Chest pain

durantealessandro
5 days ago
3 min read

Chest pain: when to worry and what you need to know

Chest pain is one of the most common—and at the same time most feared—symptoms. It doesn’t always mean a “heart attack,” but it always deserves attention: the chest contains the heart, lungs, major vessels, esophagus, muscles, and nerves, and each of these structures can generate pain with different characteristics.

On this page you will find useful information to recognize the various types of chest pain, understand when to consult a doctor, and learn the typical features of cardiac-related chest pain.

Why chest pain is not all the same

Chest pain can originate from many different causes. The main causes can be divided into several major groups:

1. Cardiac causes

Stable angina
Unstable angina / Acute myocardial infarction
Pericarditis
Aortic dissection

2. Pulmonary causes

Pulmonary embolism
Pneumothorax
Pneumonia
Pleurisy

3. Gastrointestinal causes

Gastroesophageal reflux (GERD)
Esophageal spasms
Gastritis or ulcer

4. Musculoskeletal causes

Costochondritis
Muscle strains or contractures
Trauma to the chest wall

5. Neurological or psychogenic causes

Intercostal neuralgia
Panic attacks
Acute anxiety

How to distinguish cardiac chest pain from other types of chest pain

Cardiac pain has some relatively typical characteristics.

Below are the most important elements that help physicians make a diagnosis.

Characteristics of cardiac (anginal) pain

Quality

Sensation of tightness, pressure, heaviness
Sometimes described as a “vise,” “weight on the chest,” or “stone on the chest”

Location

Retrosternal area or center of the chest

Radiation

Often spreads to:

left arm or both arms
jaw
neck
shoulders
back

Duration

Typically lasts more than a few minutes; it is not a brief, fleeting pain
Does not change with breathing or movement

Triggers

Physical exertion
Emotional stress
Intense cold
Heavy meals

Relieving factors

Rest
Sublingual nitroglycerin (in known cases of angina)

When chest pain is not typically cardiac

Muscular or osteoarticular pain

Worsens with movement or when pressing on the painful spot
Sharp or related to breathing

Pain from reflux or gastrointestinal disorders

Burning sensation behind the sternum
Related to meals
Improves with antacids

Pleuritic or pulmonary pain

Sudden sharp pain that worsens with deep breathing
May be accompanied by cough or fever

Anxiety-related pain or panic attacks

Sensation of tightness associated with rapid breathing, trembling, or intense fear
ECG and cardiac tests are often normal

When to seek immediate medical attention

Call emergency services (911/112 depending on your country) or go to the emergency department if chest pain is:

Sudden, severe, or associated with cold sweating
Accompanied by shortness of breath, nausea, fainting, or palpitations
Radiating to the arm, jaw, or back
Not improving after a few minutes of rest
Present in a patient with cardiovascular risk factors (hypertension, diabetes, high cholesterol, smoking, family history)

Diagnosis: how the cause of chest pain is identified

Doctors always assess chest pain using a structured approach:

1. Medical history

Characteristics of the pain
Triggering factors
Medical history and risk factors

2. Physical examination

Blood pressure, heart rate, oxygen saturation
Cardiac and lung auscultation
Evaluation of the chest wall

3. Diagnostic tests

Electrocardiogram (ECG)
Blood tests (troponin)
Chest X-ray
Echocardiogram
Stress test or coronary CT when indicated

Conclusion

Chest pain should never be ignored: recognizing its characteristics can help patients understand when to seek prompt medical attention. At the same time, many forms of chest pain are not heart-related and can be managed safely.

If you have doubts or recurrent symptoms, talk to your cardiologist: a targeted specialist evaluation is always the best way to determine the origin of the pain and choose the most appropriate diagnostic pathway.