Chest pain

Page last reviewed: 13/07/2011

Chest pain is any sort of pain felt in your upper body, from your shoulders down to your ribs.

Although it can be a symptom of many conditions, chest pain must be taken seriously as it could mean you are having a heart attack.

This information should not be used to self-diagnose your condition, but should give you an idea of what is causing your chest pain and whether you need to get emergency help or see your GP. It does not include every possible cause, but describes the most common reasons for chest pain.

When to get help

Pain in your chest could be heart pain if:

  • Your chest pain is triggered by physical activity and relieved by rest.
  • Your chest pain feels heavy, pressing or tight.
  • You have other symptoms, such as breathlessness, nausea, sweating or pain that spreads to your arm.
  • You have a risk factor for heart disease (see box, left).

Could it be a heart attack?

If your chest pain is triggered by physical activity but passes a few minutes after you stop exercising, it may be angina. The chest pain or tightness may spread from your chest to your left arm, neck and back.

Angina is caused by restricted blood flow to the heart. This is because one or more of the three arteries supplying blood to the heart muscle has narrowed. It causes pain because the heart does not get enough oxygen.

If you have the symptoms above but the pain lasts for more than 15-20 minutes, you could be having a heart attack. A heart attack can feel as if your chest is being pressed or squeezed by a heavy object.

The differences between angina and a heart attack are: 

  • Angina is brief, usually brought on by physical effort and relatively mild.
  • Discomfort from a heart attack continues despite medication (glyceryl trinitrate spray, which gives immediate relief from the symptoms of angina). It often occurs at rest or during sleep, is severe and can be accompanied by other symptoms, such as sweating.

If you think you could be having a heart attack, call 999 immediately and ask for an ambulance. Do not worry if you have any doubts about whether it is a heart attack. Paramedics would prefer to be called out to find that an honest mistake has been made than to be called out when it is too late to save a person's life.

Common causes of chest pain

Most chest pain is not caused by conditions as serious as heart problems. The most common causes of chest pain include:

  • heartburn and gastro-oesophageal reflux disease, where stomach acid leaks from the stomach and up into the oesophagus, the tube that runs from the mouth to the stomach 
  • anxiety 
  • a pulled muscle
  • chest wall pain

The guide below should give you an idea of whether these conditions are causing your chest pain. However, see your GP for a proper diagnosis and for advice about how to relieve the pain and tackle any underlying cause.

Your chest pain gets worse when you lie down

Pain in your chest that gets worse when you lie down is probably not heart disease. It is likely to be heartburn caused by acid leaking from your stomach and into your oesophagus. This is very common and known as heartburn and gastro-oesophageal reflux disease (GORD). It can easily be treated by changing your lifestyle and, if necessary, using medication.

Your chest feels tender

If you have tenderness in the chest as well as chest pain, it could have several causes.

Chest pain and tenderness without any swelling may be the result of a pulled muscle in the chest wall, which can be surprisingly painful. The pain eases with rest, and the muscle will heal with time.

If you have pain, swelling and tenderness over the ribs and around the breastbone, the problem may be inflammation in the chest wall. It usually improves on its own after a few weeks.

If you think your chest pain may have another cause, you could have anxiety. As well as making you feel worried or "on edge", anxiety may also cause physical symptoms such as chest pain, shortness of breath and heart palpitations. If your GP diagnoses anxiety as the cause of your chest pain, they will talk to you about psychological treatment for this, such as cognitive behavioural therapy.

Less common causes

Less commonly, chest pain may be caused by any of the conditions below. See your GP if you think you have one of these.

Pleurisy

Pleurisy is inflammation of the double-layered membrane that surrounds the lungs. The two layers rub against each other, causing a sharp, stabbing chest pain that gets worse when you breathe in.

The pain of pleurisy is often relieved when you take shallow breaths. The pain may be managed with ibuprofen while your GP investigates the underlying cause of your pleurisy.

Shingles

Shingles is an infection of a nerve and the area of skin around it. It is caused by the herpes varicella-zoster virus, which also causes chickenpox.

Shingles is fairly easy to diagnose as it causes a distinctive rash on your body as well as pain in your chest or tummy, although the rash may not appear until 24 hours after the pain has started.

Your GP can advise you on how to manage the symptoms and recommend a suitable painkiller.

Mastitis

Mastitis is pain and swelling of the breast tissue, usually caused by breastfeeding or an infection. Antibiotics will clear any infection. Otherwise, it should improve if you change your breastfeeding technique. Your GP or midwife will advise you.

Risk factors for heart disease

You have a higher risk of angina or a heart attack if you:

  • are a smoker
  • have a family history of premature heart disease
  • have diabetes, high blood pressure or high cholesterol
  • are obese

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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