Pain in upper chest and neck. Upper Chest and Neck Pain: Causes, Symptoms, and Treatment Options
What are the common causes of pain in the upper chest and neck. How can you differentiate between various conditions causing discomfort in these areas. When should you seek medical attention for chest and neck pain. What diagnostic methods and treatments are available for different causes of upper chest and neck pain.
Understanding the Connection Between Upper Chest and Neck Pain
Pain in the upper chest and neck can be a perplexing and often concerning experience. These two areas are intricately connected, and discomfort in one region can often radiate to the other. The causes of such pain can range from minor, temporary issues to more serious medical conditions that require immediate attention.
Does the location of pain always indicate its source? Not necessarily. Pain felt in the chest may originate from the neck, and vice versa. This phenomenon, known as referred pain, occurs due to the complex network of nerves that connect these areas. Understanding this connection is crucial for proper diagnosis and treatment.
Common Causes of Upper Chest and Neck Pain
Several conditions can lead to pain in the upper chest and neck. Here are some of the most common causes:
- Angina
- Heartburn
- Pericarditis
- Chest infections
- Esophagus disorders
Each of these conditions has distinct characteristics and requires different approaches to diagnosis and treatment. Let’s delve deeper into each cause to better understand their symptoms and implications.
Angina: A Signal of Reduced Blood Flow to the Heart
Angina is a condition characterized by reduced blood flow to the heart. It often manifests as chest pain or discomfort that can extend to the neck, jaw, shoulder, arms, or back. But what are the specific symptoms of angina?
- Nausea and dizziness
- Shortness of breath
- Pain radiating to adjacent areas
Is all angina the same? No, there are two main types: stable and unstable angina. Stable angina typically occurs due to overexertion and subsides with rest. Unstable angina, on the other hand, is more severe and can occur even at rest. It often indicates a significant reduction in blood flow to the heart, possibly due to a blood clot or ruptured blood vessel.
How is angina diagnosed? Doctors typically use a combination of methods, including:
- Electrocardiogram (ECG)
- Chest X-ray
- Blood tests
Treatment for angina usually involves lifestyle changes and medication. In some cases, surgical intervention may be necessary. It’s crucial to note that unstable angina could be a precursor to a heart attack and requires immediate medical attention.
Heartburn: More Than Just Indigestion
Heartburn, despite its name, has nothing to do with the heart. It occurs when stomach contents are forced back into the esophagus, causing a burning sensation in the chest. This discomfort can sometimes extend to the neck area.
What factors increase the risk of heartburn? Several lifestyle factors can exacerbate heartburn symptoms:
- Smoking
- Obesity
- Consumption of spicy foods
How often should heartburn occur before seeking medical attention? If you experience heartburn multiple times a week or if the pain worsens, it’s advisable to consult a healthcare provider. While heartburn is often benign, frequent occurrences could indicate a more serious condition such as gastroesophageal reflux disease (GERD).
Treatment for heartburn typically involves lifestyle modifications and over-the-counter medications. In more severe cases, prescription medications may be necessary.
Pericarditis: Inflammation of the Heart’s Protective Sac
Pericarditis is the inflammation of the pericardium, the saclike membrane surrounding the heart. This condition can cause chest pain that may extend to the left shoulder and neck. The pain associated with pericarditis often worsens when:
- Coughing
- Breathing deeply
- Lying down
Why is pericarditis sometimes difficult to diagnose? The symptoms of pericarditis can mimic those of other heart and lung conditions, making accurate diagnosis challenging. Doctors typically rely on a combination of physical examination, patient history, and diagnostic tests such as:
- Electrocardiogram (ECG)
- Chest X-ray
- Echocardiogram
While some cases of pericarditis improve without treatment, others may require medication to reduce inflammation and alleviate symptoms. In rare cases, a complication called cardiac tamponade may occur, necessitating hospitalization and drainage of excess fluid around the heart.
Chest Infections: When Breathing Becomes Painful
Chest infections, while primarily affecting the chest, can also cause pain in the neck, especially when breathing or swallowing. Two common types of chest infections are pneumonia and bronchitis.
