Chest pain or discomfort is a common symptom of numerous conditions related to the chest wall, heart, respiratory system, gastrointestinal tract, stress, and anxiety. Most of these conditions are not dangerous, but the cardiac causes of chest pain can be very serious, and every chest pain should be therefore carefully investigated.
A cardiac chest pain caused by the impaired blood supply to the heart muscle due to narrowings or blockages in the coronary arteries. Typical anginal pain feels like a tightness, pressure or constriction across the chest with radiation to the left arm and jaw, triggered by physical exertion or stress and relieved by rest and GTN spray.
Myocardial infarction (heart attack)
A heart attack is caused by a sudden blockage in coronary arteries supplying oxygen to the heart. If not promptly treated, oxygen starvation can cause damage to the heart and trigger arrhythmias. Symptoms of a heart attack usually include severe central chest pain radiating to arms and jaw and accompanied by sweating and breathlessness.
Pneumonia
Lung infection caused by bacteria or viruses. Pain in pneumonia worsens on taking a deep breath and is associated with coughing, phlegm and raised temperature.
Pleurisy
Infection of the membrane surrounding the lungs made worse by taking a deep breath in. Pleurisy is usually a consequence of pneumonia. It can be excruciating but responds well to simple painkillers such as paracetamol or ibuprofen.
Heartburn
A symptom of gastro-oesophageal reflux disease (GORD); a burning sensation arising from the stomach and radiating to the chest. Heartburn is caused by gastric juices that leak back into the oesophagus (gullet) and irritate the wall lining. As the name suggests, the pain has a burning character and typically occurs after hot and spicy meals. Heartburn can be easily mistaken for angina and heart attack due to their resemblance.
Stretched/ pulled chest wall muscles
Muscles can be strained after heavy lifting, sudden movement or prolonged coughing. The diagnosis is usually based on history and confirmed by triggering the pain on movement and deep breathing.
Anxiety and stress
Family or work-related stress often causes psychosomatic symptoms, such as chest pain, inability to take a deep breath in, palpitations and dizziness. Chest pain can be attributed to stress only when other, more serious causes have been excluded. Treatment may be simply rest and a solution to the underlying problem, but sometimes medication (antidepressants) and psychological treatment, such as cognitive behavioural therapy, are needed.
When in doubt, call an ambulance: better safe than sorry!