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
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
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
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.
- 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?
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