Pneumonia: Inflammation of the Lung’s Air Sacs
Pneumonia is an inflammation of the air sacs in the lungs, often caused by bacterial or viral infections. How is pneumonia diagnosed? Doctors typically use a combination of physical examination and diagnostic tests, including:
- Chest X-rays
- Blood tests
- Sputum tests
Treatment for pneumonia focuses on preventing complications and may include:
- Antibiotics (for bacterial pneumonia)
- Cough medication
- Hospitalization in severe cases
Bronchitis: Inflammation of the Bronchial Tubes
Bronchitis occurs when the lining of the bronchial tubes becomes inflamed. It can be acute (short-term) or chronic (long-term). How is bronchitis diagnosed? Doctors may use:
- Chest X-rays
- Sputum tests
- Pulmonary function tests
Treatment for acute bronchitis often involves managing symptoms, as many cases improve on their own. For chronic bronchitis, treatment may include pulmonary rehabilitation programs and learning specific breathing techniques.
Esophagus Disorders: When Swallowing Becomes Painful
Disorders of the esophagus can cause pain in both the chest and neck areas. Two common conditions are esophagitis and esophageal spasms.
Esophagitis: Inflammation of the Esophageal Lining
Esophagitis occurs when the lining of the esophagus becomes inflamed. This can result in heartburn or pain when swallowing. What causes esophagitis? Common causes include:
- Gastroesophageal reflux disease (GERD)
- Infections
- Allergies
- Certain medications
How is esophagitis diagnosed and treated? Diagnosis often involves endoscopy or X-ray studies. Treatment may include:
- Over-the-counter antacids
- H-2 receptor blockers
- Proton pump inhibitors
- Dietary modifications
Esophageal Spasms: Uncontrolled Contractions of the Esophagus
Esophageal spasms are involuntary contractions of the esophagus that can cause chest pain. Many people describe this pain as a squeezing sensation or a feeling of something being stuck in their throat.
How are esophageal spasms diagnosed? Doctors may use:
- Endoscopy
- Esophageal manometry
- Barium swallow test
Treatment for esophageal spasms often involves addressing underlying conditions such as GERD or anxiety. Medications to relax the swallowing muscles, such as calcium channel blockers or phosphodiesterase-5 (PDE5) inhibitors, may be prescribed. In severe cases that don’t respond to conservative treatments, surgical options may be considered.
When to Seek Medical Help for Upper Chest and Neck Pain
While some causes of upper chest and neck pain may be benign, others can be life-threatening. It’s crucial to know when to seek medical attention. Here are some situations that warrant immediate medical care:
- Sudden, severe chest pain
- Pain accompanied by shortness of breath, sweating, or nausea
- Pain that radiates to the jaw, left arm, or back
- Chest pain accompanied by a feeling of pressure or squeezing
- Persistent pain that doesn’t improve with rest
Remember, it’s always better to err on the side of caution when it comes to chest pain. If you’re unsure about the severity of your symptoms, consult a healthcare professional.
Diagnostic Approaches for Upper Chest and Neck Pain
Diagnosing the cause of upper chest and neck pain often requires a multifaceted approach. Healthcare providers typically start with a thorough medical history and physical examination. Depending on the suspected cause, they may recommend various diagnostic tests:
- Electrocardiogram (ECG): This test records the electrical activity of the heart and can help diagnose conditions like angina or heart attacks.
- Chest X-ray: This imaging test can reveal infections, tumors, or other abnormalities in the chest cavity.
- Blood tests: These can help detect markers of inflammation, infection, or heart damage.
- Endoscopy: This procedure allows doctors to examine the inside of the esophagus and stomach.
- CT scan or MRI: These advanced imaging techniques provide detailed pictures of the chest and neck structures.
- Stress tests: These tests evaluate how the heart functions during physical activity.
The choice of diagnostic tests depends on the patient’s symptoms, medical history, and the healthcare provider’s clinical suspicion. In some cases, multiple tests may be necessary to reach an accurate diagnosis.
Treatment Options for Upper Chest and Neck Pain
The treatment for upper chest and neck pain varies widely depending on the underlying cause. Here’s an overview of potential treatment options for different conditions:
Medication-Based Treatments
Many conditions causing upper chest and neck pain can be managed with medications:
- Antacids and proton pump inhibitors for heartburn and GERD
- Nitroglycerin for angina
- Antibiotics for bacterial infections
- Anti-inflammatory drugs for conditions like pericarditis
- Muscle relaxants for esophageal spasms
Lifestyle Modifications
In many cases, lifestyle changes can significantly improve symptoms:
- Dietary changes to reduce heartburn and GERD symptoms
- Smoking cessation to improve overall cardiovascular health
- Stress management techniques for conditions exacerbated by stress
- Regular exercise to improve heart health (under medical supervision)
Surgical Interventions
In some cases, surgery may be necessary:
- Coronary artery bypass grafting for severe coronary artery disease
- Fundoplication for severe GERD
- Myotomy for severe esophageal spasms
Rehabilitative Therapies
For some conditions, especially those affecting the musculoskeletal system, rehabilitative therapies can be beneficial:
- Physical therapy for neck pain related to poor posture or injury
- Pulmonary rehabilitation for chronic bronchitis
- Cardiac rehabilitation following a heart attack or heart surgery
It’s important to note that treatment should always be tailored to the individual patient, taking into account their specific diagnosis, overall health status, and personal preferences. Always consult with a healthcare professional before starting any new treatment regimen.
