Chest pain can be the sign of a serious life-threatening condition, yet the majority of patients with chest pain may not have any serious heart or other life-threatening condition.

Understanding different aspects of chest pain can help to determine when to seek medical help. 

Dr Kamalesh Anbalakan, Consultant from the Department of Cardiology at National Heart Centre Singapore (NHCS), a member of the SingHealth group, shares on the definition of chest pain, its various characteristics, the duration and tempo of pain, red flags that require immediate attention, and possible diagnoses.

Definition of chest pain

Chest pain refers to any discomfort or pain that you feel along the front of your body above the tummy. The sensation can vary widely in intensity, duration, and type. 

Chest pain can originate from different structures within the chest, including the heart, lungs, esophagus (food pipe), muscles, ribs, or nerves. It can also be ‘referred’ pain which is an issue in one area of your body, but you feel the pain in another area.

Types of chest pain

Understanding the character or quality of chest pain is essential in identifying its cause. Here are some common descriptions of chest pain and their potential implications:

1. Sharp or stabbing chest pain

  • Possible causes: Sharp or stabbing chest pain is often associated with conditions such as pericarditis (inflammation of the sac around the heart), pleuritis (inflammation of the lining of the lungs), or musculoskeletal problems such as a strained muscle or rib injury and shingles. Of the following musculoskeletal problems are the most common.

  • Specific characteristics: This type of pain is usually localised to a specific area and can worsen with certain movements or breathing. If there is an accompanying rash along the distribution of pain, the diagnosis is likely to be shingles which is a reactivation of the chickenpox virus. 

2. Pressure or squeezing chest pain

  • Possible causes: These sensations are commonly linked to heart-related issues such as angina or a heart attack (myocardial infarction). Angina occurs when blockages in the heart’s blood vessels result in its muscles not getting enough blood. Acid reflux can also mimic such symptoms as the food pipe is directly behind the heart.

  • Specific characteristics: The pain might feel like someone is pressing or squeezing the chest and can radiate to the arms, shoulders, neck, jaw, or back. Angina tends to be exacerbated by physical activity like walking, climbing stairs, or running. Acid reflux tends to be closely related to food intake and recumbency. 

3. Burning sensation

  • Possible causes: A burning feeling in the chest can be a sign of acid reflux also referred to as gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus.

  • Specific characteristics: This type of pain often accompanies a sour taste in the mouth and can be triggered by eating or lying down.

4. Aching or dull chest pain

  • Possible causes: Dull, aching pain might be related to muscle strain, costochondritis (inflammation of the cartilage connecting the ribs to the breastbone), or even anxiety and stress.

  • Specific characteristics: The pain is usually mild to moderate and can persist for a longer duration such as hours or days.

5. Chest tightness or constriction

  • Possible causes: Tightness in the chest is another symptom often linked to heart issues such as angina or heart attack (myocardial infarction). It can also be a sign of an anxiety or panic attack.

  • Specific characteristics: This feeling may come on suddenly and be accompanied by other symptoms such as shortness of breath, sweating, or dizziness.

Duration and tempo of chest pain

How the pain starts, progresses, and ends is critical in identifying its cause. Here's a breakdown of what different patterns might indicate:

1. Sudden, Intense pain

  • Possible causes: Aortic dissection (a tear in the big blood vessels in the chest), pulmonary embolism (a blood clot in the lungs), or heart attack (myocardial infarction) can cause sudden, severe chest pain. Musculoskeletal pain can also present with sudden intense pain but tends to resolve quickly and is not accompanied by other symptoms like breathlessness.

  • Details: These conditions require immediate medical attention. The pain often comes on abruptly and is severe from the start. They generally do not get better without treatment.

2. Intermittent pain

  • Possible causes: Angina or gastroesophageal reflux disease (GERD) can cause pain that comes and goes. With angina, pain is often triggered by physical exertion or stress and relieved by rest. GERD-related pain may be influenced by large meals or body position and can vary throughout the day.

  • Details: Important to review the triggers of intermittent pain to confirm the diagnosis. 

3. Gradual onset pain

  • Possible causes: Conditions like pericarditis (inflammation of the sac around the heart), pleuritis (inflammation of the lining of the lungs) often cause pain that develops gradually.

