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Chest Pain

By

Andrea D. Thompson

, MD, PhD, University of Michigan;


Michael J. Shea

, MD, Michigan Medicine at the University of Michigan

Last full review/revision Sep 2020| Content last modified Oct 2021
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

Chest pain is a very common complaint. Pain may be sharp or dull, although some people with a chest disorder describe their sensation as discomfort, tightness, pressure, gas, burning, or aching. Sometimes people also have pain in the back, neck, jaw, upper part of the abdomen, or arm. Other symptoms, such as nausea, cough, or difficulty breathing, may be present depending on the cause of the chest pain.

Many people are well aware that chest pain is a warning of potential life-threatening disorders and seek evaluation for minimal symptoms. Other people, including many with serious disease, minimize or ignore its warnings.

Causes of Chest Pain

Many disorders cause chest pain or discomfort. Not all of these disorders involve the heart. Chest pain may also be caused by disorders of the digestive system, lungs, muscles, nerves, or bones.

Common causes

Overall, the most common causes of chest pain are

Life-threatening causes

Evaluation of Chest Pain

People with chest pain should be evaluated by a doctor. The following information can help people decide when evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with chest pain or discomfort, certain symptoms and characteristics are cause for concern. They include

  • Crushing or squeezing pain

  • Shortness of breath

  • Sweating

  • Nausea or vomiting

  • Pain in the back, neck, jaw, upper abdomen, or one of the shoulders or arms

  • Light-headedness or fainting

  • Sensation of rapid or irregular heartbeat

When to see a doctor

Although not all causes of chest pain are serious, because some causes are life threatening, the following people should see a doctor right away:

  • Those with new chest pain (within several days)

  • Those who have a warning sign

  • Those who suspect that a heart attack is occurring (for example, because symptoms resemble a previous heart attack)

These people should call emergency services (911) or be taken to an emergency department as quickly as possible. People should not try to drive themselves to the hospital.

Chest pain that lasts for seconds (less than 30 seconds) is rarely caused by a heart disorder. People with very brief chest pain need to see a doctor, but emergency services are usually not needed.

People who have had chest pain for a longer time (a week or more) should see a outpatient doctor as soon as possible unless they develop warning signs or the pain has steadily been getting worse or coming more often, in which case they should go to the hospital right away.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What they find during the history and physical examination often suggests a cause of the chest pain and the tests that may need to be done.

However, symptoms due to dangerous and not dangerous chest disorders overlap and vary greatly. For example, although a typical heart attack causes dull, crushing chest pain, some people with a heart attack have only mild chest discomfort or complain only of indigestion or arm or shoulder pain (referred pain—see Figure: What Is Referred Pain? What Is Referred Pain? Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more ). On the other hand, people with indigestion may simply have an upset stomach, and those with shoulder pain may have only sore muscles. Similarly, although the chest is tender when touched in people with musculoskeletal chest wall pain, the chest can also be tender in people who are having a heart attack. Thus, doctors usually do tests on people with chest pain.

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Testing

For adults with sudden chest pain, tests are done to rule out dangerous causes. For most people, initial tests include

  • Measurement of oxygen levels with a sensor placed on a finger (pulse oximetry)

  • Electrocardiography (ECG)

  • Chest x-ray

If symptoms suggest an acute coronary syndrome or if no other cause is clear (particularly in people who are at high risk), doctors usually measure levels of substances that indicate heart damage (cardiac markers) in the blood (at least two separate times over a few hours) and do repeated ECGs Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)... read more Electrocardiography .

If these tests do not show an acute coronary syndrome, doctors often then do a stress test Stress Testing Stressing the heart (by exercise or by use of stimulant drugs to make the heart beat faster and more forcibly) can help identify coronary artery disease. In coronary artery disease, blood flow... read more Stress Testing or CT angiography before people go home or within a few days. However, if a newer cardiac marker, called high sensitivity troponin, is used and that test does not show evidence of heart damage, further testing may not be required. For a stress test, ECG or an imaging test (such as echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography uses high-frequency (ultrasound) waves bounced off internal structures to produce a moving image. It uses no x-rays. Ultrasonography of the heart (echocardiography) is one of... read more Echocardiography and Other Ultrasound Procedures ) is done during exercise (often on a treadmill) or after a drug is given to make the heart beat fast or increase blood flow through the coronary arteries (such as dipyridamole).

If pulmonary embolism is suspected, computed tomography (CT) of the lungs or a lung scan Chest Imaging Chest imaging studies include X-rays Computed tomography (CT) CT angiography Magnetic resonance imaging (MRI) read more is done. If pulmonary embolism is considered only somewhat possible, a blood test to detect clots (D-dimer test) is often done. If this test is negative, pulmonary embolism is unlikely, but if the test is positive, other tests, such as ultrasonography of the legs or CT of the chest, are often done.

In people who have had chest pain for a long time, immediate threats to life are unlikely. Most doctors initially do only a chest x-ray and then do other tests based on the person's symptoms and examination findings.

Treatment of Chest Pain

Specific identified disorders are treated. If the cause is not clearly benign, people are usually admitted to the hospital or an observation unit for heart monitoring and more extensive evaluation. Symptoms are treated with acetaminophen or opioids as needed until a diagnosis is made.

Key Points about Chest Pain

  • Chest pain may be caused by serious life-threatening disorders, so people with new chest pain (within a few days) should get immediate medical attention.

  • The symptoms of life-threatening and non–life-threatening disorders overlap, so testing is usually needed to determine a cause.

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