Chest pain: what are the common causes?

Most chest pain isn’t related to your heart, but some of it is. So if you do experience chest pain it’s important to get checked out.

What’s on this page:

• What chest pain feels like
• Causes of chest pain (non-heart-related)
• Causes of chest pain (heart-related)
• Less common but serious causes of chest pain

In this article we explore the common symptoms and possible causes of chest pain, and explain when you should get medical help.

What does chest pain feel like?

People experience pain differently and pain can be difficult to describe, especially when it’s the kind of pain that we tend to associate with life-threatening conditions. Knowing how to describe what you’re experiencing may help you understand, explain and manage your symptoms.

For example, chest pain may feel like:

• tightness
• squeezing
• a dull ache
• pressure like someone is sitting on your chest.

You can also just feel uncomfortable, like something is off but it’s not stopping you from getting on with life.

Chest pain can be felt in different places in your chest:

• on the left side
• on the right side
• at the centre behind the breastbone (sternum).

It can feel like it’s only in one place (localised) or it can be spreading (radiating) to other parts of your body, like the shoulder and arm, or neck and jaw, or stomach and back. Chest pain can also be constant or it may come in waves. It may last different amounts of time and vary in how intense it feels.

Chest pain can come with different triggers, which may suggest its cause. For example, if you get chest pain after you’ve had lunch, it may be a sign of indigestion. If you only get chest pain in a specific position, it may be muscular pain. The cause of chest pain will also affect how long it lasts.

It can be hard to tell the cause of chest pain, and if you are unsure, make sure you seek medical help.

Causes of chest pain (non-heart-related)

If you have chest pain it’s natural to connect it to your heart. Common causes of chest pain that are not related to the heart include heartburn, chest infection, muscle pain, injuries and inflammation.

Heartburn

Heartburn, which may be linked to indigestion, is a common cause of chest pain. Other symptoms of heartburn include:

• a burning sensation in the middle of your chest
• an unpleasant sour taste in your mouth, caused by stomach acid
• cough or hiccups that keep coming back
• a hoarse voice, bad breath, bloating and feeling sick.

Symptoms are often worse after eating, when lying down and when bending over.

Chest infection

Chest pain or discomfort can also be caused by a chest infection, which can also cause:

• a chesty cough, which may come with green or yellow mucus
• wheezing and shortness of breath
• high temperature, headaches, aching muscles, and
• tiredness.

You can experience similar symptoms with pneumonia.

Muscular chest pain, injuries and inflammation

The sensations in your chest may also be linked to the muscles or tissues that are in this part of the body, which aren’t part of the heart.

Chest pain, tenderness or discomfort can be caused by injuries. You may also feel it in the shoulder, neck, or upper back. If you feel it after exercise, carrying heavy shopping, or sleeping in an awkward position, it is probably linked to strain on your muscles and tendons. Look out for any swelling and bruising, which may be a sign of an injury.

If your chest is painful to touch, this could be a condition called costochondritis, caused by inflammation in the rib cage.

Speak to your GP if you’re experiencing any new or ongoing chest discomfort.

Anxiety and chest pain

Anxiety-related chest pain, which may feel similar to heart-related chest pain, is common and can be difficult to manage. Your chest may feel squeezed, and your heart may feel like it’s racing and about to jump out of your chest. When you touch your wrist to check your pulse, it may feel like your heart is skipping beats. The intensity of this feeling can make you dizzy, disorientated, and breathless.

When your doctor tells you it’s ‘just’ anxiety and that you don’t have a heart problem, you may find it hard to believe. And despite being repeatedly told that your symptoms are neither life-threatening nor threatening to your physical health, you may be reluctant to work, socialise or exercise, or even get out of bed, worrying that if you exert yourself, your heart will stop altogether.

Anxiety-related chest pain affects many people. There are ways such as medication, breathing techniques, and psychotherapy, which can help you cope with or even control the symptoms over time.

• Get tips for managing anxiety

Causes of chest pain (heart-related)

Common causes of heart-related chest pain include heart attack, angina, myocarditis and pericarditis.

