Knowing the chest pain causes is essential to educate you because invariably, chest pain is one symptom, which frightens the patient and puts his physician on high alert.

Sharp chest pain without a precedent can be even more frightening. You usually think of chest pain to be due to a heart problem, but there are many other causes of chest pain that are not heart-related at all.

At times, the cause of the chest pain can be serious even to the extent of being life-threatening. At other times, though the chest pain is intense, the cause could be without much significance.

Chest pain can vary in intensity and location. It can be sharp and sudden or a dull ache.

It can be at the center of the chest behind the breastbone, on the left side of the chest, or on the right side. It can radiate to the neck, shoulders, and hands or to the back.

The variations of chest pain are because of its diverse causes – some serious and some not serious.

To determine the cause of the chest pain, the patient is put through a series of tests to identify the cause and treat it.

Testing for chest pain includes

  • Electrocardiogram
  • Stress test
  • 2D Echocardiogram (2D Echo)
  • Computerized tomography (CT scan)
  • Chest X-ray
  • Blood tests to check levels of certain enzymes
  • ICCU monitoring
  • Coronary catheterization (angiogram)

Chest pain causes and how they present

The cause of chest pain could belong to the various systems of the body.

  • Cardiovascular system. (Relating to the heart and the blood vessels)
  • Pulmonary system. (Relating to the lungs)
  • Digestive system
  • The Bony system
  • The Muscular system
  • The Skin
  • Other Causes

Cardiovascular causes of chest pain

1. Angina 

Angina causes left chest pain and is a result of deficient blood supply to the heart. This happens due to the narrowing of the lumen of the artery supplying blood to the heart.

Angina causes pain in the chest, which may radiate to the left shoulder and arm, or the neck, or it may radiate to the back. Sometimes the pain may be felt only at the back when the ischemia (deficient blood supply) is at the inferior wall of the heart. This and the pain of heart attack is what is commonly referred to as heart pain.

Chest pain due to angina or a heart attack increases with physical effort such as climbing the stairs or running or walking.

2. Chest pain of heart attack (Myocardial infarction)

The nature of a heart attack chest pain and the causes are similar to those of angina except that the severity is more in a heart attack. This is because, in a heart attack, the extent of obstruction is more and the blockage can even be absolute. This can be life-threatening.

Sometimes, there may be no chest pain even if you have had a heart attack. This can happen in older people especially females and in diabetics.

However, typically chest pain is the presenting symptom of a heart attack. There may be variations in the type of chest pain experienced. You may experience any one or more than one of the following symptoms.

  • Discomfort in the chest
  • Fullness in the chest
  • Squeezing sensation in the chest
  • Shortness of breath
  • A sort of heavy pressure on the chest

This may last for more than a few minutes or may go away and return. In some people, this can last for a few hours.

3. Chest pain due to pericarditis

Pericarditis is inflammation and swelling of the pericardium, which is the sac covering the heart. There may also be an excessive collection of fluid inside the sac.

The chest pain caused by acute pericarditis is a substernal, precordial (over the area of the heart) pain of the sharp and stabbing type. It is usually felt in the front and center of the chest behind the breastbone or on the left side of the chest. It may radiate to the left shoulder or to the neck or to the lower portion of the scapula on the back.

This chest pain may increase with coughing, swallowing, taking a deep breath, or lying down. It is relieved on sitting up and leaning forward.

4. Chest pain caused by thoracic aneurysm of the aorta 

The aorta is the main and largest artery in the body, which starts from the heart. A thoracic aortic aneurysm, also called TAA, is a puffed-out and weakened area in the wall of the aorta.

A thoracic aneurysm of the aorta causes chest pain, which is sudden, acute, and continuous. There may be accompanying pain in the jaw, neck, and upper back. The pain may, however, be absent in half the patients with an aortic aneurysm.

TAA is a serious health risk and life-threatening condition when it ruptures dissects or tears. Chest pain of aortic rupture is of the tearing type that begins between the shoulder blades and travels down the back.

Lung causes of chest pain

5. Chest pain of pulmonary embolism 

Pulmonary embolism is a blockage of an artery in the lungs due to an embolus. An embolus is a clot that has migrated from elsewhere in the body. There is sharp stabbing chest pain, which is severe and sudden.

It is usually felt below the breastbone or on one side of the chest. It can cause a burning or a dull heavy sensation. It gets worse with heavy breathing. This is a life-threatening condition.

6. Pneumonia 

Pneumonia is an infection in the lungs. It can occur in one or both of the lungs and is caused by bacteria, viruses, fungi, or chemical irritants. This causes a sharp or stabbing chest pain that becomes worse when you inhale deeply.

7. Pneumothorax

Pneumothorax is a collapse of a part of the lung and is due to the introduction of air between the lung and pleura (sac covering the lung). It can be caused by physical trauma to the chest or as a complication of medical or surgical intervention such as after a biopsy procedure.

There is sharp chest pain, which is severe and sudden. The seriousness depends upon the extent to which the lung has collapsed.

8. Pleurisy

Pleurisy is a condition in which the pleura becomes inflamed. The pleura are two thin layers of membraneous tissue that separate your lungs from your chest wall.  It is also called pleuritis. It causes sharp chest pain (pleuritic pain) that worsens during breathing.

