In December, I experienced over a week of chest pain. It wasn’t sharp, but I felt a tightening over my heart from the moment I woke up until I slept. Fearing the worst, I made an appointment with my doctor.
She performed a thorough checkup before finally suggesting that it might be anxiety. The tightness faded over the next few days, and I had a hunch it was because I was less anxious about it after seeing the doctor. (To no one’s surprise, Googling definitely did not afford me the same sense of calm.)
I learned from that encounter that no matter how much the patient’s description points to a less serious diagnosis, whenever a physician hears the words “chest pain” or “chest tightness,” they think it’s best to do a thorough review of all likely causes. The symptom of chest discomfort is shared across multiple medical conditions.
“It’s important that any chest pain is evaluated to really rule out the scariest issues, and then we can find out specifically what is going on and the best management for it,” said Carolyn Kaloostian, a family medicine specialist with Keck Medicine at the University of Southern California.
No type of chest pain should be simply brushed off. Here’s what you should absolutely address with a doctor:
Pain that has intensified over a period of time or hurts even when you’re resting.
According to Nicholas Leeper, a cardiologist at Stanford Vascular and Endovascular Care, physicians are concerned when a patient reports chest pain or tightness that has gotten worse over the last few days or weeks. You should likewise report any “rest pain,” which is when you experience chest pressure symptoms even as you’re not exerting yourself. This could be a sign of a heart issue.
Pain indicative of a heart condition can also worsen when you engage in an activity, like making the bed, and then fade quickly when you stop the activity.
A feeling like someone is sitting on your chest.
Chest discomfort can be due to blockage of the blood flow to the heart, which may result in angina or myocardial ischemia ― aka a heart attack. This can feel like tightness or heaviness, almost as if someone were sitting on your chest wall, Leeper said, or sometimes it can present as sharp or dull pain or discomfort.
In some cases, you may experience other symptoms as well, like discomfort that spreads to the jaw or down to the left arm, breathlessness, exercise intolerance, palpitations or lightheadedness. Kaloostian emphasized that heart attacks can happen even without any chest discomfort.
Sharp pain when you take a breath or lie down on your side.
If the discomfort worsens when you take a deep breath or when you lie down on your left side, this may point to pericarditis (an inflammation of the sac that “holds” the heart), said Ethel Frese, a board-certified clinical specialist in cardiovascular and pulmonary physical therapy and spokesperson for the American Physical Therapy Association.
Sharp pain or pressure can also be caused by pericarditis, myocarditis (inflammation of the heart muscle), cardiomyopathy (weakening of the heart muscle) and other serious heart conditions.
Ultimately, chest pain presents in varied ways for cardiovascular issues, so make an appointment with your doctor ASAP to pinpoint the cause.
Pain if you push down on the area.
Chest pain can also be caused by damage or inflammation to the muscle, joint, bone or connective tissues, Frese said. It may indicate that you’re dealing with a strained or torn muscle, a rib fracture, or costochondritis, which is inflammation of the cartilage where your ribs are attached.
Usually, you’ll be able to recall when you might have over-exerted yourself and potentially injured a specific area ― for example, increasing your weights in a workout.
In addition, Frese said, “If you’ve got a musculoskeletal cause of pain, almost always you’ll be able to push on the area and reproduce the pain. So if I have a fractured rib, I’m going to be able to push on that and it’s going to hurt.”
This kind of chest discomfort will be aggravated when you use the injured area, but not if you use another body part, like using your legs to walk. If you stop moving the painful area, the pain will likely fade.
Once your physician rules out heart-related causes for the discomfort, this kind of pain might be managed with anti-inflammatory medications and rest. A physical therapist can also help you strengthen your muscles or improve your posture and flexibility to prevent future strain or injuries.
Intense pain when taking a deep breath or in your shoulder.
Lung issues can cause some chest pressure or pain, and these signs are typically associated with your breathing as well.
Discomfort that worsens with deep breaths may point to inflammation in the lining of the lungs, known as pleurisy, Frese said. You may also feel pain in your shoulder when this occurs. You’ll need targeted medications and treatments from a physician to ease symptoms and instigate recovery.
According to Kaloostian, chest pain or pressure can similarly present before an asthma attack, when you have pneumonia, or when a clot plugs blood vessels in your lungs.
Burning in or near your chest.
A digestive system issue can produce chest pain that typically feels like burning or tightness. A ruptured esophagus (the tube connecting your mouth to your stomach), acid reflux, or peptic ulcer disease (an ulcer developing on the stomach or small intestine) can all cause discomfort.
If your digestive system turns out to be the problem, a physician will likely prescribe targeted medications. Your doctor may also advise you to avoid heavy and spicy meals before bedtime and elevate your head when lying down.
Sudden tightness with difficulty breathing and palpitations.
Chest pain can be a daily symptom of anxiety or it can arise in the context of a panic attack, where it may be coupled with difficulty breathing, palpitations and sweating. Many people who haven’t experienced this before may think they’re having a heart attack because the symptoms can be similar.
Anxiety-related chest tightness can be managed by working with a therapist and using relaxation techniques to divert the mind away from the chest muscle tension.
The most important thing to remember: Tell your doctor about any chest pain you’re experiencing.
“Whenever there’s an issue, especially with the chest, you’d want to get a screening just in case because it could be multiple things that are going on,” said Kahina Louis, a licensed psychologist and founder of Strengths and Solutions. “We wouldn’t want to just say that’s definitely anxiety and not get that extra medical attention.”
There is also a chance that two underlying conditions could be occurring at the same time, one more serious than the other.
“I don’t want you to say, ‘Oh, it’s just reflux. I don’t need to tell my doctor,’” Kaloostian said. “Please tell your doctor. Let them reassure you and provide a treatment that would help you feel better. Even if it could be something else, why not use this opportunity to assess your risk for any heart disease and determine how we can optimize your heart health.”