  • Details: The pain may slowly increase in intensity over time and might be associated with other symptoms like fever or cough. They tend to be related to recent illnesses like flu. Sitting up and leaning forward tends to exacerbate discomfort in pericarditis. 

4. Chronic pain

  • Possible causes: Chronic chest pain lasting weeks or months can be due to issues such as anxiety, musculoskeletal problems, or chronic gastrointestinal conditions.

  • Details: This type of pain is typically less severe but persistent and can affect daily activities.

Red flags and when to seek help

Certain symptoms accompanying chest pain indicate a need for urgent medical evaluation. These "red flags" can help identify potentially life-threatening conditions:

  1. Severe, unrelenting pain: If chest pain is severe and does not go away with rest it could signal a heart attack or another serious condition.

  2. Pain radiating to the jaw, neck or arms: This symptom is often associated with angina and heart attacks. Pain spreading beyond the chest to other parts of the upper body should not be ignored.

  3. Shortness of breath: Difficulty breathing along with chest pain can indicate conditions like a heart attack, pulmonary embolism, or lung infection.

  4. Sweating, nausea, or dizziness: These symptoms, particularly when combined with chest pain, suggest a possible heart attack. Sweating, nausea, and dizziness are common signs that need urgent evaluation.

  5. Loss of consciousness or near fainting: Fainting or feeling like you might pass out can be a sign of a serious heart condition or other medical emergencies. This may be accompanied by heart racing sensation. 

  6. Coughing up blood: Coughing up blood (hemoptysis) with chest pain can be a sign of a pulmonary embolism or other severe lung conditions.

Possible diagnoses

Several potential diagnoses can explain chest pain, ranging from benign to serious. Here are some common causes:

1. Cardiac causes

  • Angina: Chest pain due to reduced blood flow to the heart muscle, usually triggered by physical activity or stress.

  • Heart attack (myocardial infarction): Occurs when blood flow to part of the heart is blocked, causing damage to the heart muscle.

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, causing sharp, stabbing pain.

2. Lung causes

  • Pulmonary embolism: A blood clot in the lungs that causes sudden, sharp chest pain, shortness of breath, and sometimes hemoptysis.

  • Pleuritis (pleurisy): Inflammation of the pleura, the lining around the lungs, causing sharp pain that worsens with breathing or coughing.

  • Pneumonia: Infection of the lungs leading to chest pain, fever, cough, and difficulty breathing.

3. Gastrointestinal causes

  • Gastroesophageal Reflux Disease (GERD): Acid from the stomach flows back into the esophagus, causing a burning sensation in the chest.

  • Esophageal spasm: Sudden, intense contractions of the esophagus that can mimic heart attack pain. This is usually due to acid reflux.

  • Peptic ulcer disease: Sores in the stomach lining can cause burning pain that might be felt in the chest area.

4. Musculoskeletal causes

  • Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum, causing localized chest pain.

  • Muscle strain: Overuse or injury to the chest muscles can lead to pain that worsens with movement.

5. Psychological causes

  • Anxiety or panic attacks: Intense fear or anxiety can cause chest pain along with rapid heartbeat, sweating, and shortness of breath. This pain is usually fleeting but can be very distressing.

6. Other causes

  • Herpes zoster (shingles): A viral infection causing a painful rash along nerve pathways, which can include the chest area.

  • Aortic dissection: A tear in the wall of the aorta, leading to severe, ripping chest pain. This is a medical emergency.

For ease of understanding, here is a graph that shows the breakdown of possible causes of chest pain by age group.

Common causes of chest pain by age group


Graphs cited from the 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain.

How to tell when a chest pain is serious and what to do?

Chest pain due to a serious condition such as a heart attack is often described as a severe heaviness or tightness in the chest that will persist, often for hours. 

However, because time is crucial to successful treatment, anyone with prolonged chest pain for more than 15 to 20 mins should seek urgent help and call an ambulance to go to the nearest hospital.

One feature of coronary artery disease (in which the arteries supplying the heart are narrowed) is that the individual will have chest tightness brought on by exertion and often relieved by resting for a few minutes. This should prompt you to see a doctor without delay.

In contrast, mild chest pain that is poking and localised lasting just a few seconds is unlikely to be a serious heart condition.

In conclusion, chest pain should never be ignored. Understanding its various characteristics and potential causes can help you recognise when to seek help and ensure timely and appropriate medical care.

Ref: H24

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