Causes and When to Get Medical Help
There are a number of possible causes of chest and neck pain. The discomfort you experience in either your chest or neck may be the result of an underlying condition in one of the two areas or it might be pain that radiates from elsewhere.
Pain in your chest and neck may be caused by any of the following conditions:
- angina
- heartburn
- pericarditis
- chest infections
- esophagus disorders
Read on to learn more about these conditions.
Angina is caused by a reduction in blood flow to your heart, and symptoms include:
- nausea and dizziness
- shortness of breath
- pain extending to your neck, jaw, shoulder, arms, or back
Stable angina can result from overexertion and generally goes away by resting. Unstable angina is an emergency that involves severely decreased blood flow to the heart, often because of a rupture in a blood vessel or because of a blood clot.
If you experience the symptoms of angina, seek medical attention.
Diagnosis and treatment
Angina is often diagnosed through an electrocardiogram (ECG), chest X-ray, or blood tests. If you are diagnosed with angina, your doctor can determine the more specific diagnosis of stable or unstable angina.
Angina is generally treated through lifestyle changes and medication, though there are surgical options. Unstable angina could be a sign of a heart attack and requires medical treatment immediately.
Heartburn occurs when some of the contents of your stomach are forced back into your esophagus. It may result in a burning sensation in your chest, especially after eating or when lying down. Heartburn can often result in a bitter taste in your mouth.
You have an increased risk of worsening heartburn if you:
- smoke
- are overweight
- consume spicy foods
Diagnosis and treatment
Though heartburn is a common condition, experiencing heartburn on multiple occasions throughout the week — or if pain worsens — is a cue to visit your healthcare provider. It may or may not indicate a more serious condition, but, following a diagnosis, your doctor can provide appropriate treatment.
If it the diagnosis suggests heartburn, you healthcare provider will suggest proper heartburn treatment such as lifestyle changes and medications.
The saclike membrane that surrounds your heart is called the pericardium. When it swells or is irritated, it can cause chest pain in your left shoulder and neck, especially when you:
- cough
- breathe deeply
- lie down
Diagnosis and treatment
The symptoms are often difficult to distinguish from other conditions related to the heart and lungs. Your doctor can provide a diagnosis, likely through an ECG, X-ray, or other imaging tests.
Some cases improve without treatment, but there are medications that reduce symptoms. One complication of the condition is called cardiac tamponade. It requires hospitalization to remove the excess buildup of fluid surrounding your heart.
While chest infections are felt primarily in the chest, you may also experience pain in your neck when breathing or swallowing.
Two common chest infections are pneumonia, an inflammation of the air sacs in your lungs, and bronchitis, which occurs when the lining of your bronchial tubes are inflamed.
Diagnosis and treatment
Bronchitis can be diagnosed through:
- chest X-rays
- sputum tests
- pulmonary function test
Acute bronchitis symptoms sometimes improve without treatment.
Bronchitis from a bacterial infection may require medication. Chronic bronchitis is often treated through a pulmonary rehabilitation program including the learning specific breathing techniques.
Pneumonia can be diagnosed through similar tests as bronchitis. Treatment usually focuses on preventing complications. This can involve:
- antibiotics
- cough medicine
- hospitalization (more serious instances)
Two conditions related to your esophagus that could result in chest and neck pain are esophagitis and esophageal spasms.
Esophagitis occurs when the lining of your esophagus is inflamed. This can cause heartburn or pain when swallowing. Esophageal spasms are contractions of your esophagus that cause chest pain. The pain is often described as a squeezing pain or a feeling something is stuck in your throat.
Diagnosis and treatment
Diagnostic techniques for both conditions may involve an endoscopy or X-ray.
