Formula Medical Group
Apple Valley, CA

James Krider, MD

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Chest pain - angina

Most people think that angina pectoris refers only to pain related to the heart. In fact, the term literally means any pain in the chest (pectoral) area, even though in medical parlance, angina generally denotes chest pain caused by a decreased oxygen supply to the heart muscle itself.

Chest pain is a common and frightening symptom, especially in the middle-aged. In many cases, the problem is gastrointestinal and simply warrants dietary modifications. But it's rarely safe to assume that chest pain is a symptom of indigestion. All too often, it signals a heart attack, which is always an emergency.

People in the throes of heart attacks may delay seeking medical attention because they fail to recognize or acknowledge the severity of their symptoms. Such delays contribute to the fact that some 300,000 people a year die of heart attacks before reaching a hospital. If you are over 35 and develop chest pain that could possibly be originating in your heart, seek immediate help. If you cannot reach your doctor, get to a hospital emergency room. A variety of potentially life-threatening lung problems can also cause chest pain. Most other causes of chest pain are less grave, but still warrant medical attention.

Causes of chest pain

Gastrointestinal problems
Chest pain that occurs within a few hours after eating and worsens when you are bending over or lying down is usually gastrointestinal in origin. Heartburn results from a backflow of stomach acid into the esophagus and is most likely to occur if you have a hiatus hernia or an esophageal problem.

Heart disease
Chest pain, especially in men over 40, is often a symptom of heart disease or a heart attack. Heart attacks usually result from obstruction of an artery that supplies blood to the heart muscle, a condition called ischemia. Incomplete blockage of a coronary artery produces coronary-related angina, chest pain that occurs during activity but subsides immediately upon rest. Inflammation of the membrane that encases the heart can also cause chest pain. In contrast to the pain of angina or heart attack, however, this type of pain tends to worsen when you take a deep breath.

Chest pain that spreads to the arms or jaw often originates in the heart, but it may also be from the esophagus or other chest organs.


A heart attack may be signaled by one or more of the following:

  • Pressure, fullness, pain, or a squeezing sensation in the center of the chest lasting 2 minutes or longer.
  • Moderate to severe pain spreading from the chest to the shoulders, neck, jaw, or arms.
  • Lightheadedness, fainting, cold sweats, nausea, vomiting, or shortness of breath accompanying the chest pain.

If any of these symptoms occur, call an ambulance. If you can get to a hospital emergency room more quickly by car and someone else can drive you, don't wait for an ambulance.

Lung problems
Several life-threatening lung conditions give rise to chest pain. A collapsed lung, or pneumothorax, causes chest pain that worsens with inhalation, as does pulmonary embolism, a blood clot in one of the small vessels in the lungs. Chest pain and shortness of breath accompanied by a cough and fever are often signs of pneumonia (lung inflammation) or pleurisy (inflammation of the membranes around the lungs). Chest pain accompanied by a cough that produces gray-yellow sputum but no fever is probably due to bronchitis.

Chest pain that spreads to the back of the neck is sometimes due to an orthopedic rather than a heart problem.

Orthopedic problems
Less commonly, musculoskeletal problems may cause varying degrees of chest pain. These include problems with spinal disks in the neck, muscle spasms, fractured ribs, and spinal arthritis.


Shingles are caused by an infection of a sensory nerve with the varicella zoster virus, which causes chicken­pox (usually in childhood) and then lies dormant in the nervous system until some physical stress such as an illness reactivates it. If a burning pain occurs on one side of the chest and has no effect on breathing, shingles could be developing. A rash that rapidly forms small blisters at the site of the pain virtually guarantees the diagnosis.

Advice about chest pain

  • If you experience chest pain during activity and it subsides immediately when you rest, it's probably due to angina. Call your doctor for an appointment.
  • If you experience chest pain within a few hours after eating and it subsides after you take an antacid, it's probably gastrointestinal. If such food-related pain persists, call your doctor for an appointment.
  • If you experience chest pain that might signal a heart attack, or if you develop any other chest pain that you cannot easily self-diagnose, call your physician immediately or go to a hospital emergency room. Be particularly vigilant about noticing and reporting chest pain if any of your close relatives died of heart disease at an early age or if you have other cardiovascular risk factors.
This article was last reviewed November 11, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
Collapsed lung
Esophageal spasm
Heart attack
Hiatus hernia

Pulmonary embolism
Ruptured disk
Spinal arthritis

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