14 Common Causes Of Chest Pain

A stubbed toe — a common occurrence, but an extraordinarily painful one. Minor injuries like this are a painful nuisance but are a regular part of life. But what if you awoke to a squeezing sensation in your chest or felt pressure building behind your breastbone during a workout? For many people, these sensations are cause for serious concern.

This heightened awareness of sensations in the chest is not unwarranted. Heart disease is estimated to kill 695,000 Americans every year, according to the Centers for Disease Control and Prevention. As we age, the risk of cardiac complications and diseases tends to increase, too.

While chest pain is undoubtedly a scary symptom, it isn't always related to the heart. And while chest pain should be taken seriously and always merits medical attention, there's a multitude of explanations for why pain in the chest can occur — some serious, many not.

Simply put, a hernia is the protrusion of gastrointestinal contents, such as the intestines or stomach, into a location where it doesn't belong. Commonly, hernias of all types go unnoticed and do not become a problem until symptoms like pain and discomfort begin to appear.

One common hernia is called a hiatal hernia. This is when the stomach passes through a hole in the diaphragm and comes to rest in the chest, according to the Mayo Clinic. Like other hernias, this usually remains asymptomatic. However, the Mayo Clinic explains that a hiatal hernia may cause acid reflux, regurgitation, difficulty swallowing, and chest pain.

Hiatal hernias are more common with increased age and at unhealthy weights. Further, traumatic injury, surgical complications, or bouts of increased abdominal pressure (such as during weightlifting, coughing, or straining during a bowel movement) may cause this phenomenon. Diagnosis is made with imaging studies such as computed tomography and may require an upper endoscopy. Typically, definitive treatment of a hiatal hernia requires surgical repair to pull the stomach out of the chest and close the hole in the diaphragm (via Cleveland Clinic).

Chest wall syndrome, also known as costochondritis, is one of the most common causes of chest pain. In fact, chest wall pain accounts for 20% of all patients who present to the primary care offices for evaluation of chest pain, according to the American Academy of Family Physicians (AAFP). The condition usually resolves with time and is rarely dangerous, but any new chest pain warrants evaluation by a medical professional (via WebMD).

Costochondritis, very simply, is an inflammation of the cartilaginous portions of the rib cage. The pain can vary in intensity, but, according to the AAFP, it is "typically described as sharp, aching, or pressure-like" and is "exacerbated by upper body movement, deep breathing, and exertional activities." Furthermore, unlike more serious conditions, the pain of costochondritis can be reproduced by pressing on the affected area, whereas the pain from a heart attack tends to be broad. Treatment for costochondritis can include over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs.

We've probably all experienced a nasty bout of bronchitis, and perhaps an unlucky few have had to endure pneumonia. These illnesses make us feel lousy, and they are a very common cause of chest pain. This makes intuitive sense — the lungs sit within the chest and occupy the majority of its space. Unsurprisingly, according to the American Academy of Family Physicians, "Common symptoms [of pneumonia] include fever, chills, pleuritic chest pain, and a cough producing mucopurulent sputum." Importantly, the AAFP notes that older adults "often present with weakness and decline in functional and mental status." Therefore, if you notice a swift change in a loved one's mental status, it is a good idea to consider that infection may be causing atypical symptoms.

Respiratory infections may be diagnosed without the need for any blood tests or imaging studies. However, in order to assess for pneumonia, your doctor may order a chest x-ray. Most respiratory infections are viral in nature, which do not respond to antibiotic therapy, so, unfortunately, your immune system must battle alone.

Pneumothorax is more commonly known as a collapsed lung. The lungs sit in an airtight compartment in the ribcage. The pressure in this compartment must be lower than the pressure of the air so the lungs can expand. If there is a sudden increase of pressure in the ribcage, then the lung must overcome a greater force in order to expand with each breath. A collapsed lung, or pneumothorax, occurs when this pressure is far too high, making it impossible for the lung to expand (via Merck Manuals). In fact, on a chest X-ray, you can see the lung balled up within the ribcage.

