Chest pain

Hanna Rutkowski is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

Chest pain manifests itself as pulling, burning or pressure, sometimes as a stinging in the chest or a feeling of tightness with difficulty breathing. The symptoms, which often seem threatening, do not necessarily indicate a heart attack or other heart disease. In addition to the heart, there are other organs in the chest that can cause discomfort. However, harmless chest pain cannot always be distinguished from pain caused by life-threatening diseases. Read here what can be behind the chest pain.

Brief overview

Description: sudden drawing, burning, stinging in the chest or tightness with difficulty breathing
Causes: e.g. heartburn or reflux disease, tension / sore muscles, vertebral blockage, bruised ribs, broken ribs, shingles, Roemheld syndrome, angina pectoris, heart attack, pericarditis, aortic valve stenosis, high blood pressure, pneumonia, torn pulmonary embolism, pulmonary embolism, pneumothorax, lung cancer Syndrome, psychological causes (fears, stress, etc.)
When to the doctor In the case of new pain, changing pain (in terms of location, intensity, character), newly added symptoms (e.g. shortness of breath, feeling of pressure, fear), general feeling of illness, fever and drowsiness, suspected heart attack
Diagnostics: consultation with the patient (anamnesis), physical examination, EKG, x-ray, ultrasound, gastroscopy (gastroscopy), bronchoscopy, endoscopy, etc.
Therapy: depending on the cause, e.g. inhalation of nitroglycerin (for angina pectoris), loosening of vertebral blockages, medication for heartburn / reflux disease or shingles, painkillers for broken or bruised ribs
Self-help: In the case of heartburn, for example, avoiding heavy meals in the evening, spicy dishes as well as nicotine and alcohol. Gentle movement and warmth to relieve tension.

Chest pain: description

Sudden pain such as pulling, burning or stabbing in the chest can have a harmless cause, such as a harmless stomach irritation. Sometimes, however, life-threatening illnesses are also behind chest pain, such as a heart attack. This typically manifests itself in shortness of breath, left chest pain, tightness and fear of death.

In addition to the heart, the chest (thorax) also contains other organs that can cause chest pain. Doctors refer to the area between the sternum and ribs (front) and the spine and ribs (back) as the chest. The ribs protect vital, sensitive organs such as the heart and lungs from external influences. The esophagus runs through the thorax approximately in the middle to open into the stomach. Large blood vessels in the chest, such as the aorta, carry blood to the body. Muscles enable the thorax to be stretched during inhalation: the muscular diaphragm delimits the chest cavity and is also an important respiratory muscle.

It is not always easy, even for an experienced doctor, to find the source of the discomfort, as every person perceives and communicates pain differently. A stitch in the left chest can quickly be dismissed as a rib block, while in reality a heart attack is behind the symptoms. On the other hand, heartburn, for example, can cause chest pain to be so severe that sufferers call an emergency doctor.

Since chest pain can have many causes, it is especially important to be careful when you experience first-time or unfamiliar complaints.

Chest pain: causes and possible diseases

The chest is the scene of many simultaneous and well-coordinated processes of the most varied of organs - and the causes of chest pain can be just as diverse as the anatomical structure of the chest.

Menacing causes of chest pain

The most serious, often life-threatening causes of chest pain include:

