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Chest Problems

Topic Overview

Chest pain and heart attack

Chest discomfort or pain may be a key warning symptom of a heart attack. Heart attack symptoms may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

Chest discomfort or pain that comes on or gets worse with exercise, stress, or eating a large meal and goes away with rest may also be a symptom of heart disease called angina.

If you have any of these symptoms of a heart attack, call 911 or other emergency services immediately. After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself. Since most of the damage to the heart muscle during a heart attack occurs in the first 6 hours, emergency treatment may prevent damage to the heart muscle and death. For men and women, the most common symptom is chest pain or pressure. Women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Other causes of chest discomfort or pain

Most people fear that chest pain always means that something is wrong with the heart. This is not the case. Chest discomfort or pain, especially in people who are younger than age 40, can have many causes.

  • Angina (say "ANN-juh-nuh" or "ann-JY-nuh") is a type of chest pain or discomfort that happens when there is not enough blood flow to the heart muscle. Angina is a symptom of coronary artery disease, also called heart disease. Angina is called stable angina when you can usually predict when your symptoms will happen. You probably know what things cause your angina. A sudden and unexpected change in your usual pattern of angina means that the blood flow has become more impaired and you could be having a heart attack. This is called unstable angina.
  • Pain in the muscles or bones of the chest often occurs when you increase your activities or add exercise to your schedule. This is sometimes called chest wall pain.
  • Costochondritis is an inflammation of the joints formed by the cartilage connecting the ribs to the breastbone (sternum). The inflammation could be caused by an injury to the chest, but often the reason for the inflammation is not known.
  • Burning chest pain that occurs when you cough may be caused by an upper respiratory infection caused by a virus.
  • Burning chest or rib pain, especially just before a rash appears, may be caused by shingles.
  • An injury such as a broken rib or bruised lung can be quite painful, especially when you cough or try to take a deep breath.
  • Swelling (inflammation) of the thin layers of tissue (pleura) covering the lungs and the chest wall may occur. This is called pleurisy.
  • Gastroesophageal reflux disease (GERD) can cause pain just below the breastbone. Many people will say they have "heartburn." This pain is usually relieved by taking an antacid or eating.

Other, more serious problems that can cause chest pain include:

  • An infection, such as pneumonia.
  • A collapsed lung (pneumothorax), which usually causes a sharp, stabbing chest pain and occurs with shortness of breath.
  • A blood clot in the lung (pulmonary embolism), which usually causes deep chest pain with the rapid development of extreme shortness of breath.
  • Lung cancer, which may cause chest pain, especially if the cancer cells spread to involve the ribs.
  • Diseases of the spine, which can cause chest pain if the nerves in the spine are "pinched."

