When to Go to the Doctor or Emergency Room for Chest Pain
While heart attacks are a major concern, chest pain has many other surprising causes, from heartburn to muscle strains and coughing fits. Joseph Cookman, DO, UnityPoint Health, explores unexpected culprits for that ache in your chest and when it’s time to see a doctor.
Chest Pain With Back Pain
Does Chest Pain Cause Back Pain?
Oddly enough, certain types of back pain can be felt in the chest, especially if the pain is in the thoracic area (middle of the back). This happens because the nerves that control your chest and back are close together. When a nerve in your back is irritated, the pain signals can travel to your chest, making it feel like the pain originated there. It’s known as referred pain.
Herniated discs, spinal stenosis, muscle strains and a pinched nerve sometimes cause this type of referred chest pain.
If you’re worried bad posture from being hunched over a keyboard all day is causing your chest pain, Dr. Cookman says it’s unlikely.
“I’ve had patients with scoliosis (sideways curvature of the spine) or kyphosis (forward curvature of the spine), and chest pain isn't a big problem for them.”
Does Back Pain Cause Chest Pain?
However, the opposite is also true. Chest pain from the heart is felt in the back and other unsuspecting areas of the body.
“Sometimes, a patient’s only complaint of heart attack discomfort is having back pain between the shoulder blades. Other times, it’s the arms, neck or it radiates from the throat to the jaw. I've had a few people over my career who’ve only experienced cardiac pain in their armpit,” Dr. Cookman says.
A life-threatening emergency, Dr. Cookman says aortic dissection pain is also felt in the back. This occurs when a tear develops in the inner layer of the aorta, your body’s main artery. The tear allows blood to flow between the layers, weakening the vessel wall. Aortic dissection pain is sudden, severe, sharp and feels like there’s a tear or rip happening inside your chest.
How to Tell if You Have Muscular Chest Pain vs Heart-Related Chest Pain
Heart pain commonly presents in the substernal area (beneath the breastbone) and shouldn’t be taken lightly. However, recognizing the difference between muscular chest pain and heart-related chest pain can be tricky. Here are some clues:
- Muscular chest pain: It often feels achy, sore and tender to touch. It’s triggered by an injury, certain movement or simply overdoing it. It usually hurts in a specific area of the chest. You may feel stiff or have a limited range of motion.
- Heart-related chest pain: The discomfort feels like pressure, squeezing, tightness or crushing in the chest. Stress, doing too much and even rest can trigger it. It’s often accompanied by shortness of breath, sweating, nausea, dizziness or feeling lightheaded.
Dr. Cookman says understanding the difference between chest pain caused by the heart, or something else, comes down to a few things.
“The pattern of the pain is important. Does it come on with activity? Is it relieved by rest? Cardiac pain usually doesn't last just a few seconds. A thorough medical history is crucial to pinpoint the cause of the chest pain.”
Cardiac Chest Pain Causes, Other Than Heart Attack
Outside of the onset of a heart attack, there are other causes of heart-related chest pain.
For example, angina is a type of chest pain that occurs when the heart muscle isn't getting enough oxygen. This usually happens because the heart's arteries are narrowed, restricting blood flow. Essentially, the heart muscle is working harder and needs more oxygen, but the blockage prevents enough oxygen-rich blood from reaching it.
Angina chest pain feels like a heavy weight or squeezing pressure on your chest. You might also experience burning, fullness or tightness. This discomfort spreads to the shoulders, arms, neck, jaw or back.
High blood pressure is another common cause of chest pain. Dr. Cookman says it’s called a “silent killer.”
“Many people have no symptoms at all when their blood pressure is extremely elevated. It’s important to see your doctor for annual check-ups and make sure your blood pressure is within normal range.”
High blood pressure causes chest pain by straining the heart and making it work harder to pump blood, damaging the arteries over time and reducing blood flow to the heart. Poorly managed high blood pressure can eventually lead to a heart attack.
How to Tell if You Have Lung-Related Chest Pain
Not only are cardiac issues a concern, infections and chronic conditions in the lungs also present with pain under the breastbone when you breathe deeply.
Dr. Cookman says, “A big differentiation point is whether the pain in your chest is pleuritic or not. Meaning, if your chest pain is worse with deep breathing, we’re concerned about a pulmonary embolism (blood clot in the lungs), or inflammation of the sack around the heart, called pericarditis. There’s also the possibility of pneumonia and irritation of the lining of the lung. Muscular, chest wall pain can be pleuritic as well. It's usually felt at rest but is worse with a deep breath, because you move your chest wall when you take a deep breath.”
Dr. Cookman says if the pain is felt on both sides of the breastbone, inflammation in the sternum is likely.
“You can have pain there from irritation between the rib and sternum connection. The sternum and ribs are both bone but what connects them is cartilage, and it can get inflamed and hurt for a variety of reasons.”
What Does Lung Pain Feel Like?
