Chest pain

Key points about chest pain

1. There are many causes of chest pain. Most of the time, it is not caused by heart problems, especially if you are younger than 40 and otherwise well.
2. However, chest pain can sometimes be a sign of something serious. If you have new symptoms of chest pain and you smoke, have high blood pressure, diabetes, high cholesterol or are more than 50 years old, you are more likely to have heart problems.
3. Some of the more serious causes of chest pain include a heart attack, angina, pulmonary embolism, pneumothorax (collapsed lung) or pericarditis (inflammation of the lining around your heart).
4. Don’t diagnose yourself from this information or any information you find on the internet. You need to talk to a healthcare professional who can give you proper advice.
5. Treatment will depend on what is causing your chest pain.

What are the causes of chest pain?

There are many causes of chest pain. Most of the time chest pain is not caused by heart problems, especially if you are younger than 40 and otherwise well. However, even mild chest tightness or discomfort can be the first sign of something more serious such as a heart attack or a blood clot in your lung.

Some of the more serious causes of chest pain caused by problems of your heart and lungs include:

• heart attack – blockage of one of the blood vessels supplying your heart
• angina – chest pain that occurs when the blood supply to the muscles of your heart is restricted
• pericarditis – inflammation of the lining around your heart
• aortic dissection – a tear in your main artery (the aorta)
• pulmonary embolus – a clot in one of the blood vessels in your lungs
• pneumonia – a chest infection
• pneumothorax (collapsed lung) – air trapped in between your lung and chest wall
• ruptured oesophagus – this can happen after retching, vomiting or medical procedures
• lung cancer or other cancers.

Other causes of chest pain include:

• heartburn, indigestion or gastroesophageal reflux disease (GORD)
• stomach ulcer or peptic ulcer
• gallstones or pancreatitis (inflammation of the pancreas)
• chest wall injury such as muscle strain or a bruised or broken rib
• costochondritis – inflammation of joints in your chest
• anxiety or panic attack
• shingles – a blistering skin rash with pain
• breast pain. 

Sometimes it is not possible to identify the cause for chest pain after a thorough medical assessment. It may then be called ‘non-specific’ chest pain.

What are the symptoms of chest pain?

Chest pain is a broad term for any pain, tightness or discomfort felt in your chest area. Depending on the cause of your chest pain, it can start suddenly or slowly, and may spread to other areas such as your back, jaw, neck or arms. It can also be a sharp pain, stabbing pain or a heavy chest pain. You may also have other symptoms along with chest pain, which will help your doctor work out what is causing your chest pain.

How are the causes of chest pain diagnosed?

Your doctor will ask you questions about your chest pain and other symptoms you may have. This will help diagnose what is causing your chest pain.

Some of the questions your doctor will ask about your chest pain include:

• Where is your chest pain?
• Did your chest pain start slowly or suddenly?
• Is there anything that will worsen or relieve your chest pain?
• How does your chest pain feel? Stabbing, burning, heaviness or tightness?
• Does your chest pain spread to other parts of your body?

Your doctor will also ask you about your past medical history and check if you have any risk factors that can increase your chance of getting heart disease, such as smoking, diabetes, high blood pressure, high cholesterol, or if you are older than 50 years.

Your doctor will examine your heart and lungs, including checking your blood pressure and pulse, and listening to your heart and lungs.

Depending on what your doctor thinks is causing your chest pain, they may order some tests. These may include:

• blood tests
• an electrocardiogram (ECG) to check the electrical activity of your heart
• an echocardiogram (echo) – an ultrasound scan of your heart to check your heart functioning
• a chest x-ray
• a coronary angiography – a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart
• a CT scan of blood vessels in your lungs (CTPA) to check for blood clots or of blood vessels in your heart (CT coronary angiogram)
• an endoscopy – a thin flexible tube with camera inserted through your gut to examine your stomach lining.

How is chest pain treated?

Treatment depends on the cause of your chest pain so it is important not to treat chest pain yourself. Your doctor will discuss the best treatment option for you for your condition.

Learn more

The following links provide further information about chest pain. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Chest pain Ministry of Health, NZ
Chest pain first aid HealthInfo Canterbury, NZ
Heart attack warning signs Heart Foundation NZ
Chest pain Mayo Clinic, US
Chest pain (beyond the basics information sheet)  UpToDate, US
Chest pain NHS, UK
Chest pain Patient Info, UK

References

1. Chest pain Auckland Regional HealthPathways, NZ, 2020
2. Recent-onset chest pain of suspected cardiac origin – assessment and diagnosis clinical guideline NICE Guidelines, UK, 2016
3. Chest pain Patient Info, UK

Reviewed by

	Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.