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have a problem in the chest area, such as pain or an injury?
Yes
Symptoms in chest area
No
Symptoms in chest area
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Do you have only breathing problems with no other symptoms?
Yes
Respiratory problem
No
Respiratory problem
Do you have moderate or severe belly pain?
This is not the cramping type of pain you have with diarrhea.
Yes
Abdominal pain
No
Abdominal pain
Is your main symptom a cough?
Yes
Cough
No
Cough
Could you be having symptoms of a heart attack?
If you're having a heart attack, there are several areas where you may feel pain or other symptoms.
Yes
Symptoms of heart attack
No
Symptoms of heart attack
Do you have symptoms of shock?
The symptoms in an adult or older child are different than the symptoms in a young child.
Yes
Symptoms of shock
No
Symptoms of shock
Do you have any shortness of breath that is not caused by pain?
Pain may make it hurt to breathe, but this is not the same as being short of breath.
Yes
Shortness of breath
No
Shortness of breath
Would you describe your shortness of breath as severe, moderate, or mild?
Severe
Severe shortness of breath
Moderate
Moderate shortness of breath
Mild
Mild shortness of breath
Have you been diagnosed with angina?
Yes
Diagnosed with angina
No
Diagnosed with angina
Has there been a change in your angina over the past week?
Yes
Change in angina in the past week
No
Change in angina in the past week
Is your treatment plan controlling the angina?
If the plan is working, it should either make the symptoms go away or get them back to the level they were at before the angina got worse.
Yes
Treatment plan is controlling symptoms
No
Treatment plan is controlling symptoms
Over the last few months, have you been getting angina more often or has it been worse than usual?
Yes
Angina occurring more often or getting worse
No
Angina occurring more often or getting worse
Have you had any symptoms that you think may have been caused by your heart?
These could include pain, pressure, or a strange feeling in the chest or a nearby area, like your neck or shoulder. Other symptoms can include shortness of breath, nausea or vomiting, or lightheadedness.
Yes
Possible heart symptoms
No
Possible heart symptoms
How recently did you have these symptoms?
Within the past week
Heart-related symptoms within the past week
More than a week ago
Heart-related symptoms more than a week ago
Have you had an injury to your chest in the past 2 weeks?
Yes
Chest injury within past 2 weeks
No
Chest injury within past 2 weeks
Is there any blood in your urine?
This can happen if you get hit in the ribs or side and damage the kidneys.
Yes
Blood in urine
No
Blood in urine
Are you coughing up blood?
This means blood that is coming up from your chest or throat. Blood that is draining down from your nose into your throat (because of a nosebleed, for example) is not the same thing.
Yes
Coughing up blood
No
Coughing up blood
How much blood is there?
A lot of bright red blood [2 tsp (10 mL) or more]
Large amount [2 tsp (10 mL)] of bright red blood in sputum
Streaks of bright red blood
Streaks of bright red blood in sputum
Specks or spots of blood
Specks or spots of blood in sputum
Has this been going on for more than 2 days?
Yes
Specks or spots of blood in sputum for more than 2 days
No
Specks or spots of blood in sputum for more than 2 days
Do you take a medicine that affects the blood's ability to clot, such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix)?
These medicines can cause bleeding and can make it harder to control bleeding.
Yes
Takes medicine that affects blood's ability to clot
No
Takes medicine that affects blood's ability to clot
Do you have pain in your ribs or the muscles of your chest?
This type of pain may feel worse when you press on or move the area or when you take a deep breath.
Yes
Pain in chest wall
No
Pain in chest wall
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Has the pain:
Gotten worse?
Pain is getting worse
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is getting better
Do you know what caused the pain, such as severe sneezing or coughing?
Yes
Pain is from sneezing, coughing, or other known cause
No
Pain is from sneezing, coughing, or other known cause
Has the pain lasted for more than 2 days?
Yes
Pain for more than 2 days
No
Pain for more than 2 days
Do you have pain deep in one leg?
Sudden chest pain that occurs with deep pain or swelling in one leg can be a symptom of a blood clot that has moved from the leg to the lung.
Yes
Leg pain
No
Leg pain
Do you think the chest problem may be causing a fever?
Yes
Possible fever
No
Possible fever
Do you have a new rash on only one side of your chest? The rash may be in a strip or band.
Yes
New rash on only one side
No
New rash on only one side
Have you had symptoms for more than a week?
Yes
Chest symptoms for more than a week
No
Chest symptoms for more than a week

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
HomeTreatment
RelatedInformation
WhereToGo

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Severe trouble breathing means:

  • You cannot talk at all.
  • You have to work very hard to breathe.
  • You feel like you can't get enough air.
  • You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

  • It's hard to talk in full sentences.
  • It's hard to breathe with activity.

Mild trouble breathing means:

  • You feel a little out of breath but can still talk.
  • It's becoming hard to breathe with activity.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

  • Passing out (losing consciousness).
  • Feeling very dizzy or lightheaded, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Symptoms of shock in a child may include:

  • Passing out (losing consciousness).
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.
HomeTreatment
RelatedInformation
WhereToGo

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
HomeTreatment
RelatedInformation
WhereToGo

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.
HomeTreatment
RelatedInformation
WhereToGo

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Abdominal Pain, Age 11 and Younger
Respiratory Problems, Age 11 and Younger
Coughs, Age 12 and Older
Abdominal Pain, Age 12 and Older
Respiratory Problems, Age 12 and Older
Coughs, Age 11 and Younger

Home Treatment

Home treatment is not appropriate for chest pain if the pain occurs with symptoms of a heart attack. If you think a heart attack might be the cause of your symptoms, call 911 or other emergency services immediately. After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Home treatment for people who have been diagnosed with chest pain (angina)

If you have stable angina, you can probably predict when your symptoms will happen. You probably know what things cause your angina. If you and your doctor have made a home treatment plan, follow that plan. If you are having angina symptoms more often than usual or if they are different or worse than usual, call your doctor right away. If you have angina symptoms that do not go away with rest or are not getting better within 5 minutes after you take a dose of nitroglycerin, call 911 or other emergency services immediately.