Not only physical stress, but emotional and mental stress cause this type of inflammatory chest pain, too. If you aren’t sure whether your chest pain is muscular or coming from your lungs, here’s a helpful hint:
Chest pain from your lungs might feel sharp and stabbing in the chest. It’s usually triggered by coughing or deep breaths. You’ll likely have other symptoms, too, like shortness of breath, a fever, cough or . If you have a nasty upper respiratory infection, the forceful action of coughing repeatedly leads to chest pain as well, straining the muscles in the area. Sometimes, continuous coughing injures the ribs.
Conditions like bronchitis or pneumonia cause inflammation in the lungs and airways, also leading to coughing and chest pain.
How to Relieve Lung Chest Pain at Home
There are a few at-home remedies to try and relieve chest pain from coughing, such as:
- Cough suppressants: Use an over-the-counter cough suppressant if you’re coughing through the night.
- Heating pad: Use for 15-20 minutes at a time.
- Humidifier: Moisture in the air helps soothe irritated airways.
- Hydration: Warm tea and water help break up phlegm.
- Ice: Alternate a heating pad with an ice pack.
- Over-the-counter pain relievers: Try acetaminophen or ibuprofen for reducing inflammation and muscle aches.
- Rest: Give your body the recovery time it needs.
Other respiratory conditions linked to chest pain include asthma and allergies. With asthma, your airways become inflamed and narrow, making it hard to breathe. This can cause chest tightness, wheezing and coughing. Allergies may trigger asthma attacks when allergens irritate your airways, leading to inflammation, chest tightness and difficulty breathing.
While the act of holding a cigarette to your mouth doesn’t cause chest pain, smoking creates a slew of other serious health conditions that cause chest pain, such as chronic obstructive pulmonary disease (COPD), heart disease and lung cancer.
Can Indigestion Cause Chest Pain?
That burning sensation in your chest? It might be your stomach acid acting up. Acid reflux, or gastrointestinal esophageal reflux disease (GERD), causes chest pain when stomach acid backs into the esophagus. The acid feels like it’s burning the lining of the esophagus, causing pain in your chest when swallowing.
You may also feel chest pain from acid reflux when bending over or laying down. That’s because gravity can’t keep your stomach acid where it belongs, allowing it to flow back up to your esophagus.
Hiatal hernia pain is felt in these positions, too. It’s when part of the stomach pushes up through the diaphragm (the muscle separating the chest and abdomen). Bending over or lying down increases the pressure on the stomach, making chest pain and heartburn worse.
Heartburn vs Heart Attack
GERD chest pain can feel like a heart attack, so it’s a good idea to recognize the differences between the two.
- Heartburn: Feels like a burning sensation in your chest, rising towards your throat.
- Heart attack: Feels like pressure, tightness or squeezing in the middle of your chest. This discomfort can spread to your arms, jaw or back. You may also have shortness of breath, sweating, nausea or dizziness.
Esophageal issues also create chest pain, including esophagitis (inflammation of the esophagus), esophageal erosions (tears in the lining) or esophageal motility disorders (problems with how food moves through the esophagus).
Gallbladder issues are another reason for chest discomfort. Interestingly, many people with gallstones experience no symptoms. However, when the stones obstruct bile flow, it causes pain in the upper abdomen or chest.
Pancreatitis, inflammation of the pancreas, also causes chest pain — as do ulcers, which develop in the stomach or duodenum, leading to discomfort in the upper abdomen.
If you’re having trouble with excessive burping and chest pain after eating, underlying GI issues like small intestinal bacterial overgrowth (SIBO), food intolerances and a variety of digestive disorders all contribute to gas buildup in the digestive tract.
Do Anxiety and Stress Cause Chest Pain?
Yes, anxiety and stress cause chest pain. It’s a common symptom, especially during panic attacks, which also cause muscle tension in the chest, elevated blood pressure and heart palpitations.
Dr. Cookman says, “Chest pain from anxiety feels different for everyone. There isn't any pattern to it, making it hard to pin down.”
Fortunately, anxiety chest pain usually doesn’t last long, anywhere from a few minutes to an hour, and gets better as your anxiety subsides. Some patients describe anxiety chest pain as an ache, tension, shooting pain, numbness or tightness. These sensations mimic serious underlying conditions, too.
How Do I Know if My Chest Pain is Serious?
Early warning signs of a heart attack are sometimes subtle and easy to dismiss. Symptoms like chest discomfort, pressure or tightness, even if brief and fleeting, shouldn’t be ignored. These seemingly minor episodes are indicators of major heart problems.
Dr. Cookman says, “For example, a patient with a 70% blockage might experience brief episodes of chest pain lasting seconds to minutes, followed by relief. This occurs because blood flow is temporarily reduced but then quickly restored. So, unfortunately, many patients delay seeking medical attention until episodes become more frequent or severe."
While the intensity varies, a heart attack can feel more like chest discomfort than chest pain.
“Many people describe a heart attack feeling like pressure, tightness, heaviness or burning in the chest. If this discomfort is accompanied by shortness of breath, sweating or nausea, go to the ER immediately.”
While most people drive themselves, or have someone else drive them, to the emergency department, Dr. Cookman says to call 911 right away if you have any suspicion you’re having a heart attack.
“Every minute counts during a heart attack, and emergency medical services can begin life-saving interventions on the way to the hospital, significantly increasing your chance of survival.”