If you have chest pain for more than 15 minutes, if the pain spreads to your arms, back, neck or jaw, if you feel pressure or heaviness in your chest, if you have discomfort such as shortness of breath and sweating, call the 911 emergency service immediately because you may have a heart attack.

Important:

If you have chest pain for more than 15 minutes, if the pain spreads to your arms, back, neck or jaw, if you feel pressure or heaviness in your chest, if you have discomfort such as shortness of breath and sweating, call the 911 emergency service immediately because you may have a heart attack. Since chest pain, which is a symptom of a heart attack, can be similar to all other chest pains, if you think you are at risk, be sure to talk to your doctor or call the 911 emergency service. If you’ve had a heart attack before, the pattern of chest pain during a new attack may not be at all like the previous ones. Therefore, do not neglect yourself.

Chest pain may not always be caused by a heart problem. The heart, lungs, shoulders, neck, musculoskeletal structures in the chest, and other organs within the chest may show signs of chest pain.



Chest pains can be classified into two categories:

  • Recurrent chest pain; It is mild or moderate, short-lived, repetitive.
  • prolonged chest pain; is severe, lasting, indicates an acute or significant illness.

What are the causes of short-term recurrent chest pain?

Angina pectoris originating from the heart is a common cause. However, musculoskeletal disorders cause more recurrent chest pain. These two reasons can often be confused with each other.

How is angina pectoris pain?

  • It is described as not well localized, overwhelming, boring, burning or heaviness.
  • It is short-lived, usually lasting 2-10 minutes.
  • The intensity of the pain is usually moderate.
  • The pain is typically felt behind the breastbone, usually. The pain may radiate to the neck, under the chin, shoulders, arms, back, and epigastrium. It is typical that it spreads to the left shoulder and arm.
  • It can start with exertion or stress.

Chest pains caused by musculoskeletal structures

Problems in the musculoskeletal structures of the neck, shoulders and rib cage can cause pain:

  • Osteoarthritis, disc disease, deformities in the neck or thoracic vertebrae and damage to the nerve roots due to these can cause chest pain. In these cases, pain can occur in both the front and back. The pain usually occurs at night. Fatigue, poor posture, or movement of the damaged area can initiate pain. It can also be exacerbated by coughing or sneezing. There is usually mild or aching pain. Sometimes there may be short periods of sharp pain. It can go on for hours. It decreases with analgesics, rest, and local application of heat.
  • There may be pain of the ribs and joints of the chest, or of the ribs and breastbone. The combination of these two causes is called Tietze syndrome. This pain can also mimic angina pectoris. The pain is usually well localized but may radiate to the chest or arms. With touching and pressing the sensitive area, the pain starts again and may spread.
  • Pain can result from any trauma. It is usually seen in young people. In the elderly, fractures can easily occur due to weakening of the bone structure. Difficulty coughing. If the free ends of the ribs are broken, sharp and burning pain may occur.
  • There may also be pain due to rib tumors. These are usually metastatic.
  • There may be a traveling, stabbing, sharp or stabbing pain without any reason. They do not resemble angina pectoris in their unexplained pain.
  • There may be painful conditions that occur when nerves, vessels and other organs are compressed for any reason in the upper exit throat of the thorax. This is called thoracic outlet syndrome. In these cases, there may be chest pains. Depending on the severity of the pressure on the vessels and nerves, there may be pain, tingling and numbness. Muscle weakness is uncommon. Widespread pain occurs. Easy fatigue of the upper extremity is observed. Arm and head movements may be disturbingly slow. Edema and swelling may occur in the neck due to compression in the vessels coming to and from the brain and arms to the rib cage. Detailed examination with angiography may be required.
  • In some shoulder diseases, pain that radiates to the chest may also occur. On detailed examination, it is evident that the pain only occurs when shoulder movements increase. Any cause can cause this pain in the shoulder joints, bones or muscles.
  • Although it is rarely seen, widespread and burning pain may occur in the area of involvement in herpes zoster (shingles). The appearance of vesicles, redness and rashes on the skin 3-4 days after the onset of pain and burning makes it easier to recognize.
  • A blockage in the lymphatic pathways in any part of the chest can also cause chest pain.