Heart attack

Symptoms of a heart attack can include:

• sudden chest pain or discomfort that doesn’t go away
• pressure, squeezing or heaviness in your chest that may spread to your left or right arm or to your neck, jaw, back or stomach
• feeling sick, sweaty, light-headed or short of breath.

Coughing or wheezing can also happen because of fluid build-up in the lungs. If you suspect that you are having a heart attack, call 999.

Angina

Angina may feel like:

• pressure, tightness or squeezing in your chest
• discomfort in the shoulders, arms, neck, jaw, back or stomach.

It can make you fatigued and dizzy. You may sweat and feel sick and breathless.

• If you’ve not been diagnosed with angina and you have chest pain that stops after a few minutes of resting, get an urgent doctor’s appointment. If the pain does not stop after a few minutes’ rest, call 999 immediately because you could be having a heart attack.
• If you have been diagnosed with angina but it feels worse, happens more often, or changes in any way, talk to your doctor as soon as you can. If your chest pain doesn’t stop after a few minutes’ rest, and two doses of your GTN medication, call 999 immediately because this could be a heart attack.

Myocarditis and pericarditis

Myocarditis and pericarditis are when certain parts of the heart become inflamed, usually following a virus.

In both myocarditis and pericarditis, chest pain can feel like:

• a sharp pain or tightness
• or a dull, pressure-like pain.

Pericarditis sometimes is felt more on the left-hand side of the chest and tends to get worse when coughing, swallowing or lying down.

Both myocarditis and pericarditis may also cause a high temperature, shivers, trouble breathing, light-headedness, and feeling sick.

Less common but serious causes of chest pain

Less common but serious causes of chest pain include aortic dissection, pulmonary embolism and spontaneous coronary artery dissection (also known as SCAD). If you experience any of the symptoms associated with these conditions, you should phone 999 immediately to get medical help.

Aortic dissection

Aortic dissection is when the weakened wall of the aorta tears, causing blood to leak between the layers that make up the walls of your arteries. Symptoms include:

• sudden, severe pain across the chest, or in the back or between the shoulder blades
• pain that spreads to the jaw, face, abdomen, back or the legs
• feeling cold, clammy and sweaty
• breathlessness and sometimes fainting.

Pulmonary embolism

A pulmonary embolism is a blood clot that blocks blood flow in an artery in the lungs. Symptoms include:

• pain, especially when you breathe in, cough, or bend over
• coughing up blood
• sudden shortness of breath and fainting due to a sudden drop in blood pressure.

Spontaneous coronary artery dissection (SCAD)

Spontaneous coronary artery dissection (SCAD) is a condition when a tear appears in the wall of a coronary artery, which supplies blood to your heart. Symptoms include:

• chest pain
• tightness or pain in the arms, neck, jaw, back or stomach
• feeling dizzy or lightheaded
• feeling tired or out of breath
• nausea
• feeling sweaty or clammy.

If you call 999, a first responder will be able to assess your condition and take you to hospital if needed. It’s better to wait for an ambulance rather than taking yourself to A&E, as the paramedics can start helping you as soon as they arrive and can let the hospital know you’re coming.

Thank you to the British Heart Foundation for this information

10 signs you might have heart disease

We explore the symptoms you need to take seriously.

Around 4 million males and 3.6 million females in the UK  are living with some form of heart or circulatory disease.

But how can you spot the signs of a potential heart problem?

While pain in your chest might immediately raise alarm bells, other signs of heart disease such as a painful jaw or swollen ankles can be less obvious.

Here are 10 signs that could mean it’s time to see a doctor.

1. Chest pain

It’s the classic sign of a heart attack, but how do you know if chest pain is a medical emergency? 

If your chest pain does not stop after resting for a few minutes and you feel extremely unwell, dial 999 and get an ambulance as soon as possible. 

If it’s a heart attack, this pain may feel like heaviness, tightness or pressure in the chest.

People often describe it as ‘an elephant’ or ‘a tight band’.

