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Chest Pain


Andrea D. Thompson

, MD, PhD, Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan;

Michael J. Shea

, MD, Michigan Medicine at the University of Michigan

Last full review/revision Sep 2020| Content last modified Sep 2020

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

Acute coronary syndromes (heart attack or unstable angina) involve a sudden blockage of an artery in the heart (coronary artery) that cuts off the blood supply to an area of the heart muscle. If some of the heart muscle dies because it does not get enough blood, that effect is termed a heart attack (myocardial infarction). In stable angina, long-term narrowing of a coronary artery (for example by atherosclerosis) limits blood flow through that artery. This limited blood flow causes chest pain when people exert themselves.

Life-threatening causes

Some causes of chest pain are immediately life threatening but, except for heart attack or unstable angina, are less common:

Other causes range from serious, potential threats to disorders that are simply uncomfortable.

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?). 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.

Some Causes and Features of Chest Pain


Common Features*


Heart disorders

Heart attack (myocardial infarction) or unstable angina

Immediately life threatening

Sudden, crushing pain that

  • Spreads to the jaw or arm
  • May be constant or come and go

Sometimes shortness of breath or nausea

Pain that occurs during exertion and is relieved by rest (angina pectoris)

Certain abnormal heart sounds, heard through a stethoscope

Often warning signs‡

ECG, done several times over a period of time

Blood tests to measure substances that indicate heart damage (cardiac markers)

If ECG and cardiac marker levels are normal, often CT of heart arteries or a stress test

If ECG or cardiac marker levels are abnormal, heart catheterization

Thoracic aortic dissection (a tear in the wall of the part of aorta in the chest)

Immediately life threatening

Sudden, tearing pain that spreads to or starts in the middle of the back

Sometimes light-headedness, stroke, or pain, coldness, or numbness in a leg (indicating inadequate blood flow to the leg)

Sometimes a pulse or blood pressure in one limb that differs from that in the other limb

Usually in people who are over 55 and have a history of high blood pressure

Warning signs

Chest x-ray

CT of the aorta

Transesophageal echocardiography (ultrasonography of the heart with the ultrasound device passed down the throat)

Pericarditis (inflammation of the membrane around the heart)

Potentially life threatening

Sharp pain that

  • Is constant or comes and goes
  • Is often worsened by breathing, swallowing food, or lying on the back
  • Is relieved by leaning forward

An abnormal heart sound, heard through a stethoscope



Blood tests to measure substances that indicate heart damage (cardiac markers)


Digestive tract disorders

Esophageal rupture

Immediately life threatening

Sudden, severe pain immediately after vomiting or after a medical procedure involving the esophagus (such as endoscopy of the esophagus and stomach or transesophageal echocardiography)

Several warning signs‡

Chest x-ray

X-rays of the esophagus taken after the person swallows water-soluble contrast (esophagography)

Pancreatitis (inflammation of the pancreas)

Potentially life threatening

Severe, constant pain that

  • Occurs in the upper middle of the abdomen or in the lower chest
  • Is often worse when lying flat
  • Is relieved by leaning forward


Upper abdominal tenderness

Sometimes shock

Often in people who abuse alcohol or who have gallstones

Blood tests to measure an enzyme (lipase) produced by the pancreas

Sometimes CT of the abdomen

Peptic ulcer§

Recurring, vague discomfort that

  • Occurs in the upper middle of the abdomen or lower chest
  • Is relieved by antacids and sometimes by food

Often in people who smoke, drink alcohol, or do both

No warning signs‡

A doctor's examination

Sometimes endoscopy

Gastroesophageal reflux (GERD)§

Recurring, burning pain that

  • Spreads from the upper middle of the abdomen to the throat
  • Is worsened by bending over or lying down
  • Is relieved by antacids

A doctor's examination

Sometimes endoscopy

Gallbladder and bile duct disorders (biliary tract disease)§

Recurring discomfort that

  • Occurs in the upper right of the abdomen or the lower middle of the chest
  • Occurs after meals (but not after exertion)

Ultrasonography of the gallbladder

Sometimes hepatobiliary scan (HIDA)

Swallowing disorders in which there is abnormal movement (propulsion) of food through the esophagus

Pain that

  • Has developed gradually over a long period of time
  • May or may not occur during swallowing

Usually difficulty swallowing

Sometimes x-rays of the upper digestive tract after barium is given by mouth (barium swallow)

A test to determine whether contractions in the digestive tract are normal (esophageal manometry)

Lung disorders

Pulmonary embolism (blockage of an artery in the lungs by a blood clot)

Immediately life threatening

Often sharp pain when breathing in, shortness of breath, rapid breathing, and a rapid heart rate

Sometimes mild fever, coughing up blood, or shock

More likely in people with risk factors for pulmonary embolism (such as previous blood clots, recent surgery especially surgery on the legs, prolonged bed rest, a cast or splint on a leg, older age, smoking, or cancer)

CT or nuclear scanning of the lungs

A blood test to detect blood clots (D-dimer test)

Tension pneumothorax (a collapsed lung with a high-pressure buildup of air in the chest)

Immediately life threatening

Significant shortness of breath

Low blood pressure, swollen neck veins, and weak breath sounds on one side, heard through a stethoscope

Typically occurs only after a severe chest injury

Usually only a doctor's examination

Sometimes chest x-ray


Potentially life threatening

Fever, chills, cough, and usually yellow or green phlegm

Often shortness of breath

Sometimes pain when breathing in

A rapid heart rate and congested lungs, detected during the examination

Chest x-ray

Pneumothorax (a collapsed lung)

Potentially life threatening

Sudden, sharp pain, usually on one side of the chest

Sometimes shortness of breath

Sometimes weak breath sounds on one side, heard through a stethoscope

Chest x-ray

Pleuritis (inflammation of the membrane around the lung)§

Sharp pain when breathing

Usually in people who have recently had pneumonia or a viral respiratory infection

Sometimes cough

No warning signs‡

Usually only a doctor's examination

Other disorders

Pain in the chest wall,§ including the muscles, ligaments, nerves, and ribs (musculoskeletal chest wall pain)

Pain that

  • Is typically persistent (lasting days or longer)
  • Is worsened by movement and/or breathing
  • May have no apparent cause or may result from coughing or overuse

Tenderness in one spot on the chest

No warning signs‡

Only a doctor's examination


Pain that is

  • Nearly constant
  • Affects widespread areas of the body
  • Is usually accompanied by fatigue and poor sleep quality

Only a doctor's examination


Sharp pain in a band around the middle of the chest but only on one side

A rash of many small blisters. sometimes filled with pus, in the painful area and sometimes appearing only after the pain

Only a doctor's examination

Cancers of the chest or chest wall

Sometimes pain that is worse when breathing in

Sometimes chronic cough, smoking history, weight loss, swelling of lymph nodes in the neck

Chest x-ray

Chest CT

Sometimes a bone scan

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† For most people with chest pain, the oxygen level in blood is measured with a sensor placed on a finger (pulse oximetry), ECG is done, and a chest x-ray is taken.

‡ Warning signs include

  • Abnormal vital signs (an abnormally slow or fast heart rate, rapid breathing, and abnormally low blood pressure)
  • Signs of decreased blood flow (such as confusion, pale or gray skin color, and excessive sweating)
  • Shortness of breath
  • Abnormal breath sounds or pulses
  • New heart murmurs

§ Unless otherwise described, causes are usually not dangerous, although they are uncomfortable.

CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.


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.

If these tests do not show an acute coronary syndrome, doctors often then do a stress test 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) 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 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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
acetaminophen TYLENOL
dipyridamole PERSANTINE

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