Heart pain (angina pectoris): A temporary circulatory disorder of the heart is called angina pectoris ("chest tightness"). This is usually triggered by constricted coronary arteries (arteriosclerosis) as in coronary heart disease (CHD). These can no longer supply the heart with sufficient blood, especially during physical exertion - typical angina pectoris symptoms occur: severe chest pain, tightness in the chest, heart pounding and shortness of breath. The pain rarely radiates to the shoulder, the (mostly left) arm and the jaw. Angina symptoms subside after a few minutes. The immediate weapon against the complaints is inhaling nitroglycerin using a pump spray.
Heart attack: Myocardial infarction occurs when a blood clot forms in a coronary blood vessel and blocks it completely. The heart muscle is no longer supplied with blood in this area and dies: Sudden, severe pain in the chest (often behind the breastbone), stinging in the left chest, tightness and shortness of breath can occur. Typically, the pain radiates to the left shoulder, upper abdomen, back, neck and lower jaw. Sweats, nausea, and fear of death often accompany the crushing pain. A heart attack can express itself differently, especially in women: The focus is then on symptoms of the upper abdomen. In general, however, the following applies: Compared to angina pectoris, the symptoms of a heart attack last for at least twenty minutes and do not subside when administered with nitrospray - a drug that dilates the heart vessels.
High blood pressure: Blood pressure peaks of up to 230 mm Hg can cause symptoms that are similar to angina pectoris: shortness of breath and sternum pain, sometimes also heart pain.
Pulmonary embolism: A pulmonary vessel is blocked by a clot that has been washed up with the blood. Sudden chest pain, shortness of breath and coughing, and even loss of consciousness can result.
Inflammation of the lungs (pneumonia): Typical signs of pneumonia are coughing, stinging in the chest and chest pain, labored breathing, high fever and sputum.
Pneumothorax: If the pleura is torn, air enters the gap between the lungs and pleura and causes the lungs to collapse. Sudden shortness of breath, stinging in the chest, cough, and a feeling of suffocation are typical symptoms. Pneumothorax can be caused by external injuries, but sometimes also by physical predisposition.
Lung cancer: With this malignant tumor disease, steadily increasing pain in the chest, accompanied by coughing, shortness of breath and hoarseness as well as bloody sputum can occur.
Mitral valve prolapse: In this heart valve defect, the mitral valve (= heart valve between the left atrium and the left ventricle) is bulging. This sometimes causes chest pain in those affected.
Inflammation of the pericardium (pericarditis): Typically, pericarditis causes stinging in the chest, which becomes worse when you inhale deeply and cough. The symptoms also worsen when lying on the left side. Since it is an infection, fever and shortness of breath are common companions of the palpitations.
Aortic valve constriction: A constriction (stenosis) of the aortic valve - the heart valve at the exit of the left ventricle - hinders the flow of blood. This can lead to recurring angina pectoris symptoms that increase in severity over time.
Mediastinitis (inflammation of the middle skin): Purulent infections can spread to the middle skin between the two lungs (mediastinum) and cause serious inflammation there. A strong pulling in the chest, accompanied by a high fever up to clouding of consciousness and severe general symptoms are always life-threatening alarm signals.
Inflammation of the breasts (pleurisy): This is characterized by sharp pain in the chest that gets worse when you breathe and cough. There are also fever and shortness of breath.
Aortic dissection: This is a sudden tear in the vessel wall of the main artery. The most severe chest pain radiating to the back, legs and stomach may indicate this. There is danger to life!
Esophageal rupture: As a result of an existing reflux disease and a previously damaged esophagus, strong pressure (e.g. when vomiting) can lead to a rupture of the organ. This rare complication causes severe stabbing in the chest.

Harmless causes of chest pain

The harmless chest pain, which does not require immediate action, must be distinguished from the more serious causes:

Heartburn: This is when stomach acid rises up into the esophagus, which can cause severe pain behind the breastbone, often accompanied by acid regurgitation. For some people, this only happens occasionally, such as after a large meal. Others are more likely to have heartburn, which could indicate reflux disease. The burning sensation in the chest is often confused with symptoms of angina pectoris.
Tension and sore muscles: Tension in muscles and pain in the upper back often radiate into the chest and cause movement-dependent chest pain. Sore muscles can also cause chest pulling.
Intercostal neuralgia: This is a pain syndrome that originates from one or more intercostal nerves. Sufferers report a burning sensation in the chest and stabbing pain. Intercostal neuralgia can occur, for example, in the context of shingles, broken ribs or inflammation of the vertebrae (spondylitis).
Vertebral blocks: Sometimes there are vertebral blocks behind back and chest pain. These restrictions on the movement of the spine often occur suddenly and irritate the nerves and muscles between the ribs. Especially in the thoracic spine, such blockages lead to symptoms that are similar to angina pectoris.
Rib fracture and bruise: An uncomplicated rib fracture is not threatening, but it can lead to severe chest pain, especially when breathing, laughing and coughing. Bruises in this area are often extremely painful and uncomfortable for several weeks.
Psyche: The influence of the psyche should not be underestimated. Stress and anxiety can cause anxiety and chest pain. Sometimes the symptoms are mistakenly interpreted as symptoms of angina pectoris.
Shingles (herpes zoster): When you first become infected with herpes viruses of the varicella zoster type, you get chickenpox. The viruses remain in the body even after recovery and can later lead to a new outbreak of the disease - then in the form of shingles. The viruses spread in the supply area of a nerve branch. One half of the chest is often affected. A belt-shaped rash and an electrifying tearing in the chest are the result.
Diaphragmatic hernia: This is a gap in the diaphragm. Part or all of the stomach can slide up into the chest through the gap, causing severe chest pain.
Gallbladder and pancreatic diseases: Diseases such as gallstones or inflammation of the pancreas (pancreatitis) are accompanied by pain in the upper abdomen, which often radiates and causes severe pulling in the chest.
Roemheld syndrome: This leads to gas accumulations in the abdominal cavity, which press the diaphragm upwards and thus cause heart problems that manifest themselves as symptoms of angina pectoris: stinging in the left chest, stinging of the heart and feeling of pressure.
Tietze syndrome: This very rare disease causes swelling of the costal cartilage in the area of the sternum. Those affected report pain in the ribs and sternum.
Bechterew's disease: A pre-curvature and stiffening of the spine as well as inflammation of the joints cause symptoms such as stinging in the chest in this rheumatic disease. Exercise can relieve symptoms.

