Chest pain 

Introduction 

Heart attack

A consultant cardiologist explains what a heart attack is, the symptoms, surgical treatments and why it's important for coronary heart disease patients to reduce their risk factors.

Media last reviewed: 02/10/2013

Next review due: 20/10/2015

Chest pain is pain felt in your upper body, from your shoulders down to your ribs.

Although chest pain can be a symptom of many different conditions, it should always be taken seriously because it could be a sign of a heart attack (see below).

The information and advice on this page should not be used to self-diagnose your condition, however, it will give you an idea of what is causing your chest pain and whether you need to see your GP or seek emergency help. It does not include every possible cause of chest pain, but the most common causes are covered.

When to get help

Chest pain could be heart pain if:

Could it be a heart attack?

If your chest pain is triggered by physical activity but passes a few minutes after you stop exercising, it may be angina. The chest pain or tightness may spread from your chest to your left arm, neck and back.

Angina is caused by restricted blood flow to the heart. This is because one or more of the three arteries supplying blood to the heart muscle has narrowed. It causes chest pain because the heart does not get enough oxygen.

If you have the symptoms listed above but the pain lasts more than 15-20 minutes, you could be having a heart attack. A heart attack can feel as if your chest is being pressed or squeezed by a heavy object.

The main differences between angina and a heart attack are: 

  • angina is brief, relatively mild, and usually triggered by physical effort
  • the discomfort of a heart attack will continue despite medication (glyceryl trinitrate spray, which provides immediate relief from the symptoms of angina). It often occurs at rest or during sleep, is severe and can be accompanied by other symptoms, such as sweating

Dial 999 immediately to request an ambulance if you think that you or someone else is having a heart attack.

Do not worry if you have any doubts about whether it is a heart attack. Paramedics would prefer to be called out to find that an honest mistake has been made than to be called out when it is too late to save a person’s life.

Common causes of chest pain

In most cases, chest pain is not caused by heart-related conditions. Common causes of chest pain include:

The information below should give you an idea of whether these conditions are causing your chest pain.

However, you should always visit your GP for a proper diagnosis and for advice about how to relieve the pain and tackle any underlying cause.

Chest pain that gets worse when lying down

Chest pain that gets worse when you lie down could be the result of acid leaking from your stomach and into your oesophagus.

This common condition is known as heartburn and gastro-oesophageal reflux disease (GORD). It can be usually be easily treated by making lifestyle changes and, if necessary, using medication.

Read more about treating GORD.

It is important to be aware that heart-related chest pain can sometimes occur while lying down. For example, angina decubitus is a complication of heart failure that causes tightness in the chest and a stitch-like feeling around the heart.

Therefore, you should go to see your GP if you have unexplained chest pain while you are lying down.

Chest pain and a tender chest

There are several potential causes of chest pain and a tender chest.

Chest pain and tenderness without any swelling may be caused by a pulled muscle in your chest wall. This can be surprisingly painful, but with rest, the pain should ease and the muscle will heal with time.

If you have pain, swelling and tenderness around your ribs, you may have a condition called costochondritis. This is caused by inflammation in the joints between the cartilages that join the ribs to the sternum (breastbone). Your symptoms should improve after a few weeks.

Chest pain can also be caused by other problems, such as anxiety. As well as making you feel worried, anxiety can also cause physical symptoms, such as chest pain, shortness of breath and heart palpitations.

If your GP thinks your chest pain is being caused by anxiety, they will discuss with you the possibility of psychological treatments, such as counselling.

Less common causes

Less commonly, chest pain may be caused by one of the conditions described below. See your GP if you think you have one of these.

Pleurisy

Pleurisy is inflammation of the double-layered membrane surrounding the lungs. The two layers rub against each other, causing a sharp, stabbing chest pain that gets worse when you breathe in.

The pain of pleurisy can often be relieved by taking shallow breaths. The pain can be treated with ibuprofen while your GP investigates the underlying cause of your pleurisy.

Read more about pleurisy.

Shingles

Shingles is an infection of a nerve and the area of skin around it. It is caused by the herpes varicella-zoster virus, which also causes chickenpox.

The shingles rash usually affects a specific area on either the left or right side of the body and does not cross over the midline (an imaginary line that runs from between your eyes, down past your belly button).

Read more about shingles.

Mastitis

Mastitis is pain and swelling of the breast which is usually caused by an infection, most commonly during breastfeeding.

Antibiotics may be prescribed to help clear the infection. You may also need to change your breastfeeding technique. Your GP or midwife will be able to advise you about this.

Read more about mastitis.




Page last reviewed: 29/11/2012

Next review due: 29/11/2014

Ratings

How helpful is this page?