This can cause chest pain that is more pronounced on one side of the chest. Further, breath sounds will be reduced on the affected side. Most cases of pneumothorax follow an injury to the lung itself, or a penetrating injury to the chest wall (gunshot wound, stabbing, or rib fracture). However, pneumothorax is a common complication from surgical operations that take place within the chest.

Pneumothorax is commonly diagnosed with chest X-rays, though other imaging modalities can also be helpful. To treat a pneumothorax, a medical professional must decompress the chest cavity and restore negative pressure. This is usually accomplished surgically with the placement of a chest tube. In this surgery, an incision is made in the muscles between the ribs and a tube is passed into the chest cavity (via Mayo Clinic). This tube is often connected to suction in order to restore the negative pressure our lungs need in order to breathe effectively.

Of course, when chest pain is felt, the first thing you may think of is heart attack — and that may very well be the cause. Heart attacks happen when a portion of heart muscle fails to receive adequate blood flow. Medical professionals broadly classify this as acute coronary syndrome, or, ACS (via Mayo Clinic). This can lead to tissue death that impacts the ability of the heart to do its job, leading to cardiac arrest and death of the patient. ACS can be broken down into myocardial infarctions (heart attacks) and a condition called unstable angina.

There are two types of myocardial infarction which, in general, are classified by how the present on electrocardiogram. These are ST elevated myocardial infarction (STEMI) and non-ST elevated myocardial infarction (NSTEMI), according to Merck Manuals. Both of these are very serious conditions. Unstable angina is a cousin of STEMI and NSTEMI and refers to chest pain that is neither relieved with rest nor a commonly prescribed drug called nitroglycerine. Unstable angina increases the risk of developing STEMI or NSTEMI and therefore should be investigated immediately.

Classically, the pain from ACS is described as an extreme pressure on the center of the chest, sometimes radiating to the arms. Sweating, clammy skin, and an impending sense of doom have also been described. However, not everyone with ACS experiences these symptoms. Women are more likely to describe atypical symptoms such as nausea or dizziness along with a general discomfort in the chest. ACS requires immediate treatment in the hospital in order to decrease the risk of death.

Heart failure is a very frightening term. While chronic, congestive heart failure is a treatable disease (via Medical News Today). An article published in StatPearls noted, "Common etiologies of this type of congestive heart failure include severe anemia, thyrotoxicosis, obesity, nutritional deficiencies (thiamine deficiency, etc.), and pregnancy." This commonly occurs when the body is overfilled with liquids. The increased blood volume causes increased pressure in our blood vessels. This forces the heart to work harder than usual and can lead to failure of the pump.

Congestive heart failure often causes patients to complain of difficulty catching their breath and chest tightness or discomfort related to exertion. Classically, too, patients in congestive heart failure will have pitting edema. Congestive heart failure is definitively diagnosed through a procedure called an echocardiogram, per StatPearls. This is an ultrasound that measures how effectively the heart is working. Congestive heart failure is treated with oral medications, including diuretics and common blood pressure medications like ACE inhibitors.

While we remain immune to chickenpox after inoculation, the virus never really goes away. Not to worry, for many people the virus remains at bay for our lives — it is simply kept dormant in the body. However, in older age and in times of acute stress, the virus can reappear as a disease commonly called shingles (via Johns Hopkins Medicine).

"[Shingles] is characterized by a painful, unilateral vesicular eruption, which usually occurs in a restricted dermatomal distribution," according to UpToDate. That means both pain and skin lesions will follow a bandlike strip of skin and will not cross the midline of the body.

Because shingles can appear on any patch of skin, the chest may be affected. As such, early shingles is a commonly missed cause of chest pain (via NJ Cardiovascular Institute). There is good news though, according to UpToDate, "Fewer than 20 percent of patients who develop a rash have significant systemic symptoms, such as headache, fever, malaise, or fatigue." Treatment of shingles may be accomplished with antiviral medications and pain management.