accompanied by a sour taste and the
sensation of food re-entering your mouth (regurgitation).
Heartburn-related chest pain usually follows a meal and may last for
hours. Signs and symptoms occur more frequently when you bend
forward at the waist or lie down.
If you experience periods of intense fear accompanied by chest pain,
rapid heartbeat, rapid breathing (hyperventilation), profuse
sweating and shortness of breath, you may be experiencing a panic
attack a form of anxiety.
Sharp, localized chest pain that's made worse when you inhale or
cough may be caused by pleurisy. This condition occurs when the
membrane that lines your chest cavity and covers your lungs becomes
inflamed. Pleurisy may result from a wide variety of underlying
conditions, including pneumonia and, rarely, autoimmune conditions
such as lupus. An autoimmune disease is one in which your body's
immune system mistakenly attacks healthy tissue.
In this condition also known as Tietze's syndrome the cartilage
of your rib cage, particularly the cartilage that joins your ribs to
your breastbone, becomes inflamed. The pain from costochondritis
may occur suddenly and be intense, leading you to assume you're
having a heart attack. Yet the location of the pain is different. Costochondritis causes your chest to hurt when you push on your
sternum or on the ribs near your sternum. Heart attack pain is
usually more widespread, and the chest wall usually isn't tender.
This condition occurs when a blood clot becomes lodged in a lung
artery, blocking blood flow to lung tissue. Symptoms of this
life-threatening condition can include sudden, sharp chest pain that
begins or worsens with a deep breath or cough. Other signs and
symptoms can include shortness of breath, rapid heartbeat, anxiety
and faintness. It's rare for pulmonary embolism to occur without
preceding risk factors, such as recent surgery or immobilization.
Other lung conditions.
A collapsed lung (pneumothorax), high blood pressure in the arteries
carrying blood to the lungs (pulmonary hypertension) and asthma also
can produce chest pain.
Muscle-related chest pain tends to come on when you twist side to
side or when you raise your arms. Chronic pain syndromes, such as
fibromyalgia, can produce persistent muscle-related chest pain.
Injured ribs or pinched nerves.
A bruised or broken rib, as well as a pinched nerve, can cause chest
pain that tends to be localized and sharp.
Several disorders of the esophagus, the tube that runs from your
mouth to your stomach, can make swallowing difficult and even
painful. One type is esophageal spasm, a condition that affects a
small group of people with chest pain. When people with this
condition swallow, the muscles that normally move food down the
esophagus are uncoordinated. This results in painful muscle spasms.
Because esophageal spasms can be calmed with the medication
nitroglycerin which also rapidly relieves some heart-related pain
this condition is sometimes mistaken for a heart problem. Another
swallowing disorder, which also affects a small group of people with
chest pain, is achalasia. In this condition, the
valve in the lower esophagus doesn't open properly to allow food to
enter your stomach. Instead, food backs up into the esophagus,
causing pain. Pain with swallowing also can accompany heartburn.
This infection of nerves caused by the chickenpox virus can produce
pain and a band of blisters on your back around to your chest wall.
This sharp, burning pain may begin several hours to a day or so
before blisters appear.
Gallbladder or pancreas problems.
Gallstones or inflammation of your gallbladder (cholecystitis) or
pancreas can cause acute abdominal pain that radiates to your chest.
Rarely, cancer involving the chest or cancer that has spread from
another part of the body can cause chest pain.
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