Chest Pain
Chest Pain: points to keep in mind
Chest pain is one of the most common reasons people seek medical attention. It can range from mild discomfort to severe, crushing pain, and it may signal a variety of conditions—from minor issues such as indigestion or muscle strain to life-threatening emergencies like heart attack or pulmonary embolism.
Because chest pain is associated with the heart, it often causes fear and anxiety. However, not all chest pain is cardiac in origin. Causes can include gastrointestinal, musculoskeletal, lung-related, or even anxiety disorders. Understanding the possible reasons for chest pain, when to seek urgent help, and what tests or treatments may be needed is essential for safeguarding health.
Cardiac-related chest pain (angina or heart attack):
Pressure, heaviness, tightness, or squeezing in the chest
Pain radiating to the arm, shoulder, jaw, neck, or back
Shortness of breath, Sweating, nausea, or lightheadedness
Worsening with exertion, improving with rest (typical angina)
Lung-related causes:
Sudden sharp pain with breathing or coughing (pleurisy)
Pain with shortness of breath (pulmonary embolism, pneumonia)
Pain after trauma (pneumothorax)
Gastrointestinal causes:
Burning sensation (acid reflux/heartburn)
Pain after eating or lying down. Bloating, belching, indigestion
Anxiety/panic attack:
Tight chest with palpitations. Shortness of breath
Tingling in hands and face
Feeling of impending doom
Musculoskeletal causes:
Localised sharp pain, worsens with movement, deep breathing, or touch
Injury, strain, or inflammation in ribs or muscles
Chest pain has many causes, and the same discomfort can come from the heart, lungs, gullet, muscles or from anxiety. This section looks at what raises the chance of a heart cause, and what tends to bring on the other causes.
Risk factors for heart-related chest pain (angina and heart attack)
Smoking, high blood pressure and high cholesterol.
Diabetes, being overweight and being inactive.
Family history: a father or brother with heart disease before 55, or a mother or sister before 65.
Increasing age and chronic kidney disease.
Long-term inflammatory conditions such as rheumatoid arthritis, lupus and psoriasis.
South Asian family background is linked with a higher risk of coronary heart disease.
Some factors specific to women: pre-eclampsia or gestational diabetes in pregnancy, and an early menopause.
Heavy alcohol use, chronic stress and depression, and stimulant drugs such as cocaine and amphetamines, which can cause coronary artery spasm.
Features that point towards the heart
Heart-related pain (angina) is typically a tight, heavy or squeezing pressure in the centre of the chest, which may spread to the neck, jaw, shoulders or arms. It is usually brought on by exertion or emotion and eases within a few minutes of rest or a GTN spray. Sharp pain in one small spot, pain that changes with breathing or body position, or pain you can reproduce by pressing on the chest is less often cardiac. No single feature rules heart disease in or out, which is why unexplained chest pain should always be assessed.
Non-heart causes and what brings them on
Acid reflux: large or late meals, alcohol, obesity and lying down after eating.
Muscle or rib strain: heavy lifting, new exercise, twisting movements and persistent coughing.
Anxiety and panic: stress, over-breathing and poor sleep.
Lung causes: chest infections, and blood clots in the lungs, which are more likely after long-haul travel, surgery, long periods of immobility, pregnancy, hormone medicines or a previous clot. A collapsed lung is more common in tall, slim young adults and in smokers.
Shingles: burning pain on one side of the chest, sometimes before the rash appears.
What brings on angina?
Angina is usually predictable. Common triggers are physical effort (especially uphill or after a meal), cold weather, heavy meals and emotional stress. If your pain starts to come on more easily, occurs at rest or lasts longer than before, seek urgent medical help, because this can be a sign of unstable angina.
Can heart-related chest pain be prevented?
Stop smoking.
Control blood pressure and cholesterol, with medicines if advised.
Keep diabetes well controlled.
Aim for about 150 minutes of moderate activity a week and a healthy weight, with a Mediterranean-style diet.
Keep alcohol within 14 units a week, spread over three or more days.
Manage stress and low mood, and seek help for them.
Seek immediate emergency medical help (call 999 in the UK) if you experience:
Sudden, severe chest pain or pressure
Pain radiating to arm, jaw, or back
Associated shortness of breath, sweating, nausea, or fainting
Chest pain lasting longer than a few minutes
Known heart disease with worsening chest pain
See your GP or a specialist if:
You have recurrent mild chest pain
Pain is linked with exercise or stress
You have risk factors such as diabetes, high blood pressure, smoking, or family history of heart disease
You are unsure of the cause and want a medical assessment
Doctors will take a history and perform a physical exam, followed by tests depending on the suspected cause. Common tests include:
Electrocardiogram (ECG/EKG): To detect heart attack, arrhythmias, or ischemia
Blood tests (e.g., troponins): To look for heart muscle damage
Chest X-ray: To assess lungs, ribs, and heart size
Echocardiogram (heart ultrasound): To examine heart structure and function
Exercise stress test: To check for coronary artery disease
Coronary angiography or CT coronary angiogram: To look at blood vessels of the heart
Endoscopy: If gastrointestinal cause is suspected
CT or MRI scan: For more detailed imaging of chest organs
Tests we offer for suspected heart-related chest pain include exercise ECG, CT coronary angiogram, stress echocardiogram and echocardiogram.
