What's causing your chest pain?

Chest pain causes

Frustratingly for doctors and patients alike, there are a lot of things that can potentially cause chest pain.

Dr Jeff Foster, a GP at Spire Parkway in Solihull, explains: "Chest pain can be difficult to manage sometimes because it can be caused by several completely different parts of the body: heart, lungs, digestive system, muscles, bones and psychological conditions. Virtually all of these systems can have minor or serious conditions which can make it hard for a doctor to find the cause."

Fortunately, most of the time chest pain does not have a serious cause, but it's still important to seek medical advice as soon as possible after experiencing it, explains cardiologist Dr Michael MacDonald.

He reveals that your doctor will consider conditions like angina, a chest infection, digestive conditions like acid reflux or stomach ulcers, gallstones, inflammation of tissues around your ribs and muscle injuries.

"The good thing is that most chest pain is not too serious. But it's still important you seek medical advice and let your doctor decide on the diagnosis. If you have any concern it is a heart attack, dial 999 [if in the UK] straightaway," he says.

Patient picks for Chest pain

Chest and lungs

What is the treatment for costochondritis?

Costochondritis is a common condition. Costochondritis is a condition where the cartilage (connective tissue) joining the ribs to the breastbone (sternum) becomes inflamed and painful. It usually causes sharp chest pain, worse on deep breathing. The symptoms of costochondritis can be similar to other serious conditions, such as a heart attack. Costochondritis, though, isn't serious and gets better with time. Pain medicines, including anti-inflammatory medicines, can help to treat the symptoms.

by Dr Doug McKechnie, MRCGP

Chest and lungs

Pleurisy

Pleurisy is due to inflammation of the pleura next to the lung. It is most often caused by infection with a germ (a viral infection). In these cases the pain can be severe but soon goes. Various other lung disorders can also cause a 'pleuritic pain' similar to pleurisy. A pleuritic pain is a chest pain which is typically sharp and 'stabbing' in a part of the chest. The pain is usually made worse when you breathe in or cough.

by Dr Doug McKechnie, MRCGP

When it could be serious

The warning signs of a heart attack, explains McDonald, are: "A sudden chest pain that may spread to your jaw, neck, arms (usually left), or back. At the same time, you may have pressure, squeezing, heaviness or tightness in your chest, shortness of breath, nausea and sweating. If you have these, [if in the UK] call 999 immediately."

Some people's description of a heart attack is that it was "like an elephant sitting on my chest".

Heart attack in women

In women the symptoms of a heart attack may be less severe and many women seek medical help later than they should.

Foster says: "There is increasing evidence that the symptoms felt in heart attacks can differ in men and women. Women often still feel a central crushing chest pain radiating to the arm or neck, but some studies suggest that women may report this pain in a different way: as being sharp, or being located in the upper abdomen, or with back pressure. Women may also have common nonspecific symptoms such as extreme fatigue, dizziness, or fainting."

Angina

Angina is chest pain that comes from the heart. This is a common but potentially serious condition.

There are two types of angina:

• Stable angina which occurs during exercise.

• Unstable angina which occurs at any time.

Foster describes angina as being a 'pre-heart attack' condition.

"Once the arteries are narrow to a point of nearly being blocked off, occasionally the blood supply to the heart will be compromised enough to cause chest pain which mimics a heart attack. Unstable angina is very close to a full-blown heart attack," he reveals.

How doctors investigate chest pain

Foster reveals that doctors use the acronym SOCRATES to help them get to the bottom of what's causing a patient's chest pain. Socrates stands for: Site, Onset, Character, Radiation, Associations, Time, Exacerbating factors and Severity.

Site

The site of the pain. Is the pain felt on the right, left or centre of your chest? If it's on the left or central, it could be due to a heart problem. If it's felt on the right, it could signal an issue with your lungs or a particular muscle.

Onset

How long you have had the pain is an important factor. Has it been there for weeks and it's getting worse (which could be linked to anxiety) or has it come on suddenly?

Character

What type of pain is it? A sharp and stabbing pain could signal lung disease or a nerve problem. While a more burning pain could be due to indigestion.

Radiation

Where is the pain and does it radiate down the arm? Pain in the left arm can be linked to heart disease, whereas on the right it could be your gallbladder.

Association

Does your pain seem associated with anything like coughing or anxiety?

Time

How long does the pain last? Is it worse in the morning, evening or after eating?

Exacerbating factors

Does anything help, such as over-the-counter medication?

Severity

And finally, how severe is it? A scale of 1-10 describes mild pain that comes on gradually, to severe pain.

Don't self-diagnose; see your GP

It's important not to self-diagnose, but you can prepare for your appointment with your doctor by thinking about these questions.

And whichever type of chest pain you have, it's sensible to have it checked out, especially if it occurs during exercise. Make some notes about when it happens, how often you experience it, and the type of pain it is. If you are in any doubt that it could be a heart attack, if in the UK, call 999 immediately.

See our Chest Pain leaflet for more detailed information.