Chest Pain

Heart or blood vessel problems that can cause chest pain:

• Heart attack: The most common symptom of a heart attack is chest pain that may feel like tightness, heavy pressure, squeezing or crushing pain. The pain may spread to the arm, shoulder, jaw or back. Associated symptoms can include nausea, vomiting, sweatiness, palpitations and shortness of breath.
• Angina: This term refers to pain or discomfort in the chest due to underlying heart problems. This most commonly occurs from lack of adequate blood flow to the heart muscle (due to blocked arteries and coronary artery disease) but can also be the result of other heart conditions such as severe valve disease, cardiomyopathies and congestive heart failure.
• Aortic dissection: This catastrophic problem refers to a tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body. Such tears typically cause sudden, severe pain in the chest and upper back. Depending on the extent of the tear and its location, many other symptoms involving the head, neck, arms and legs, abdomen and pelvis can occur. Like heart attacks, aortic dissections are true medical emergencies that require immediate attention.  
• Pericarditis: The normal heart has a thin tissue sac (called the pericardium) that surrounds it inside the chest cavity. Swelling (inflammation) in the sac that surrounds the heart is called pericarditis and can cause pain in the center part of the chest. Chest pain from pericarditis is usually very sharp and often varies in intensity with taking breaths.

Lung problems that can cause chest pain include:

• Pneumonia is a direct infection of the lung tissue with either bacteria or viruses that can cause chest pain. These chest pains often get worse when you take a deep breath or cough.
• Pulmonary embolism is when a blood clot goes into lung arteries and blocks blood flow to the lung.  Clots can come from anywhere but most commonly from the veins in the legs or pelvis/abdomen which return blood to the side of the heart that pumps blood to the lungs.  Small blood clots are usually tolerated well but larger ones can be very debilitating and life-threatening.
• Pleurisy refers to chest pain resulting from inflammation of the thin tissue lining around the lung This chest pain also usually feels sharp, and often gets worse when you take a deep breath or cough.
• Pneumothorax or collapse of the lung (pneumothorax) can cause severe chest pain and shortness of breath. The collapse can be sudden, the result of severe lung illness or medical procedures. If the collapse is small and doesn’t get worse, it can be tolerated well.  A large collapse is a serious and life-threatening emergency and requires immediate management and treatment.

Other Causes of Chest Pain:

• Strain of the muscles and tendons between the ribs.
• Inflammation where the ribs join the breastbone or sternum (costochondritis).
• Infections such as shingles, which cause sharp, tingling pain on one side that stretches from the chest to the back and may cause a rash.
• Panic attack, which often occurs with fast breathing.

Chest pain can also be due to the following digestive system problems: 

• Heartburn or gastroesophageal reflux (GERD)
• Spasms or narrowing of the esophagus (the tube that carries food from the mouth to the stomach)
• Stomach ulcer or gastritis: Burning pain occurs if your stomach is empty and feels better when you eat food  
• Gallstones or gall bladder inflammation can cause pain that gets worse after a meal (most often a fatty meal). Although the gallbladder is in the upper right portion of the abdomen, pain from it can radiate to the heart region at the center or even the left part of the chest. 

In children, most chest pain is not caused by the heart. For most causes of chest pain, it is best to check with your healthcare provider.

Call 911 or go to the Emergency Room if:

• You have chest pain or shortness of breath that is severe and does not go away
• Chest pain lasts longer than 3 to 5 days
• You have a fever or a cough that produces yellow-green phlegm
• You are having problems swallowing