Chest pain is quite common, affecting 20-40% of the general population during their lifetime. It can be as a result of various causes, most of which aren’t life-threatening.
However, since chest pain can be an indicator of a serious condition, such as heart or lung conditions, you should seek medical help.
Pleurisy and Pleuritic Chest Pain
Pleurisy is the inflammation of the pleura, the two thin tissue layers that separate your lungs from your chest wall. One layer lines the inside of your chest cavity while the other wraps around your lungs.
The main symptom of pleurisy is a sharp chest pain that doctors call pleuritic chest pain, which can occur on one or both sides of your chest and even spread to your shoulders or back.
Usually, when you breathe, the pleural layers glide past each other smoothly. But when the membranes become inflamed, their surfaces roughen, causing them to rub painfully against each other when you inhale and exhale.
The pain tends to worsen when you breathe, cough, sneeze, or laugh. Taking shallow breaths can help ease pleuritic chest pain.
Other Causes of Chest Pain
Besides pleurisy, chest pain has many other potential causes, which include:
- Pneumonia. A bacterial, viral, or fungal infection that inflames the air sacs in one or both of your lungs and whose symptoms include sharp pain in the chest.
- Tuberculosis. An infectious bacterial disease that mostly affects the lungs. If infected, you may experience a cough, pain in the chest, night sweats, loss of appetite, among other symptoms.
- Lung cancer. Cancer that begins in the lungs and which may cause pain in your chest, back, or shoulders.
- Pulmonary embolism. A potentially life-threatening condition where a blood clot gets clogged in an artery in your lung, blocking blood flow to part of the lung. A PE can cause shortness of breath and chest pain.
- Pneumothorax. The medical term for a collapsed lung, which occurs when air leaks into your pleural cavity. Pneumothorax can cause sudden sharp chest pain that gets worse when inhaling or with deep breathing.
- Heart attack (myocardial infarction). A condition caused by a blockage of blood to your heart, causing the heart muscles to begin to die. Chest pain or discomfort is the most common sign of a heart attack in both men and women.
- Pericarditis. The inflammation of the pericardium, i.e., the double-walled sac surrounding the heart. The condition typically causes a stabbing chest pain that worsens when you breathe or lie down.
- Aortic dissection. A life-threatening condition that occurs when the inner layer of the aorta tears. Blood forces its way through the tear, causing the inner and middle layers of the aorta to separate (dissect). When dissection occurs, you feel a sudden, severe, tearing pain in your chest or upper back. Aortic dissection can be fatal from causing aortic rupture or decreased blood flow to organs, including the heart.
- Angina. Chest pain or discomfort that occurs due to reduced blood flow to the heart. Angina may feel like squeezing, tightness, or pressure in the chest.
- Heartburn. A burning sensation in your chest caused by acid reflux.
- Esophageal swallowing disorders. These include dysphagia (difficulty swallowing) and odynophagia (painful swallowing).
- Gallbladder and pancreas problems. Pancreatitis, cholecystitis, and gallstones can cause upper abdominal pain that radiates to your chest.
- Broken or bruised ribs. Rib fractures are often a result of chest trauma, such as from a fall or motor vehicle accident. Symptoms include chest pain that worsens when taking a deep breath, moving, your body or pressing on the affected area.
- Costochondritis. An inflammation of the cartilage that joins your ribs to your sternum (breast bone) that is accompanied by chest or rib pain. The pain can range from mild to severe and usually gets worse with deep breathing and coughing.
- Muscle pull or strain. A pulled chest muscle may cause a sharp pain in your chest that gets better with rest.
- Panic attack. A sudden episode of intense fear that triggers several physical reactions such as chest pain, rapid breathing, rapid heartbeat, profuse sweating, nausea, among others.
- Shingles (herpes zoster). A viral infection caused by the reactivation of the chickenpox virus in your nerve tissues. Shingles cause a painful rash that often appears as a stripe of blisters on either side of your torso ( chest, back, or abdomen). Usually, sharp, stabbing pain in the affected skin area precedes the rash.
Symptoms of Chest Pain
People experience chest pain in various forms depending on its cause. It may be:
- Crushing, squeezing, or tightening
The pain may spread to your neck, jaw, shoulder, back, or both arms. Lying down, breathing deeply, and coughing may worsen some types of chest pain, such as that caused by pleurisy and pericarditis.
Symptoms of heart-related chest pain
While chest pain is often associated with heart problems, especially a heart attack, many people with a heart condition describe the feeling as discomfort rather than pain. Chest discomfort associated with heart disease may be described as or accompanied by:
- Chest pressure, tightness, or heaviness
- Crushing pain that spreads to your jaw, neck, shoulders, back, and arms
- Pain that lasts more than 15 minutes, gets worse with exertion, comes and goes, or varies in intensity
- Shortness of breath
- Cold sweats
Symptoms of other types of chest pain
Chest pain is less likely due to a heart condition if you have:
- A sour taste in your mouth
- Difficulty swallowing
- Pain that gets better or worse when you change your body position
- Pain that worsens with deep breathing or coughing
- Pain that persists for many hours
- Fever or body chills
- Feelings of panic or anxiety
Your doctor will run various tests to diagnose or rule out heart-related problems. These include:
- Electrocardiogram (ECG/EKG): records your heart’s electrical activity.
- Blood tests: to measure protein and enzyme levels in your blood.
- Chest X-ray: to examine your heart, lungs, and major blood vessels.
- Computed tomography (CT) scan: shows more details of your internal organs, bones, soft tissue, and blood vessels than a regular x-ray.
- Echocardiogram: produces live images of your heart.
- Angiogram: helps identify any blockage in or narrowing of your coronary arteries.
- Stress tests: show how your heart performs during physical activity.
Treatment for chest pain depends on what’s causing it and may include:
- Artery relaxers: such as nitroglycerin, which relaxes and widens heart arteries
- Thrombolytic drugs: clot-busting drugs
- Blood thinners: slow down your body’s process of forming clots
- Antacids: to ease the symptoms of acid reflux and GERD
- Antidepressants: to help control the symptoms of a panic attack
- Antibiotics: used to treat bacterial pneumonia and drug-resistant TB
- Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen and aspirin): helps reduce pain and inflammation
Surgical and other procedures
- Bypass surgery: to create an alternative route for blood to go around a blocked artery
- Angioplasty and stent replacement: to widen a narrowed or blocked artery
- Aortic dissection repair: emergency surgery (open-heart surgery or endovascular) may be required to repair the damaged aorta and prevent death
- Lung reinflation: doctors insert a tube in your chest to reinflate a collapsed lung
Chest pain can be a symptom of various life-threatening conditions. And heart-related conditions, such as heart attack and aortic dissection, pose the most immediate threat to your life.
Maintaining a healthy lifestyle, such as eating healthy, exercising regularly, quitting smoking, keeping a healthy body weight, drinking in moderation, and reducing stress can lower your risk of heart disease.References ⌵
- Mayo clinic Staff, Chest pain symptoms and causes, December 2017
- Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85(6):572-93. doi:10.4065/mcp.2010.0046
- Damielle M.,Alana B.,Why Am I Having Chest Pain? November,2019
- Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012;4:31-52. doi:10.2147/OAEM.S29942
- David R.,Gerhard W., What could cause chest pain? January 2020
- James B., What’s Causing My Chest Pain? March 2019