Average rating

Based on 552 ratings

All ratings

Add your rating

Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

WythenshaweBi said on 19 September 2014

I get frightened when I get chest pain - it goes from front to back, and it hurts like hell. It can happen when I'm watching tv, or chatting with friends, or reading a book, all times when I'm resting.When I feel it, I try to relax and damp down the immediate panic - I don't want to stress my heart any further. My arms ache, and my neck hurts on the left, and I get a feeling of pressure in my left ear that hurts too. I had a heart trace some years ago, and my heart seemed fine, so I put it down to a freaky chance thing. It seems to be happening more often though.

Report this content as offensive or unsuitable

Ancientmariner said on 12 June 2014

I thought that the flow-chart was rather poor as it told me to phone for an ambulance. I didn't do this but dialled 111 instead. I had been doing some heavy lifting a few days earlier so suspected pulled muscles. I had also been doing sit-ups underneath my 4 x 4 fixing a loose bumper. During the job it poured down and I got wet. I then got a chill.

I noticed a pink bruise or rash on the left side of my chest. Later after searching the Internet it matches the colour of a Shingles rash exactly. The sore itchy burning sensation DOES cross over in spite of what the NHS website states and it has now gone up to the back of my neck.

There seems to be no cure so like many illnesses its just a case of working through it. What is curious is if the rash is touched it feels numb but the skin next to the rash feels sore and tingles when touched. Definitely not a heart attack!

Report this content as offensive or unsuitable

neil9327 said on 09 June 2014

I don't know why there isn't mention of the other cause of chest pain - a chest infection!
Bronchitis and Pneumonia are both chest infections, and lead to chest pains.

Report this content as offensive or unsuitable

BeckyLeeR16 said on 04 April 2014

For Jjsearle21 have you considered maybe gaul stones?? .. mime started like that and ened up in hospital several times b4 they could xray me to find out as i was 20 weeks pregnant when it all started. The pain was horendus go to doc and request an xray ect and all will show .. hope you get help :) xx

Report this content as offensive or unsuitable

bridget4 said on 17 February 2014

Mark279 this question is for u, just wondering did u get ur results back from xrey..

Report this content as offensive or unsuitable

JJSearle21_ said on 17 February 2014

So, my chest feels really tight and I am getting shooting sharp pains through my chest and shoulder and around my armpit area. My stomach feels really tight and it feels like there is a knife wedged in the top of my back. Paracetamol and Ibuprofen isn't doing anything for it.. also feeling more breathless than usual?

Any suggestions?

Report this content as offensive or unsuitable

Jonalong said on 13 February 2014

MARK279 - I would get yourself checked out by another doc - go to a&e if you have to! sooner rather than later mate just in case.

Report this content as offensive or unsuitable

MARK279 said on 28 January 2014

I don't know if this is related but I have had very bad chest pains to the right of my chest which sometimes goes to the centre of my chest, I feel faint and nauseas and when i wake up it fells like I haven't slept at all since the beginning of Christmas 2013. I have been to the doctors quiet a few times!
The first time I went the doctor said that it was muscular pain and said that it was due to anxiety and gave me some tablets. I took these tablets and didn't work so I then went back after Christmas and he then said that I have asthma and gave me a blue and brown inhaler these have proven in effective. I then took myself to A&E where they did an ECG and everything came back normal. I have been back to the doctors since and he has prescribed me antibiotics and naproxen, the antibiotic worked for a while and then the pain has come back even stronger. I have now been booked for a X-ray tomorrow to see if they is anything underlying problem.

Can anyone help me as i think my doctor is kind of useless

Report this content as offensive or unsuitable

VTkai said on 24 July 2013

The paragraph following your abstract:

" It is important to be aware that heart-related chest pain can sometimes occur while lying down. For example, angina decubitus is a complication of heart failure that causes tightness in the chest and a stitch-like feeling around the heart.
Therefore, you should go to see your GP if you have unexplained chest pain while you are lying down."

Hence: I do believe the information on this website is correct.

Report this content as offensive or unsuitable

Ajcs said on 10 September 2012

RE the following text:

"Your chest pain gets worse when you lie down

Pain in your chest that gets worse when you lie down is probably not heart disease. It is likely to be heartburn caused by acid leaking from your stomach and into your oesophagus. This is very common and known as heartburn and gastro-oesophageal reflux disease (GORD). It can easily be treated by changing your lifestyle and, if necessary, using medication. "

I read this and was reassured by it following symptoms my father had been experiencing. However I've subsequently discovered it's incorrect - there are some forms of angina (angina decubitus - which is what my dad was suffering from) which specifically occur when someone is lying down. The information on this website should be corrected.

Report this content as offensive or unsuitable

Healthy hearts

Heart disease is the most common cause of death in the UK. Find out what to do to keep your heart fit for purpose

NHS ambulance services

Read about different ambulance services in England and find out when to call 999