Tests and services that may help
We can arrange the investigations used to find the cause of chest pain:
ECG reporting, UK-wide
Consultation by telephone, video or face to face
If your chest pain is severe, sudden or getting worse, call 999 rather than waiting for an appointment.
Cardiac causes (angina, heart attack, coronary artery disease):
Medications: aspirin, nitrates, beta-blockers, ACE inhibitors, statins
Procedures: angioplasty, stent insertion, bypass surgery
Lifestyle changes: diet, exercise, smoking cessation
Lung causes:
Antibiotics (pneumonia)
Anticoagulants/thrombolysis (pulmonary embolism)
Chest drain (pneumothorax)
Gastrointestinal causes (acid reflux, ulcer, gallbladder disease):
Antacids, proton pump inhibitors (PPIs), H2 blockers
Dietary changes (avoiding spicy/fatty foods, reducing alcohol)
Surgery for gallstones or severe reflux
Musculoskeletal pain:
Pain relief (NSAIDs, paracetamol), Heat or ice packs
Rest, physiotherapy, stretching
Living with chest pain
If chest pain is due to a chronic condition like angina, acid reflux, or musculoskeletal problems, long-term management is essential:
Maintain a heart-healthy lifestyle: balanced diet, regular exercise, avoid smoking/alcohol excess
Adhere to prescribed medications
Manage stress and anxiety with mindfulness or therapy
Monitor triggers (exercise, certain foods, stress) and learn how to avoid them
Attend regular follow-ups with your GP or cardiologist
Driving, work and travel
Driving rules depend on the cause of the chest pain. For car and motorcycle (Group 1) licences, based on DVLA guidance last updated 7 November 2025:
Angina: do not drive if symptoms occur at rest, with emotion or at the wheel. You may drive again once symptoms are satisfactorily controlled, and you need not tell the DVLA.
Heart attack: do not drive. Driving may resume after 1 week if you had successful angioplasty (PCI), no further urgent procedure is planned and your pumping function was at least 40% before discharge. Otherwise the wait is 4 weeks. You need not tell the DVLA.
Angioplasty or stent: no driving for at least 1 week. Bypass surgery: at least 4 weeks.
Bus, coach and lorry (Group 2) rules are stricter, and most cardiac conditions must be reported to the DVLA.
If you have had chest pain at the wheel, or chest pain that has not yet been explained, it is sensible not to drive, and to avoid strenuous exertion, until it has been assessed. Rules change, so always check GOV.UK, and see our DVLA cardiac assessment page if you drive for work.
The outlook depends entirely on the underlying cause:
Heart attack or severe coronary artery disease: Prognosis varies, but outcomes are better with rapid treatment and lifestyle changes
Stable angina: Manageable with medications and lifestyle adjustments
Non-cardiac causes (reflux, musculoskeletal): Usually good prognosis with correct treatment
Anxiety-related chest pain: Improves with therapy and stress management
Lung-related causes: Ranges from good (pneumonia with antibiotics) to life-threatening (pulmonary embolism if untreated)
- Not all chest pain is heart-related, but it should never be ignored.
- Heart attacks can present differently in women and people with diabetes.
- Chest pain with shortness of breath, nausea, or sweating needs urgent medical attention.
- Gastroesophageal reflux is one of the most common non-cardiac causes.
- Musculoskeletal chest pain often worsens with movement or pressure.
- Panic attacks can mimic heart attack symptoms.
- ECG and troponin blood tests are crucial in ruling out heart attacks.
- Lifestyle changes can significantly reduce the risk of cardiac chest pain.
- Prompt treatment of pulmonary embolism can be life-saving.
- Always seek emergency help if chest pain is sudden, severe, or unexplained.
Guidelines and sources
This page follows current UK and European guidance:
NICE CG95: Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis.
Vrints C et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal 2024;45:3415-3537.
Byrne RA et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal 2023;44:3720-3826.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
These are the questions patients most often ask about chest pain.
Is all chest pain caused by the heart?
No. Chest pain can come from the heart, lungs, gullet (reflux), muscles and ribs, or anxiety. Even so, it should never be ignored, because heart and lung causes can be serious and need to be ruled out.
How can I tell whether chest pain is from my heart?