For treating esophagitis, your doctor may help you determine which food allergies could trigger inflammation or recommend medications to relieve symptoms, such as:
- Over-the-counter antacids that reduce acid production, such as Mylanta
- Over-the-counter H-2-receptor blockers that block acid production, such as Pepsid
- Prescription strength H-2-receptor blockers
For treating esophageal spasms, your doctor may recommend treating underlying conditions such as GERD or anxiety. To relax swallowing muscles, they may suggest medications such as Viagra or Cardizem.
If conservative approaches do not work, surgery is an option for both conditions.
Experiencing pain in your chest and neck may require immediate medical attention. In fact, many symptoms of the above conditions are similar to those of a heart attack.
It is best to be cautious and seek medical attention for chest pain, especially if symptoms worsen or persist or you are at risk for a heart attack due to related conditions, age, or family history.
Conditions related to either your chest or neck may be a sign of an underlying condition that causes the pain to spread to surrounding areas. Pain in your chest or difficulty breathing or swallowing should always be taken seriously, seek medical attention for a proper diagnosis and treatment.
10 Causes, Treatments, and More
Several different conditions may cause chest and upper back pain together. Causes can be related to the heart, digestive tract, and other parts of the body.
While some causes of chest and upper back pain aren’t emergencies, others are. You should always seek emergency medical attention if you have sudden or unexplained chest pain that lasts more than a few minutes.
Read on to learn more about the causes of upper back and chest pain, how they’re treated, and when to see a doctor.
Here are 10 potential causes of upper back and chest pain.
1. Heart attack
A heart attack happens when the blood supply to the muscles of your heart is blocked. Because of this, people having a heart attack may experience chest pain that can spread into the neck, shoulders, and back.
Other symptoms to look out for include:
- sensations of pressure or tightness in the chest
- cold sweats
- shortness of breath
- feeling lightheaded or faint
- nausea
Women are more likely than men to experience heart attack pain involving the back or jaw. It’s also important to note that some people having a heart attack may experience very few symptoms or none at all.
2. Angina
Angina is pain that occurs when your heart tissue isn’t getting enough blood. It can commonly occur in people with coronary artery disease. It often happens while you’re exerting yourself.
Similar to pain from a heart attack, angina pain can spread to the shoulders, back, and neck.
Angina symptoms can vary between men and women. Women may feel pain in the back, neck, or abdomen in addition to or instead of chest pain.
Other angina symptoms can include:
- feeling fatigued or weak
- shortness of breath
- sweating
- feeling lightheaded or faint
- nausea
3. Heartburn
Heartburn happens when the acid or contents of your stomach comes back up into your esophagus. This causes a painful, burning sensation in your chest, behind your breastbone. It may also sometimes be felt in your back or abdomen.
Heartburn tends to be worse after eating a meal or in the evening. You may also notice an acidic taste in your mouth or pain that gets worse while lying down or bending over.
Being pregnant, overweight, or obese can also increase your risk of developing heartburn. Some foods can also trigger the condition, including spicy foods, citrus, and fatty foods.
4. Pleurisy
Pleurisy happens when the membranes that line your lungs and your chest cavity become inflamed.
Normally, these membranes move smoothly past each other. When they’re inflamed, they can rub against each other, which leads to pain.
Pleurisy can be caused by a variety of things, including infections, autoimmune conditions, and cancers.
The pain of pleurisy gets worse as you breathe in deeply or cough. It can also spread to your shoulders and back.
Other symptoms that can occur include:
- coughing
- shortness of breath
- fever
- chills
- unexplained weight loss
5. Gallstones
Your gallbladder is a small organ that stores a digestive fluid called bile. Gallstones occur when this fluid hardens inside your gallbladder, forming stones.
Gallstones may cause pain to occur in several different places, including:
- the upper right area of your abdomen
- right below your breastbone
- between your shoulder blades
- in your right shoulder
The amount of time you experience pain from gallstones can last for a few minutes to several hours. You may also experience symptoms such as nausea or vomiting.
There are several risk factors that may increase your risk of gallstones, including being female, being pregnant, and being overweight or obese.
6. Pericarditis
The pericardium lines the surface of your heart. Pericarditis happens when the pericardium becomes inflamed. It can be caused by an infection or autoimmune condition. It can also happen after a heart attack or heart surgery.
Pericarditis causes sharp chest pain. This pain may become worse while breathing deeply, lying down, or swallowing. The pain from pericarditis may also be felt as pain in the left shoulder, back, or neck.
Other symptoms to be aware of include:
- dry cough
- feelings of fatigue
- anxiety
- difficulty breathing when lying down
- swelling in your lower extremities
7. Musculoskeletal pain
Sometimes muscular problems may cause pain in the chest and upper back. Repetitive use or overuse of multiple muscle groups, for example through activities such as rowing, can lead to aching pain in the chest, back, or chest wall.
