Chest pain

When to get immediate help 

It is important to try to identify if the cause is serious or life threatening. The information below should not be used to self-diagnose your condition.

It should give you an idea of what is causing your chest pain and whether you need to get emergency help or see your GP.

It does not include every possible cause, but describes the most common reasons for chest pain.

You should call 999 for an ambulance immediately if you develop sudden severe chest pain, particularly if:

• the pain is central or band-like and feels heavy, pressing or tight
• the pain lasts longer than 15 minutes
• the pain spreads to other parts of your body, such as your arms, back or jaw
• you also have other symptoms, such as:
  • breathlessness
  • nausea
  • sweating
  • coughing up blood
• you are at risk of coronary heart disease, for example:
  • you smoke,
  • are obese
  • have high blood pressure, diabetes or high cholesterol

If you think you could be having a heart attack, call 999 immediately and ask for an ambulance.

Do not worry if you have any doubts about whether it is a heart attack.

Paramedics would prefer to be called out to find that an honest mistake has been made than to be called out when it is too late to save a person's life.

If the discomfort is not sudden and severe, or has resolved, it may be more appropriate to see your GP. 

If your own GP surgery is closed, you should contact your local out of hours service if you are concerned and need advice as to whether you need assessment or treatment.

Heart problem

Chest pain is often a problem that is not caused by a heart condition.

Chest pain related to a heart problem is commonly caused by:

• angina – where the blood supply to the muscles of the heart is restricted
• a heart attack – where the blood supply to part of the heart is suddenly blocked

Both of these conditions can cause a dull, heavy or tight pain in the chest that is central, or band-like. The pain can spread to the arms, neck, jaw or back. They can also cause additional symptoms, such as breathlessness, nausea, paleness and sweating.

The main differences between these conditions is that chest pain caused by angina tends to be triggered by physical activity or emotional stress, and gets better with rest after a few minutes.

If you have previously been diagnosed with angina, the pain may also be relieved by your angina medication.

Symptoms that last more than 15 minutes, occur at rest, and include sweating and vomiting are more likely to be caused by a heart attack.

Dial 999 immediately to request an ambulance if you think you or someone else is having a heart attack, or if you have the symptoms above and haven't been diagnosed with a heart condition.

If you have an angina attack and you've previously been diagnosed with the condition, take the medication prescribed for you.

A second dose can be taken after five minutes if the first dose is ineffective.

If there is no improvement five minutes after the second dose, call 999 and ask for an ambulance.

Common causes of chest pain 

Most chest pain is not heart-related and isn't a sign of a life-threatening problem.

Some common causes of chest pain are outlined below.

This information should give you an idea of whether these conditions may be causing your chest pain.

However, see your GP for a proper diagnosis and for advice about how to relieve the pain and tackle any underlying cause.

Gastro-oesophageal reflux disease (GORD) 

Gastro-oesophageal reflux disease (GORD) is a common condition where acid from the stomach comes up into the oesophagus (gullet).

Common symptoms of GORD include:

• burning upper abdominal discomfort or pain/ chest pain (heartburn) which may sometimes be difficult to differentiate from a heart problem without clinical assessment
• an unpleasant taste in the mouth caused by stomach acid coming back up into your mouth

Symptoms are usually improved by antacids and may be relieved, or worsened, by food.

These symptoms usually occur soon after you've eaten and get worse if you bend over or lie down.

GORD can often be treated by making lifestyle changes and, if necessary, using medication.

Bone or muscle problems 

If your chest is painful and tender to touch, it may be caused by a strained muscle in your chest wall. 

This can be surprisingly painful, but with rest the pain should ease and the muscle will heal in time.

If you have pain, swelling and tenderness around your ribs, and the pain is made worse by lying down, breathing deeply, coughing or sneezing, you may have a condition called costochondritis.   

This is caused by inflammation in the joints between the cartilage that joins the ribs to the breastbone (sternum). 

The symptoms often improve after a few weeks and may be relieved by painkillers.

Anxiety and panic attacks 

Some episodes of chest pain occur as part of an anxiety or panic attack.

As well as chest pain and overwhelming feelings of anxiety, these attacks can cause symptoms such as heart palpitations, sweating, breathlessness and dizziness.

Most panic attacks last for five to 20 minutes.

In the long-term, you may benefit from psychological therapy and medication, or both.

Lung conditions 

If you have sharp chest pain that gets worse when you breathe in and out, and is accompanied by other symptoms such as a cough and breathlessness, it may be caused by a condition affecting the lungs or surrounding tissue, such as:

• pneumonia – inflammation of the lungs, usually caused by an infection
• pleurisy – inflammation of the membrane surrounding the lungs, also usually caused by an infection

Mild cases of pneumonia can usually be treated with antibiotics, rest and fluids. For people with other health conditions, the condition can be severe and they may need to be treated in hospital.

Treatment for pleurisy will depend on the underlying cause.

Pleurisy caused by a viral infection will often resolve without needing treatment.

Pleurisy caused by a bacterial infection will usually need to be treated with antibiotics.

People who are frail or already in poor health may need to be admitted to hospital for treatment.

Other possible causes 

There are many other potential causes of chest pain, including:

• shingles – a viral infection of a nerve and the area of skin around it, which causes a painful rash that develops into itchy blisters
• mastitis – pain and swelling of the breast, which is usually caused by an infection, most commonly during breastfeeding
• acute cholecystitis – inflammation of the gallbladder, which can cause a sudden sharp pain in the upper right side of your tummy that spreads towards your right shoulder
• stomach ulcers – a break in the lining of the stomach, which can cause a burning or gnawing pain in your tummy
• a pulmonary embolism – a blockage in the blood vessel that carries blood from the heart to the lungs, which can cause sharp, stabbing chest pain that may be worse when you breathe in, as well as breathlessness, a cough, coughing up blood and dizziness: if your symptoms are particularly severe, dial 999 immediately and ask for an ambulance
• pericarditis– inflammation of the sac surrounding your heart, which can cause a sudden, sharp and stabbing pain in your chest, or more of a dull ache; the pain usually worsens when lying down

Some of these conditions can be very serious. Make sure you seek medical advice so you can be correctly diagnosed and treated.

More useful links

• How to use your health services
• Emergency healthcare
• Northern Ireland Chest Heart & Stroke
• British Heart Foundation