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Heart Disease

Information, Symptoms, Treatments and Resources


Not a Heart Attack? Other Causes of Chest Pain


When chest pain may be a sign of something else

By Katherine Solem 


Chest pain (also called angina) is nothing to mess around with. Chest pain or discomfort is a key warning sign of a heart attack. And when treating a heart attack, time is of the essence: the sooner you seek emergency medical treatment, the better your chances of surviving a heart attack and reducing damage to the heart muscles. 

However, especially in people younger than 40, when heart attack and heart disease is less common, chest pain can also be a symptom of range of conditions that aren't directly related to the heart or heart disease, like indigestion and asthma.

Here are some conditions that can cause chest pain plus other distinguishing symptoms. Just remember, if you think you are having a heart attack, even if you're not sure, call 911 immediately.



Condition Chest Pain Symptoms Other Symptoms What it Is
Stable angina

· Typically occurs with activity or stress

· Occurs behind or slightly to the left of the breastbone

· Feels like tightness, heavy pressure, squeezing or crushing pain

· May spread to the shoulder, arm, jaw, neck or back

· Usually begins slowly and gets worse before going away; pain typically lasts less than 5 minutes

· May feel like gas or indigestion

· Occurs at predictable times with a specific amount of exertion or activity

· May continue without much change for years

· Quickly relieved by rest or nitrates (nitroglycerin), but returns with additional activity or stress

Angina is caused by too little blood flow to the heart. The most common cause of angina is coronary heart disease (CHD).

Unstable angina

· Sudden chest pain that may also be felt in the shoulder, arm, jaw, neck or back

· Feels like tightness, squeezing, crushing, burning, choking or aching

· Occurs at rest and does not easily go away when using medicine


· Suddenly becoming more frequent, severe or longer-lasting or brought on by less exertion than before

· Occurring at rest with no obvious exertion or stress; pain may wake you up

· Doesn't respond to rest or nitroglycerin

· Has started recently and become more severe over time


Unstable angina is a type of acute chest pain that occurs when your heart doesn't get enough oxygen. It can be a warning sign of a heart attack.

Coronary artery disease due to atherosclerosis is by far the most common cause of unstable angina.

If you have stable angina, and the chest pain starts to feel different, lasts longer than 15 - 20 minutes or occurs at different times, you may be developing unstable angina.

Heart attack

· Lasts longer than 5 minutes and is not relieved by rest or nitroglycerin tablets

· Feels like pressure, tightness, squeezing, crushing, intense burning or aching

· Pain or discomfort radiates to your back, shoulder, neck, jaw or teeth, arm or wrist


· Shortness of breath

· Dizziness

· Fainting

· Nausea

· Vomiting

· Rapid or irregular heartbeat

· Loss of consciousness

· Feeling of impending doom

A heart attack is when low blood flow causes the heart to starve for oxygen. Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. Without enough oxygen, the heart muscle dies or becomes permanently damaged.


Coronary artery spasm (also called variant angina)

· Severe pain under the chest bone

· Feels like pressure, squeezing tightness, constriction or crushing

· May spread to the neck, jaw, shoulder or arm

· Often occurs at rest

· May occur at the same time each day, usually between midnight and 8:00 AM

· Lasts from 5 to 30 minutes


Coronary artery spasm is a temporary, sudden contraction in one location in the artery muscle walls in the heart which slows or stops blood flow through the artery and starves the heart of oxygen-rich blood.

Coronary artery spasm is relatively rare. It affects approximately 4 out of 100,000 people and approximately 2% of patients with angina.



· Burning sensation in the esophagus, just below or behind the breastbone

· Often rises in your chest and may radiate to the neck or throat

· Burping

· Back up of food into the mouth

· Nausea, vomiting

Heartburn is often caused by indigestion. If you have frequent, ongoing heartburn, you may have  gastroesophageal reflux disease (GERD).

An over-the-counter antacids and dietary changes can help relieve symptoms.


· Chest tightness


· Wheezing

· Coughing (this may be the main symptom in some people)

· Rapid, shallow breathing or difficulty breathing

· Sleep disturbance

· Tiring quickly during exercise


Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swell, reducing the amount of air that can pass by, and can lead to wheezing sounds.

Panic attack

· Chest pain or tightness

· Pounding or racing heart or irregular heartbeat

· Feeling of intense fear, terror or anxiety

· Trouble breathing or very fast breathing

· Sweating

· Nausea or an upset stomach

· Numbness or tingling

· Dizziness, shaking or trembling

· Chills or hot flashes

· Fear that you are going to die, lose control or "go crazy"

· Feelings of being detached from yourself or from reality

· A choking feeling or feeling like you're being smothered

· Lightheadedness

Panic disorder is an anxiety disorder  that causes repeated, unexpected attacks of intense fear.

A panic attack usually lasts from 5 to 20 minutes but may last even longer — up to a few hours. You may feel the most anxiety about 10 minutes after the attack starts.

Chest wall pain

· Pain in the bones, cartilage or muscles that make up the chest wall

· May feel worse when pressure is applied to the area

· Lying on the affected area or moving, such as twisting to the side or raising the arms, also can make chest wall pain feel worse

· Coughing, in some people

Chest wall pain can be caused by many problems, such as:

· An injury, such as a blow to the chest

· Prolonged or violent coughing, which can strain the muscles or ligaments in the chest

· Inflammation of the cartilage of the rib cage (costochondritis

· Pneumonia or a blood clot to the lungs (pulmonary embolism)

Upper respiratory infection

· Burning or stabbing chest pain that occurs or worsens with coughing

· Tightness in the chest

· Coughing, with green or yellow mucus

· Shortness of breath or difficulty breathing

· Fever

· Chills

· Other symptoms depending on type of infection

Coughing from an upper respiratory infection such as  pneumonia or bronchitis may lead to pain and tightness in the upper chest.


Broken rib

· Pain at the site where the chest was injured, with deep breathing or when pressure is applied to the injured area


A rib fracture is a crack or break in one of the bones of the rib cage or a break in the cartilage that connects the ribs to the breastbone.

A fractured rib typically occurs from a direct blow to the chest, often from a car accident or fall. A severe cough can also cause a rib fracture, but is more typical in people who have osteoporosis or another condition which weakens the bones.



· Burning chest or rib pain, especially just before a rash appears

· Red rash limited to one side, usually appears as a band

· Grouped, dense, deep, small blisters that ooze and crust

· Fever, chills

· General fatigue

· Headache

· Swelling of the lymph nodes

· Vision problems

Shingles, or herpes zoster, is caused by the same virus that causes chickenpox. After an episode of chickenpox, the virus becomes dormant in the body. Shingles occurs as a result of the virus re-emerging after many years.

Shingles may affect any age group, but it is much more common in adults over 60 years old, in children who had chickenpox before the age of one year and in individuals with a weakened immune system.

Katherine Solem is a health writer and editor living in San Francisco.

Published: July 8, 2010

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