If you feel pain or tightness in your chest that goes away after a few minutes of resting, you may have angina.

Angina is feeling of pain or discomfort caused by reduced blood flow to the heart.

You should go and see a doctor, but you do not have to call 999.

However, if you have been diagnosed with coronary heart disease and your chest pain does not go away after taking two sprays of GTN (glyceryl trinitrate) medication, call an ambulance.

• Find out more about the common causes of chest pain.

2. Stomach pain like indigestion

A painful or burning feeling in your chest or stomach can be a sign of a heart attack or related heart problem.

However, it can be hard to tell the difference between heart pain and indigestion.

That’s because the heart, the stomach and the gullet (the passage between your mouth and stomach) all lie right next to each other. 

If you’re not sure which one is causing your stomach pain, call NHS 111 for advice.

• Read more about the heart symptoms that mean you need urgent help.

3. Arm, jaw or back pain

If you’re having a heart attack, pain may also spread to other parts of your body. This includes your arm, jaw, neck or back. 

It’s more likely to be a heart attack if the pain is going down your arm, especially your left arm or into your neck.

If it does not go away, or if you have used your GTN spray two times to no effect, call 999 for an ambulance.

• Learn more about heart attack symptoms in women.

4. Feeling sweaty 

Working up a sweat because it’s a hot day or you’ve been to the gym is nothing to worry about. 

However, you should call 999 for an ambulance if you start to feel hot and clammy along with chest pains, as it could be a heart attack.

5. Choking feeling 

Angina can sometimes cause a feeling of tightness or pain up in the throat. This is often described as a ‘restricting’ or ‘choking’ sensation.

In fact, the word ‘angina’ comes from the Latin word for choking.

If this feeling continues, and you have not previously been diagnosed with heart problem, you should call NHS 111.

And if you are also experiencing other signs of a heart attack, such as chest pain or feeling sick, you must call an ambulance. 

6. Feeling sick 

Most of the time, feeling queasy will not be related to your heart.

However, if you suddenly start feeling sick and notice pain in your chest as well, it could be another sign that you’re having a heart attack.  

If you feel sick and experience some discomfort in your chest, but not intense pain, call NHS 111 for advice.

If you feel intense chest pain even when you’re resting and you also feel sick, call 999 for an ambulance. 

7. Swollen ankles

Swollen ankles are common and have lots of causes. For example, they may be caused by tablets you are taking, such as blood pressure medication.

However, that does not mean you should ignore them, especially if your ankles get very big, as this can be a marker of heart failure.

This means that your heart may not be pumping blood around your body as well as it should be, and fluid collects in your lower limbs. 

So, if you’re getting swollen ankles, it’s worth making an appointment with your GP.

8. Leg pain

A gripping, cramping sensation in your calves when you are walking is a marker of peripheral arterial disease (PAD). The pain is caused by your legs not receiving enough blood.

It’s most common in people who smoke and those who have diabetes. If you notice this symptom, make an appointment with your GP. 

9. Extreme fatigue

Feeling tired all the time can be a symptom of lots of conditions – including heart failure.

However, as there are so many causes of tiredness, it can be difficult to know for sure. 

If you’re tired and you’ve been working long hours or staying up late, it’s probably not your heart.

But if you start experiencing extreme tiredness and your lifestyle has not changed, it’s a good idea to chat to your GP. 

• Get expert tips on living fatigue when you have a heart condition.

10. Palpitations

Suddenly becoming aware of your own heartbeat and feeling like it is racing and missing beats is known as palpitations.

These are usually harmless, and can be caused by things like stress, caffeine or hormonal changes. 

However, if your heart is going very fast and jumping around erratically, then that’s when you should see your GP. 

If you notice this and you also experience blackouts, call 999 for an ambulance. 

Palpitations can also be a sign of an abnormal heart rhythm (arrythmia), which may be caused by an underlying condition. 

One of the most common arrythmias is atrial fibrillation (AF), which can increase your risk of a stroke. 

Thank you to the British Heart Foundation for this information