The pleural sac contains small amounts of pleural fluid. This allows the two layers of the pleural cavity to slide over each other to allow for the expansion and contraction of the chest during breathing.

Pleurisy causes chest pain, which is a stabbing type of pain usually situated on one side of the chest. It can radiate to the shoulder or the belly. It becomes worse when you cough, sneeze or inhale deeply.  You may, therefore, avoid breathing in deeply.

Digestive system causes

9. GERD or gastroesophageal reflux disease

GERD causes reflux of the acidic liquid contents from the stomach into the esophagus. This gives rise to a painful burning sensation in the chest that can spread to the throat and leave a sour taste.

Pain is worse after eating spicy food or drinking alcohol. A sudden severe pain would be due to a diffuse esophageal spasm.

10. Gastric ulcer pain

The pain of a gastric ulcer is felt between the breastbone and navel and can be referred to the chest. This pain is more when the stomach is empty. This is because the stomach acid comes in direct contact with the ulcerated portion of the stomach wall and eats into it.

11. Gallbladder pain

The gallbladder is an organ that nestles just below the liver. It stores bile, which helps to digest fat in the small intestine. The gallbladder pain occurs in the right upper part of the abdomen behind the ribs. It can radiate to the chest, the back, and the right shoulder. It can be due to several reasons and the type of pain will depend on the cause:

  • Biliary colic is due to the formation of gallstones, which are crystals that obstruct the cystic duct. It occurs due to the spasm of the cystic ducts that are blocked by the gallstones. This type of pain is an intermittent and often severe pain in the epigastrium (just below the breastbone) or right upper quadrant of the abdomen, which can radiate to the chest, back, or the right shoulder. It comes on suddenly and increases rapidly. It can occur at any time of the day or night and can last from a few minutes to 4 to 5 hours, but more often for 4 to 5 hours.
  • Acute cholecystitis is an inflammation of the gallbladder. The gallstones obstructing the cystic duct often are the cause of this condition. The pain of acute cholecystitis is a sharp, cramping, or dull pain, which occurs in the epigastrium and the right upper quadrant of the abdomen. It spreads to the back or the right shoulder. It often onsets after a heavy fatty meal and usually lasts for at least thirty minutes.

12. Hiatus hernia

A hiatus hernia is a protrusion or herniation of the upper portion of the stomach into the thorax through the weakened esophageal opening in the diaphragm. It is more common in people over the age of 50 years.

Hiatus hernia often causes reflux of food into the esophagus (GERD) causing heartburn and chest pain. You will usually notice this pain after smoking, drinking alcohol or coffee, or eating chocolate. It tends to get worse when you bend over or lie down.

 13. Chest pain due to gas      

Gaseous distension of the stomach can cause chest pain especially when gastroesophageal reflux disease (GERD) coexists. You will feel a burning sensation in the chest.

The gas causes bloating of the intestines and the stomach, which is felt in the abdomen. However, this pain radiates to the chest on the left side. It lasts for a short time and you get relief from the pain once you have passed the gas.

14. Chest pain due to pancreatitis

Acute pancreatitis is the inflammation of the pancreas, which predominantly causes pain in the epigastrium. However, pain can radiate to the chest and the back. It is aggravated on eating and slowly worsens over time. Chronic pancreatitis causes constant pain that is severe and radiates to the back and the chest.

15. Achalasia 

Achalasia is a condition wherein the sphincter between the esophagus and the stomach does not open to let the food pass into the stomach. The food, therefore, backs up into the esophagus and the distended and stretched esophagus produces pain in the chest.

Chest pain is a sharp pain and it is difficult to diagnose the condition firsthand. However, achalasia causes difficulty in swallowing liquid and solid food and this can help the doctor to look for this condition. As age advances, the pain diminishes.

Bony causes

16. Costochondritis 

Costochondritis is a condition wherein a joint between the ribs and the sternum (breastbone) gets inflamed and causes musculoskeletal chest pain. Costochondritis is a common cause of chest pain in adolescents and children with maximum cases seen between the ages of 12 to 14 years. It is seen more in females than in males.

This chest pain is localized and increases on applying pressure on the site of pain with your fingers (tenderness). The cause is not yet known and this condition subsides on its own. Chest pain could be on the left side or the right side depending on which side of the breastbone, the costochondritis exists.

17. Rib fracture

A rib fracture will give rise to localized pain with tenderness. Chest pain due to the rib fracture worsens with deep breathing and coughing.

Muscular causes of chest pain

18. Muscle strain

Any inflammation or muscle tear or tendon tear, as a result of over-straining of that part, can result in this condition. The pain increases on the movement of that part or may even show tenderness.

In case of inflammation of the muscles between the ribs, a deep breath may aggravate the chest pain.

Skin causes of chest pain

19. Singles (Herpes Zoster)

Any inflammatory condition like shingles (also called herpes zoster) on the skin of the chest gives rise to sharp pain over the infected area, which stretches from the front to the back. This condition is caused by a virus and gives rise to a rash, which spreads from the front to the back.

Other causes

20. Chest Pain Due To Stress

Just as you can have a tension headache caused by stress, you can also have stress-related chest pain. Anxiety and panic attacks trigger such types of chest pain. Chest pain due to stress and related disorders is nonspecific and dull in nature. It worsens with increasing stress.