Other symptoms you may experience include muscle stiffness, muscle twitching, and feelings of fatigue.
8. Aortic aneurysm
Your aorta is the largest artery in your body. An aortic aneurysm happens when part of the aorta becomes weakened. In some cases, this weakened area may tear, which can lead to life-threatening bleeding. This is called aortic dissection.
Many times, an aortic aneurysm will develop with very little or no symptoms. However, some people may feel pain or tenderness in their chest. In some cases, pain may also occur in your back.
Other symptoms to look out for include:
- shortness of breath
- cough
- feeling hoarse
9. Spinal problems
In some cases, a pinched nerve in the upper part of the spine may cause pain to radiate to the area of the chest and possibly to the extremities.
In addition to pain, other symptoms you may experience include muscle spasms and stiffness in the affected area of the spine, which may restrict movement.
Additionally, there are some case studies in which a herniated disc in the upper portion of the spine has caused pain in the chest or chest wall.
10. Lung cancer
Chest and back pain can also occur as a symptom of lung cancer. Although chest pain is a common symptom, the Dana-Farber Cancer Institute reports that 25 percent of people with lung cancer reported back pain as a symptom.
Back pain from lung cancer can happen when a tumor in the lungs begins to put pressure on the spine. Pain from lung cancer may feel worse when you breathe deeply, laugh, or cough.
In addition to chest and back pain, other signs of lung cancer can include:
- persistent cough, which may include coughing up blood
- feeling hoarse
- shortness of breath or wheezing
- feeling weak or fatigued
- unexplained weight loss
- recurrent lung infections, such as pneumonia
The treatment for your upper back and chest pain will depend on the underlying cause.
Heart attack
Some treatments for heart attack are typically given immediately. These can include aspirin to limit blood clotting, nitroglycerin to improve blood flow, and oxygen therapy. Clot-busting medications, which help to break up any blood clots, may then be given.
A procedure called percutaneous coronary intervention (PCI) can help open up any arteries that are found to be narrowed or blocked. This procedure uses a small balloon attached to a catheter to compress plaque or clotted blood against the wall of the affected artery and restore blood flow.
Other potential treatments can include:
- medications to help prevent another heart attack, such as ACE inhibitors, blood thinners, or beta-blockers
- heart bypass surgery
- lifestyle changes such as eating a heart-healthy diet, increasing physical activity, and managing stress
Angina
A variety of medications can be prescribed to help manage angina. These medications may prevent blood clots, reduce angina pain, or widen blood vessels. Examples of angina medications include:
- beta-blockers
- calcium channel blockers
- blood thinners
- nitrates
- statins
Heart-healthy lifestyle changes will also be recommended as part of your treatment plan. If medications and lifestyle changes can’t successfully manage the condition, procedures like PCI and heart bypass surgery may be necessary.
Heartburn
Several over-the-counter (OTC) medications can be used to relieve heartburn. These can include antacids, h3 blockers, and proton pump inhibitors. If OTC medications aren’t helping to relieve your symptoms, your doctor may prescribe you stronger medications.
Pleurisy
Pleurisy can be treated through addressing the underlying condition that may be causing it. Medications may also help relieve symptoms, including acetaminophen or NSAIDs for pain, and cough syrups to ease cough.
In some cases, fluid may need to be removed from the affected area. This can help to prevent lung collapse.
Gallstones
Many times, gallstones don’t require treatment. In some cases, your doctor may prescribe medication to help dissolve the gallstones. People with recurring gallstones may have their gallbladder removed.
Pericarditis
Pericarditis can be managed with treatments that relieve inflammation and pain, such as NSAIDs. If these aren’t effective, your doctor may prescribe a stronger anti-inflammatory medication.
If an infection is causing your condition, an antibiotic or antifungal medication will also be prescribed.
In some cases, you may need a procedure to drain fluid. This can help reduce pressure on your heart.
Musculoskeletal pain
Muscle issues that result in upper back and chest pain may be treated with rest and medications that relieve pain and inflammation, such as NSAIDs.
Applying heat to the affected area may also help. In more severe cases, physical therapy may be recommended.
Aortic aneurysm
In some cases, your doctor will recommend monitoring of your aneurysm using imaging technology such as CT scan or MRI scan. Additionally, your doctor may prescribe medications such as beta-blockers, angiotensin II receptor blockers, and statins to help lower blood pressure or cholesterol levels.
