Chest pain ranges from muscle tension to heart attack. In case of a feeling of pressure, shortness of breath, or radiating pain to the arm or jaw: call 144 immediately — when in doubt, it's better to call once too often.
Possible causes
Muscles, ribs and spine
Movement- or pressure-dependent, often persisting over days and changing with body posture.
Heart and coronary arteries
Pressure or tightness behind the breastbone, often triggered by exertion, sometimes radiating into the arm, neck, jaw or back — always take this seriously.
Lungs and pulmonary vessels
A pulmonary embolism typically causes sudden shortness of breath with breathing-dependent pain and a racing heart. In a pneumothorax, air escapes into the pleural space: sudden one-sided pain with breathlessness. Both are emergencies.
Aorta
A tear in the wall of the aorta (aortic dissection) typically causes sudden, very severe, tearing pain, often radiating between the shoulder blades — this is an emergency.
Pericardium and heart muscle
Inflammation of the pericardium or heart muscle often causes pain that depends on position, easing when sitting up and leaning forward; it often occurs after an infection.
Stomach and oesophagus
Heartburn causes a burning sensation behind the breastbone, usually after eating or when lying down.
Typical steps at the doctor's office
- 1If warning signs are present, every minute counts — call 144 immediately, do not try to assess this yourself.
- 2Without warning signs, the doctor asks about the symptoms, risk factors and pre-existing conditions, and examines the heart and lungs.
- 3If a cardiac cause is suspected, an ECG and measurement of the heart muscle marker troponin are part of the basic work-up. A single value does not rule out a recent heart attack, so the measurement is usually repeated over time.
- 4Depending on the suspected cause, this may be followed by an X-ray, cardiac ultrasound, exercise tests or a CT scan of the blood vessels.
What makes serious causes more likely
- Factors suggesting a cardiac cause include older age, smoking, high blood pressure, diabetes, elevated blood lipids, being overweight and a known heart condition.
- Heart attacks in close relatives at a young age are also included.
- Factors suggesting a pulmonary embolism include prolonged bed rest or immobilisation, recent surgery, a long journey, cancer, pregnancy, taking the contraceptive pill, and previous blood clots (thrombosis).
- In women and in people with diabetes, a heart attack more often occurs without the typical chest pain — shortness of breath, nausea, weakness or upper abdominal discomfort may be the main symptoms.
What typically happens next?
Chest pain caused by the muscles usually improves within days to two weeks. Symptoms caused by heartburn usually ease quickly with treatment. When the cause is cardiac, the timing of treatment is the main factor determining the further course. If an initial assessment was unremarkable but the symptoms persist, change, or newly occur during exertion, they should be assessed by a doctor again.
Not sure whether you should go or whom to see? Describe your symptoms — we'll find the right practice in your area.