Heart-related pain (angina) is typically a tight, heavy or squeezing pressure in the centre of the chest that can spread to the arm, neck or jaw, comes on with exertion or stress and eases within a few minutes of rest. Sharp, localised pain that changes with breathing, position or pressing on the chest is less often cardiac. However, no single feature is reliable, so new or unexplained chest pain should be assessed rather than self-diagnosed.
When should I call 999?
Call 999 if chest pain is sudden and severe, feels like crushing pressure, spreads to your arm, jaw or back, comes with breathlessness, sweating, nausea or fainting, or lasts more than a few minutes. Do not wait to see whether it passes, and do not drive yourself to hospital.
Could my chest pain be anxiety?
Anxiety and panic attacks commonly cause chest tightness, palpitations and breathlessness. But they can feel very like a heart problem, so anxiety is best diagnosed after heart and lung causes have been considered. A normal assessment is often reassuring in itself.
If my ECG is normal, can heart disease be ruled out?
No. A resting ECG is often normal in people with angina, because it may only change during an episode or when the heart is under stress. A blood test (high-sensitivity troponin) is used when a heart attack is suspected, and tests such as an exercise ECG, CT coronary angiogram or stress echocardiogram may be needed if angina is suspected.
What tests might I need?
It depends on your symptoms. Common tests are an ECG, blood tests and an echocardiogram. If angina is suspected, the next step may be an exercise ECG, a stress echocardiogram or a CT coronary angiogram. Your cardiologist will explain which is most useful for you.
What is a CT coronary angiogram?
A CT coronary angiogram (CTCA) is a scan, using contrast dye, that shows the coronary arteries and any narrowing or plaque. NICE recommends it as the first-line test for people whose symptoms suggest angina. It involves a small dose of radiation and a contrast injection, and a slow, steady heart rate gives the clearest pictures.
Can acid reflux cause chest pain?
Yes. Reflux is one of the commonest non-cardiac causes, typically a burning pain behind the breastbone after meals or when lying down or bending, which antacids relieve. But reflux and angina can feel alike and can occur together, so if pain is brought on by exertion, or you have heart risk factors, get it checked rather than assume it is reflux.
Can a pulled muscle or rib problem cause chest pain?
Yes. Pain that is sharp, localised and made worse by pressing on the area, twisting or taking a deep breath is often musculoskeletal, and usually settles over days to weeks. If there is any doubt, heart and lung causes should be excluded first.
Is chest pain different in women or people with diabetes?
It can be. Women and people with diabetes are more likely to have less typical symptoms, such as breathlessness, unusual tiredness, nausea, or discomfort in the back, jaw or upper abdomen, without the classic crushing chest pain. Do not dismiss new symptoms because they are different from what you expect.
Should I exercise if I have chest pain?
Do not push through chest pain: stop and rest. Until the cause has been assessed, avoid strenuous exertion. Once the cause is known, activity is usually helpful, and for heart-related pain a cardiac rehabilitation programme can help you build up safely.
How do I use a GTN spray?
Only use GTN that has been prescribed for you. As a general guide: stop and sit down, take one dose under the tongue, and wait 5 minutes. If the pain has not eased, take a second dose. If it is still not relieved 5 minutes after the second dose, call 999. Follow the instructions you were given by your own doctor.
Can I have a chest pain assessment privately?
Yes, if your symptoms are not an emergency. A consultation by telephone, video or face to face in Peterborough or Corby can review your symptoms, with an ECG, echocardiogram, exercise ECG, stress echocardiogram or CT coronary angiogram arranged as needed. If chest pain is severe or sudden, call 999 instead.
- What could be causing my chest pain?
- Do I need urgent hospital tests or can it be investigated as an outpatient?
- Am I at risk of a heart attack?
- What tests will help determine the cause of my symptoms?
- How can I distinguish between heart-related and non-heart chest pain?
- What lifestyle changes can reduce my risk of future chest pain?
- Should I carry emergency medications like nitroglycerin?
- How often should I follow up with you?
- What signs should make me call 999 immediately?
- What treatment options are best suited for my condition?
Where can chest pain come from?
Chest pain has many causes, and the more serious ones involve the heart, lungs or the aorta. Because the causes can feel alike, symptoms alone are not a reliable guide, which is why assessment includes an ECG and, where appropriate, blood tests and imaging.
When is chest pain urgent?
Features such as crushing pressure, spread to the arm or jaw, sweating or breathlessness need an emergency response. Pain that is new, changing or brought on by exertion should be assessed promptly, even if it settles.
If you are experiencing chest pain now, call 999 immediately.
If you have chest pain, tightness or pressure, you may benefit from a telephone consultation or video consultation to discuss your symptoms in detail, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as ECG reporting, CT coronary angiography (CTCA), exercise stress echo and cardiac monitoring may be recommended to further evaluate your condition.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.