People with larger aortic aneurysms may require repair surgery. This can be performed via open-chest surgery or endovascular surgery. Emergency surgery is required for an aortic aneurysm that has ruptured.
Spinal problems
Treatment for spinal problems depends on their severity. It can include reducing your activity level and taking medications such as NSAIDs and muscle relaxers to help with pain or inflammation. Physical therapy exercises may also be recommended.
More severe cases may require surgical intervention to repair them.
Lung cancer
Several therapies can help treat lung cancer. Which type is used depends on the type of lung cancer and how far the cancer has spread. Your doctor will work with you to create a treatment plan that’s right for you.
Treatment options can include chemotherapy, radiation therapy, and targeted therapy. Additionally, surgery may be recommended to remove the cancer tissue.
Here are some good rules of thumb for preventing many of the causes of upper back and chest pain:
- Eat a heart-healthy diet.
- Make sure that you get enough exercise.
- Maintain a healthy weight.
- Avoid smoking and secondhand smoke.
- Limit alcohol consumption.
- Manage your stress levels.
- Stay on top of your routine physical appointments and be sure to see your doctor if new or worrisome symptoms appear.
Some additional tips include:
- Limit foods that may trigger heartburn, such as spicy foods, fatty foods, or acidic foods.
- Try not to lay down right after eating to prevent heartburn symptoms.
- Avoid eating late or large meals to help prevent gallstones.
- Stretch properly before engaging in exercise or sports to avoid muscle injury or strain.
You should always take chest pain seriously, as sometimes it may be an indicator of a serious health condition, like a heart attack.
Always seek emergency medical attention if you have unexplained or sudden chest pain, especially if you have difficulty breathing or the pain has spread to other areas like the arm or jaw.
You should also make a doctor’s appointment for any condition that isn’t relieved using OTC medications or has symptoms that recur, are persistent, or begin to worsen.
You can connect to a physician in your area using the Healthline FindCare tool.
There are several things that can cause upper back pain and chest pain to occur together. Some of the causes of this type of pain aren’t serious, but it’s always important to take chest pain seriously.
Chest pain can be a sign of a potentially life-threatening condition, such as a heart attack. If you have unexplained chest pain that comes on suddenly or is severe, seek emergency medical assistance.
possible causes and when to sound the alarm
What to do when there is a feeling of discomfort or pain in the chest? Perhaps it’s a heart attack, or maybe another, less serious problem? In this article, we will look at the most common causes of pain in the chest cavity, as well as the typical signs of the diseases in which they appear.
The nature of the manifestation of pain is different: from sharp and piercing – to dull, but not strong. Sometimes it is described as squeezing or burning. In some cases, the pain radiates to the neck, then to the jaw, after which it moves to the back or down one or two arms.
The causes of chest pain can be varied, but the most dangerous of them are those related to the heart or lungs. Although in many cases the cause of pain has nothing to do with these organs.
Pain in the chest comes from:
- The organs that are located in it are the heart, lungs and esophagus.
- The components of the chest wall are skin, muscles and bones.
- Organs located near the chest – liver, gallbladder, stomach, pancreas.
Sometimes chest pain is caused by pain in the neck that radiates to the chest. This is called referred or repercussion pain.
Causes related to the heart
- Angina pectoris
All organs and tissues of our body need oxygen and nutrients that are carried in the blood. The heart pumps oxygenated blood through a huge network of arteries. This network includes vessels that supply blood to the heart muscle itself. These vessels are located on the surface of the heart and are called coronary arteries. They branch into smaller vessels located inside the heart muscle.
In people with coronary heart disease, the coronary arteries become clogged with fatty deposits called plaque. These deposits cause arteries to narrow and prevent oxygenated blood from reaching the heart. Angina pectoris is the term for chest pain caused by ischemia.
When the heart has to work harder, it needs more blood and oxygen. If additional oxygen-rich blood cannot pass through the narrowed coronary arteries, the heart begins to ache. That is why angina pectoris is especially manifested during physical activity.
Chest pain caused by angina pectoris manifests as discomfort or tightness behind the sternum during exertion. Sometimes it radiates to the arms, neck, jaw, or stomach area. As a rule, the pain of angina pectoris is mild and subsides after 10 minutes of rest.
- Myocardial infarction (heart attack)
During a heart attack, the plaque is damaged or ruptured. Subsequently, the blood coagulation mechanism is triggered, during which a thrombus forms at the site of damage. The latter completely blocks the coronary artery or one of its small branches. This means that part of the heart muscle is left without blood and oxygen. If the artery is not quickly freed from blockage, the part of the heart muscle that remains without oxygen is damaged or dies. This is myocardial infarction.