You may be able to control how much your angina bothers you by making changes in your lifestyle. You may find it helpful to:

  • Avoid strenuous activities that bring on angina.
  • Eat balanced, nutritious meals. Try to limit the amount of fats and fatty foods you eat.
  • Maintain a healthy weight.
  • Limit the amount of alcohol you drink. Don't drink more than 2 alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are a woman.
  • Do not smoke or use other tobacco products. For more information, see the topic Quitting Smoking.
  • Reduce stress. For more information, see the topic Stress Management.
  • Control your blood pressure with diet and medicine. For more information, see the topic High Blood Pressure.
  • Avoid extremely cold or hot environments.
  • Take all medicines, such as nitroglycerin, as instructed by your doctor.
  • Follow the exercise or activity program you and your doctor developed.

If you do not need 911 emergency medical treatment for your chest pain or angina, take your pulse before reporting your symptoms to your doctor. Your heart rate and rhythm at the time of your chest pain may help your doctor evaluate your symptoms.

Home treatment for minor pain in the chest

Home treatment for minor chest pain depends on the cause of the pain. Minor chest pain often improves with home treatment. A visit to your doctor may not be needed.

Chest wall pain

For chest wall pain caused by strained muscles or ligaments or a fractured rib:

  • Rest. Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
  • Ice. Cold will reduce pain and swelling. Apply an ice or cold pack immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply warmthto the area that hurts.
  • Do not wrap or tape your ribs for support. This may cause you to take smaller breaths, which could increase your risk for developing pneumonia or partial lung collapse (atelectasis).
  • Medicated creams that you put on the skin (topical) may soothe sore muscles.
  • Gentle stretching and massage may help you get better faster. Stretch slowly to the point just before discomfort begins, then hold the stretch for 30 to 60 seconds. Do this 3 to 4 times a day. It is really helpful after the use of heat.
  • As your pain gets better, slowly return to your normal activities. Any increased pain may mean that you need to rest a while longer.
Medicine you can buy without a prescription

Try a nonprescription medicine to help treat your fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Safety tips

Be sure to follow these safety tips when you use a nonprescription medicine:

  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

If you have other symptoms along with your minor chest pain, see the Related Information section for topics that relate to your other symptoms.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • You have increased difficulty breathing.
  • Chest discomfort lasts longer than 1 week.
  • Symptoms become more severe or frequent.

Prevention

The following tips may prevent chest problems or injuries.

  • Stay in good overall physical shape. Do stretching and range-of-motion (ROM) exercises for your arms and shoulders.
  • Maintain good posture. Stand straight and relaxed, without slumping.
  • Warm up well and stretch before any activity.
  • Wear protective gear during contact sports or recreational activities, such as hockey or football.
  • Wear your seat belt when in a motor vehicle.
  • Make sure your child's backpack is the right size with good support. Carrying heavy backpacks may increase his or her risk of chest problems or injury.

Preparing For Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • When did the chest pain begin?
    • How long does the pain last?
    • How often does the pain occur?
    • How severe is the pain?
    • What does the pain feel like?
    • Where is the pain located?
    • Does the pain change or get worse when you take a deep breath?
  • What were you doing when it started? Is the pain related to activity? Is it related to eating? Is it related to body position?
  • Does the pain start in the chest and spread to another part of the body? Or does it start somewhere else and spread to the chest?
  • Did you have other symptoms with the chest pain? What are the other symptoms?
  • Has this ever happened before? If so, did you see a doctor?
    • What was the diagnosis?
    • What tests were done?
    • How was it treated?
  • Have you had a chest injury or a fall?
    • How and when did an injury occur?
    • Have you had any chest injuries in the past? Do you have any continuing problems because of the previous injury?
  • What activities make your symptoms better or worse?
  • What home treatment have you tried to relieve the pain? Did it help?
  • What nonprescription medicines have you taken? Did they help?
  • Do you have any health risks?

Credits

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine

Current as ofNovember 20, 2017

Current as of: November 20, 2017

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine