Chest pain is one of the main reasons why hundreds of thousands of people go to the emergency room every year in Turkey. When many people feel pain in their chest, the first thing that comes to their mind is a heart attack, and they rightfully experience great fear. But the truth is that 70-80% of chest pain is caused by non-cardiac causes. However, this rate should never make you complacent because the remaining 20-30% is vital and can result in death if not intervened in time.
In this article, we will explain in detail the 25 most common causes of chest pain. Hangi ağrının zararsız, hangisinin acil olduğunu anlamanız için ağrının yeri, şiddeti, süresi, eşlik eden belirtiler gibi tüm ipuçlarını sizinle paylaşacağız. After reading it, you will know your own pain much better and know exactly when to stay calm and when to call 112 without wasting any time.
What are the Types and Characteristics of Chest Pain?
Chest pain does not feel the same for everyone. While some people describe a vise-like squeezing pain in the middle of their chest, others use completely different expressions such as burning, stinging, or pinprick. Using these differences, doctors can largely predict the source of pain without even examining it.
Pain can usually be felt in the middle part of the chest, on the left side, on the right side, or as if radiating to the back, jaw, or arms. Sometimes it occurs only while breathing, sometimes while eating, and sometimes while sitting without moving at all. Its severity can range from mild discomfort to pain so severe that you cannot speak. Its duration can range from a few seconds to several weeks. All these details are the greatest guide in finding the cause of the pain.
Chest Pain Due to Cardiovascular Diseases
Heart Attack (Myocardial Infarction)
During a heart attack, there is a feeling of severe squeezing, crushing and heaviness in the chest, usually in the middle or on the left side. Patients describe it as "an elephant sat on me" or "my chest is being squeezed in a vice". Pain may radiate to the left arm, jaw, back, or shoulder. It is accompanied by cold sweats, nausea and vomiting, shortness of breath and fear of death. It lasts longer than 20 minutes and is not relieved by rest. In women and the elderly, it can sometimes manifest itself only with atypical symptoms such as shortness of breath or stomach upset.
Angina Pectoris
It is the heart's inability to receive enough oxygen as a result of narrowing of the cardiac vessels. It usually occurs when climbing stairs, walking fast, getting angry, or in cold weather. The pain lasts 2-10 minutes and goes away in a few minutes with rest or sublingual medication (nitrate). While stable angina continues in the same way for many years, unstable angina is an emergency and a sign of crisis if it has just started or increased in severity in recent days.
Aortic Dissection (Aortic Rupture)
It is a tearing pain towards the back that starts suddenly and is described as "the most severe pain of my life". Blood pressure becomes very high, there may be asymmetry in pulses. For every hour of delay, the risk of death increases by 1-2%. You should definitely call 112 at the same time and go to the nearest emergency room without choosing a hospital.
Pericarditis and Myocarditis
It is an inflammation of the pericardium. The pain is stinging and increases with bending forward and decreases with lying on your back. Deep breathing and coughing aggravate the pain. It is common in young people after viral infection.
Pulmonary Embolism (Lung Clot)
Sudden onset of shortness of breath accompanied by chest pain. Pain usually increases with breathing. Suspicion increases if there is a history of leg swelling, redness, long plane rides or post-operative inactivity.
Chest Pain Originating from the Digestive System
Reflux (GERD) – The Cause Most Often Confused with a Heart Attack
A burning pain occurs in the middle of the chest as a result of stomach acid leaking into the esophagus. It usually increases after eating, when lying down, or when leaning forward. It is accompanied by bitter water in the mouth, burping, and a feeling of stuckness in the throat. Many patients go to the emergency room thinking "I'm having a heart attack", but the tests are completely normal.
Esophageal Spasm
It is a sudden and violent contraction of the esophagus muscles. The pain can be exactly the same as a heart attack: crushing, shooting in the left arm, causing sweating. However, it goes away on its own within a few minutes. Cold or hot drinks may trigger it.
Gallbladder Stones and Pancreatitis
There is severe pain in the right upper quadrant or lower chest, radiating to the back. It starts after a fatty meal and is accompanied by nausea and vomiting.
Chest Pain Originating from Musculoskeletal System
Costochondritis (Tietze Syndrome)
It is the inflammation of the cartilages where the ribs meet the breastbone. The pain is sharp and stinging, and when you press with your finger, there is severe pain at that point. Coughing, breathing deeply, and moving the arms increase the pain. It usually occurs after a viral infection and resolves spontaneously within a few weeks.
Muscle Strain and Fibromyalgia
It occurs after sports, heavy lifting or sleeping in the wrong position. Pain increases with movement and decreases with rest. There is sensitivity to touch.
Chest Pain Originating from Respiratory System
Pneumonia and Pleuritis
Inflammation of the lung membrane due to pneumonia causes stinging pain when breathing. It is accompanied by fever, phlegmy cough and weakness.
Pneumothorax (Lung Collapse)
Especially in tall, thin young men, sudden onset of chest pain localized to one side and shortness of breath occur. The risk is very high in smokers.
Chest Pains of Psychological Origin
Panic Attack
It is characterized by sudden onset of intense chest pain, heart palpitations, feeling of not being able to breathe, and fear of death. The pain lasts 10-20 minutes and goes away on its own. Patients frequently go to the emergency room, but all tests come back normal.
Shallows (Herpes Zoster)
One-sided, throbbing pain begins in the chest area, and within a few days, water-filled rashes appear in the same area.
When Should You See a Doctor Urgently?
If you have any of the following situations, call 112 or go to the nearest emergency room without delay:
- The pain has just started and is getting worse
- Pain lasts longer than 5 minutes and is not relieved by rest
- There is cold sweat, nausea, vomiting, feeling faint
- Severe shortness of breath
- There is spread from the chin down to the arms and back
- Blood pressure is high or low, pulse is irregular
- You have risk factors such as diabetes, smoking, high cholesterol
- If you have ever had heart disease
- Pain started with physical activity
- Your consciousness becomes blurred or you cannot speak
What Will the Doctor Ask You and What Examinations Will He Perform?
When you go to the emergency room, an ECG will be taken and blood will be taken (such as troponin, D-dimer). If the ECG is normal and troponin is not elevated, the chance of a heart attack is greatly reduced. Then, a chest x-ray, heart ultrasound (echocardiography), stress test or coronary CT angiography may be requested if necessary. Endoscopy is sufficient for suspected reflux, and physical examination is sufficient for musculoskeletal pain.
Relaxation Methods and Suggestions at Home
- If reflux is suspected, raise the head of the bed 15-20 cm, eat dinner at least 3 hours before bedtime, stay away from chocolate, coffee and acidic drinks.
- Hot shower or hot towel application relieves muscle pain.
- If you are having a panic attack, breathe slowly and deeply (inhale for 4 seconds, hold for 4 seconds, exhale for 8 seconds).
- Do not lift heavy items for a while for costochondritis, ibuprofen group drugs may be useful (consult your doctor).
Frequently Asked Questions
If chest pain occurs in the left arm, is it definitely a heart attack?
No, it is not definitive. Reflux, esophageal spasm, muscle pain, and panic attacks can also spread to the left arm. However, if there is left arm pain, it is the safest way to go to the emergency room as the risk is high.
I have chest pain after eating, could it be heart disease?
Chest pain after eating is usually caused by reflux or esophagus. Heart attacks are rarely food related. However, if it has just started and its severity is increasing, you need to be careful.
What causes chest pain in young people? Could I have a heart attack?
The most common causes in young people between the ages of 20-30 are panic attacks, costochondritis, muscle pain and reflux. Heart attack is very rare, but the risk increases in those who have a family history of heart disease at an early age, smokers, or use substances such as cocaine.
What does it mean if there is back pain along with chest pain?
Chest pain in the back suggests serious conditions such as heart attack, aortic dissection, pancreatitis, gallbladder inflammation or esophageal rupture. You need to go to the hospital urgently.
How long does chest pain last before I should go to the emergency room?
In case of chest pain that lasts longer than 5 minutes and increases in severity, 112 should be called without waiting. The thought of “Let me wait a little longer” can be life-threatening.