The most common symptom of a heart attack is severe chest pain at rest. However, scientists from Harvard Medical School warn that pain is just one of the possible symptoms of an attack. Seek immediate medical attention if a person notices one or more of the following symptoms:
- Compressive, burning pain in the center of the chest. Sometimes patients with a heart attack feel as if a belt is pulled tightly around their chest.
- Pain, numbness, tingling or other discomfort in one or both arms, back, neck, jaw or stomach.
- Shortness of breath or difficulty breathing.
- Sudden nausea or vomiting.
- Dizziness or lightheadedness.
- Unusual tiredness and feeling of heaviness.
- Heat or cold sweat.
Sometimes chest pain from a heart attack resembles angina pectoris, but in most cases it is more severe and prolonged.
Some heart problems that are not related to blood flow in the coronary arteries can also cause chest pain.
- Variant angina
This type of angina is caused by a temporary spasm of the coronary arteries. Usually in this case, the arteries do not have constrictions or blockages.
- Pericarditis
This inflammation of the pericardial sac (pericardium) causes severe pain that is worse when the person takes a deep breath or lies down.
- Myocarditis
This is an inflammation of the heart muscle itself that causes chest pain. Myocarditis feels very similar to angina pectoris. Often inflammation of the myocardium is provoked by a viral infection.
- Hypertrophic cardiomyopathy
In this disease, the heart muscle (myocardium) thickens, making it harder for the heart to pump blood. In a small number of patients, this disease manifests itself in the form of shortness of breath and chest pain. Sometimes the work of the electrical system of the heart is disrupted, resulting in an arrhythmia.
- Aortic dissection
This rare but life-threatening condition affects the main artery that comes out of the heart, the aorta. This vessel consists of layers of muscle cells that can delaminate and rupture. Blood subsequently leaks to areas of the body outside the circulatory system. This is an extremely serious condition that requires the intervention of a vascular surgeon. With aortic dissection, the pain is very severe and appears suddenly, giving to the back or to the area between the shoulder blades.
Lung-related causes
A number of lung-related problems cause chest pain:
- Pulmonary embolism
In a pulmonary embolism, a blood clot forms and blocks the flow of blood to the lungs. The pain comes on suddenly, is accompanied by shortness of breath, and may get worse when the person breathes deeply.
- Pneumonia
Infection in the lungs causes not only cough and fever, but also chest pain.
- Pleurisy
If the membrane that covers the lungs becomes inflamed, it causes pain. They are usually aggravated during inhalation and coughing. Pleurisy may occur due to a viral infection, as well as a complication of pneumonia, pulmonary embolism, or chest trauma.
- Pneumothorax
With pneumothorax, air enters the space between the chest wall and the lung – the pleural cavity. Chest pain comes on suddenly and can last for hours.
- Pulmonary hypertension
If pressure rises in the arteries that carry blood to the lungs, a person may experience chest pain.
Digestive causes
- Heartburn (acid reflux)
if gastric juice enters the esophagus.
- Gallbladder or pancreas problems
Gallstones or inflammation of the pancreas cause abdominal pain that radiates to the chest.
- Gastric or duodenal ulcer
An ulcer causes pain in the upper abdomen, just below the breastbone. The pain characteristic of an ulcer comes and goes, and sometimes feels like chest pain. Accompanying symptoms of peptic ulcer disease are bloating, vomiting, feeling unwell, and a feeling of a full stomach after eating.
- Esophagitis
Esophagitis is an inflammation of the esophagus that is sometimes caused by medication.
Other causes of chest pain include:
- Panic attacks
panic attacks.
- Herpes zoster
This is an infection that affects a nerve and the area of skin it innervates. If lichen affects the nerve that innervates the skin in the chest area, a person develops chest pain. In most cases, 2-3 days after the first pain sensations appear in the area of nerve damage, a rash appears.
What should I do if my chest hurts?
Any new, severe or prolonged pain should be seen by a doctor as soon as possible. This is especially true for people who have previously experienced heart or lung disease. If you are worried about very severe chest pain that radiates to your arms or jaw, you feel unwell, you sweat a lot or are out of breath, call an ambulance immediately. These symptoms may indicate a heart attack.