Chest Pain: When Should You See a Doctor?

In particular, patients who frequently suffer from chest pain, for example in the context of reflux disease, often do not recognize the urgency of a visit to the doctor. If the pain differs from the previous one in terms of location, character or intensity, or if new symptoms appear, such as shortness of breath, fear or pressure, you should pay attention.

A general feeling of illness, fever or even drowsiness in connection with chest pain should be clarified by the doctor.

You must act immediately in the event of the possible signs of an acute heart attack: severe, often radiating pain in the left chest, shortness of breath, dizziness, weakness, blue-colored lips. Call the emergency doctor immediately!

Basically, if you have chest pain, you should always be particularly attentive and act a little too cautiously: a visit to the doctor too much is better than one too late.

Chest pain: what does the doctor do?

In the initial consultation with the patient, the doctor collects important information about the medical history (anamnesis). Among other things, it can be precisely described as the quality of the pain, its duration and its occurrence. Possible questions are, for example:

Can you pinpoint the location of the chest pain or does it appear to be of undetermined origin?
Do you have stabbing or dull chest pain? Is the pain long-lasting or does it go away temporarily?
Does the chest pain recur at a certain time or with a certain posture, activity or movement?
Does the chest pain get worse over time?
Is the chest pain getting worse when you breathe?

Investigations

The information from the anamnesis interview often gives the doctor information on the possible cause of the complaints. In order to confirm or narrow down his suspicion, he can carry out various examinations. In addition to the physical examination, these include, for example:

Electrocardiography (EKG): Measuring the electrical activity of the heart is essential for detecting heart disease. Typical changes in the heart curve show, for example, a heart attack or angina pectoris.
Chest x-ray (chest x-ray): This allows the doctor to uncover many changes in the lungs and skeleton.
Ultrasound examination: This can be used, for example, to detect an accumulation of fluid in the abdomen or a diaphragmatic perforation. The doctor can also assess the heart function using ultrasound (heart ultrasound = echocardiography).
Gastroscopy: A gastroscopy can reveal abnormal changes in the esophagus and stomach.
Lungoscopy: A bronchoscopy reveals lung diseases
Mediastinoscopy: Less often, endoscopy is used to examine the middle layer.

Quick help with chest pain

Depending on the cause of the chest pain, the doctor can initiate various treatment measures:

In angina pectoris, inhalation of nitroglycerin dilates the blood vessels and relieves the discomfort. At the same time, one pump stroke lowers blood pressure by around 20 mm Hg within a short period of time.
Vertebral blockages can be released with the help of certain hand movements.
In heartburn and reflux disease, certain drugs (antacids) bind the aggressive stomach acid. Other preparations (proton pump inhibitors) suppress the excessive production of gastric acid.
Various antiviral drugs and pain relievers are used for herpes zoster (shingles).
Uncomplicated rib fractures or bruises can be treated well with pain relievers.

Chest pain: you can do it yourself

If it has been clarified by a doctor that the chest pain originates from a rather harmless source, you can treat it yourself with simple means:

Tension: A mixture of warmth and movement works best against tense muscles. Warming patches with capsaicin stimulate the blood circulation and loosen the muscles, additional movement stretches them.
Heartburn: Avoid heavy meals (especially before going to bed) and avoid acidic substances such as nicotine and alcohol, but also spicy foods.
Shingles: You can support the drug treatment with bed rest. This can make the chest pain more bearable.

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