Chest Pain: 10 Common Causes and When to See a Doctor

Chest Pain: 10 Common Causes and When to See a Doctor

Chest pain is one of the most common reasons people visit A&E (or ER in US). Whilst many people immediately associate it with a heart attack, the reality is that chest discomfort has many causes—ranging from harmless indigestion to life-threatening emergencies.

Understanding the different causes of chest pain and recognizing the ‘red flags’ can help you stay calm and take the right action.

10 Common Causes of Chest Pain

1. Gastro-oesophageal Reflux Disease (GORD)

Commonly known as heartburn, GORD occurs when stomach acid flows back into the esophagus. This often causes a burning sensation in the chest, typically after eating or when lying down.

2. Muscle Strain or Chest Wall Pain

Straining the muscles between your ribs (intercostal muscles) or the chest wall can cause sharp or dull pain. This is often triggered by heavy lifting, a persistent cough, or strenuous exercise. The pain usually feels worse when you move or breathe deeply.

3. Anxiety and Panic Attacks

A panic attack can mimic a heart attack. Symptoms often include a rapid heart rate, sweating, trembling, and a feeling of intense tightness or “suffocating” in the chest.

4.  Angina (Myocardial Ischaemia)

• Angina is (a usually rapid) chest pain caused by a temporary reduced blood flow to the heart muscle. It often feels like pressure, squeezing, or heaviness, and spreads (radiates to the left arm, neck or back).
• It is often secondary to exercise and is relieved (wthin 10 minutes) by rest.
• Whilst it isn’t a heart attack, it is a warning sign that you are at risk for one.

5. Heart Attack (Myocardial Infarction)

• Unlike angina, which is temporary, a myocardial infarction occurs when blood flow to the heart muscle is completely blocked, causing permanent tissue damage.
• The pain is similar to angina (e.g. rapid onset), but unlike angina, it lasts more than 10 minutes and does not subside with rest. It is often linked to nausea, vomiting and sweating.
• A heart attack is a life-threatening medical emergency that requires immediate intervention to restore blood flow.

6. Pericarditis

This is the inflammation of the sac surrounding the heart (the pericardium). The pain is typically sharp and gets worse when you take a deep breath, move or lie flat, but it often improves when you lean forward.

7. Pneumonia or Pleurisy

Lung infections like pneumonia or inflammation of the lung lining (pleurisy) can cause ‘pleuritic’ chest pain—a sharp pain that occurs specifically when you inhale or cough.

8. Gallstones or Gallbladder Issues

Inflammation of the gallbladder or gallstones can cause pain that radiates to the right side of the chest or the back between the shoulder blades, usually after a fatty meal.

9. Shingles

This is caused by the varicella-zoster (VZV; chickenpox) virus. Before the characteristic rash appears, shingles can cause a sharp, burning, or tingling band of pain across one side of the chest.

10. Pulmonary Embolism (PE)

A PE is a blood clot in the lung. This is a medical emergency. It usually causes rapid shortness of breath and sharp chest pain that worsens with breathing.

Other causes of chest pain

Aortic Dissection

• An aortic dissection is a life-threatening emergency that occurs when a tear develops in the inner layer of the body’s main artery, the aorta, causing blood to surge between the layers of the vessel wall.
• It typically presents as a sudden, excruciating “tearing” or “ripping” sensation in the chest (spreading into the back) or back, distinguishing it from the pressure-like pain of a heart attack.
• It requires urgent surgery at the nearest cardio-thoracic surgical centre,

Costochondritis

This is rare. It is an inflammation of the cartilage that connects your ribs to your breastbone. It causes a sharp, stabbing pain that is often tender to the touch. It is benign but can be quite painful.

When to See a Doctor: The Red Flags

It can be difficult to tell the difference between a serious heart issue and a less severe cause like indigestion. If you are ever in doubt, seek emergency medical attention immediately.

Call Emergency Services (999 in UK, and 991 in USA) if:

• Pressure or Heaviness: Your chest feels like it is being squeezed or like an “elephant is sitting on it.”

• Radiating Pain: Discomfort spreads to your arms (especially the left), neck, jaw, back, or shoulders.

• Shortness of Breath: You are struggling to breathe, even while resting.

• Associated Symptoms: You feel nauseous, dizzy, lightheaded, or break into a “cold sweat.”

• Sudden Onset: The pain started abruptly and is getting worse.

Schedule a GP Appointment if:

• The pain is mild but persistent.

• The discomfort only happens during physical exertion and stops when you rest.

• The pain is clearly linked to eating (suggesting GORD).

• You are experiencing new, unexplained chest twinges that worry you.

Summary Table: Identifying the Type of Pain

Note: Women, elderly individuals, and those with diabetes may not experience “classic” crushing chest pain during a heart attack. They might instead feel unusual fatigue, nausea, or back pain. Never ignore these “atypical” symptoms.