If the pain is mild and infrequent, an examination is necessary. Its main goal is to exclude problems with the heart and lungs, which can pose a danger to human life. The main diagnostic procedures that are performed for chest pain:
- electrocardiogram,
- blood test,
- chest x-ray,
- endoscopy and other research methods.
If you are concerned about chest pain and want to find the source of it, see a physician.
Sources:
- Chest Pain, Patient.info,
- Patient education: Chest pain (Beyond the Basics), UpToDate,
- Chest pain, Mayo Clinic,
- Chest pain: A heart attack or something else , Harvard Medical School,
- Hypertrophic cardiomyopathy, Mayo Clinic.
Chest pain – causes, examination and treatment | Symptoms
Myocardial infarction or unstable angina
Signs: Represent an immediate danger to life. Sudden, pressing pain that spreads (radiates) to the jaw or arm, may be constant or transient. Sometimes shortness of breath or nausea. Pain that comes on with exertion and goes away with rest (angina pectoris). Abnormal heart sounds heard through a stethoscope. Frequent warning signs.
Thoracic aortic dissection (tear in the wall of the thoracic aorta)
Signs: Represent an immediate danger to life. Sudden, tearing pain that extends into or begins in the middle of the back. Sometimes dizziness, stroke, and pain, coldness, or numbness in the leg. Sometimes different pulse or blood pressure in the limbs. Usually in people over 55 with a history of high blood pressure. Warning signs.
Pericarditis (inflammation of the membrane around the heart)
Signs: Potentially life-threatening. Acute pain, constant or transient, aggravated by breathing, swallowing food, or lying on the back. Relaxes when leaning forward. Abnormal heart sounds heard through a stethoscope.
Spontaneous rupture of the esophagus
Signs: Represent an immediate danger to life. Sudden, sharp pain immediately after vomiting or after a medical procedure involving the esophagus (esophageal and gastric endoscopy or transesophageal echocardiography). Some warning signs.
Pancreatitis (inflammation of the pancreas)
Signs: Potentially life-threatening. Severe, persistent pain that: appears in the upper middle abdomen or lower chest. Often aggravated in the supine position, weakened by bending forward. Vomiting and soreness in the upper abdomen, sometimes shock. Often in people who abuse alcohol or have gallstones.
Peptic ulcers
Signs: Periodic vague discomfort that is felt in the upper middle of the abdomen or in the lower chest. Relief with antacids and sometimes after meals. Common in smokers and drinkers, or both. There are no warning signs.
Gastroesophageal reflux (GERD)
Signs: Periodic burning pain that spreads from the upper middle abdomen to the throat, worse when bending over or lying down. Relieves with antacids.
Diseases of the gallbladder and bile ducts (diseases of the biliary tract)
Signs: Intermittent discomfort, which is felt in the upper right side of the abdomen or in the lower middle of the chest, is observed after eating (but not after exercise).
Swallowing disorders (in which the peristalsis of food through the esophagus is impaired)
Signs: Pain that develops gradually over a long period of time may or may not appear during swallowing. Usually difficulty swallowing.
Pulmonary embolism (blockage of the pulmonary artery by a blood clot)
Signs: Represent an immediate danger to life. Often severe pain when breathing, shortness of breath, rapid breathing and rapid heartbeat. Sometimes a slight fever, coughing up blood, or shock. More likely in patients with risk factors for pulmonary embolism (history of blood clots, recent surgery, especially leg surgery, prolonged bed rest, leg cast or splint, older age, smoking, or cancer).
Tension pneumothorax (collapse of the lung with increased air pressure in the chest)
Signs: Represent an immediate danger to life. Significant shortness of breath. Low blood pressure, swollen neck veins, and decreased breath sounds heard through a stethoscope on one side. It usually occurs only after a severe chest injury.
Pneumonia
Signs: Potentially life-threatening. Fever, chills, cough, and usually yellow or green sputum. Often shortness of breath. Sometimes pain when breathing. Palpitations and congestion in the lungs revealed during the examination.
Pneumothorax (collapse of the lung)
Signs: Potentially life-threatening. Sudden sharp pain, usually in one side of the chest. Sometimes shortness of breath, weakening of breath sounds heard through a stethoscope on one side.
Pleurisy (inflammation of the lining around the lung)
Signs: Sharp pain when breathing. Usually in patients who have recently had pneumonia or a viral respiratory infection. Sometimes cough. There are no warning signs.
Musculoskeletal chest wall pain
Signs: Pain that is usually persistent (lasting a few days or more). Increases with movement and/or breathing. May have no apparent cause or result from coughing or physical exertion.