Other causes of short-term chest pain

  • Anxiety and panic attacks can cause pain symptoms that mimic angina pectoris. In these cases, there is no relationship between pain and exercise. The duration of pain is variable. The pain may last for a few seconds or a few days. The patient has frequent breathing and sighing. Since it mimics angina pectoris, it is first examined whether there is a condition originating from the heart in such pains.
  • Reflux esophagitis, which is caused by the reflux of stomach contents into the esophagus, can mimic angina pectoris very well. Sometimes it can be caused by herniation in the area where the esophagus meets the stomach. This condition is called a hiatus hernia. This type of pain may spread from the back of the breastbone to the neck, under the chin, and to the left arm. It usually occurs after eating too much and drinking alcohol. Excessive consumption of spicy foods can also initiate such pains. This type of pain usually occurs at night. It is common for the pain to start when lying down. These patients may also experience a sour taste or bitterness in their mouths. Sometimes, in severe cases, it can be seen that the stomach contents come back into the mouth with forward bending. The pain of these patients can be relieved when they are in an upright position or when they take antacid drugs.
  • Sometimes chest pain may occur in cases of widespread spasm in the esophagus without gastric reflux. In this case, chest pain is usually in the form of pressure or tightness. It can also be in various forms. It can be mild or severe, short or long term. Similarly, a picture can be seen under the breastbone (retrosternal), spreading to the jaw and arms. This type of pain is usually caused by eating. Pain is expected when taking both liquid and solid foods. It is a pain that mimics angina pectoris.
  • Chest pain can also occur with some lung conditions. With pneumonia or other lung infections, pain may occur in one or more areas of the chest.
  • Conditions that cause hypertension in diseases of the vascular structure of the lung are called pulmonary hypertension. Pulmonary hypertensive conditions also cause chest pains that mimic angina pectoris. These conditions, which are seen with moderate or severe shortness of breath, can mimic angina pectoris.
  • In some patients with heart valve problems, especially in mitral valve problems, some patients may experience sharp, short-term pain that is not related to effort. Sometimes these patients may experience retrosternal pain. Pain in the form of weight and pressure can sometimes increase with exercise.

Long-lasting chest pains

In patients with severe and prolonged chest pain, there may be an important underlying disease such as myocardial infarction, rupture of aortic aneurysm, pulmonary embolism and pericarditis. Therefore, such patients should immediately apply to the nearest hospital. If you have long-term severe chest pain, either call 112 emergency services or apply to the nearest emergency room.

How is myocardial infarction chest pain?

In acute myocardial infarction, the pain is typically quite severe as if it were crushed, pressed, burned, tingled, or clamped in a vise. Rarely, it can be mild or moderate. If these patients have had a previous myocardial infarction, they may describe the angina pectoris pain they experience from time to time before this pain attack. This time they say that their pain is much more.

The duration of myocardial infarction chest pain is variable. It may take half an hour or several hours. It may even take longer. In these patients, chest pain is behind the sternum. But it can also be at or around the heart or in other areas. It often spreads to the anterior chest wall, under the chin, neck, shoulders and arms. Spread to the left shoulder and left arm is more common.



In patients with myocardial infarction, symptoms such as cold sweats and indigestion are also observed along with pain.

In some cases, myocardial infarction may even be painless. Sometimes, the patient may think of it as a minor or excessive gas complaint.

How is the pain of aortic aneurysm rupture (Dissecting aortic aneurysm)?

In these patients, the aorta, which is the main vessel that carries blood from the heart to the abdominal organs, lungs and arms, enlarged and ruptures occurred in the vessel wall between the layers. Blood collects between these layers. Sometimes it can be discharged by tearing the wall. In these patients, the pain is unusually severe and unbearable. The patient expresses this pain as sharp and disintegrating, tearing. To relieve these pains, it may be necessary to use high-dose narcotic drugs repeatedly.

In these patients, the pain usually occurs at the level of the rupture. If it is above the aortic valve, the pain is usually on the anterior chest wall. If it is a little further, the pain may radiate to the back. The pain usually radiates at the level where the tear occurred.

What is chest pain like in pulmonary embolism?

Chest pain occurs as a result of clogging of the pulmonary tissue vessels with clots. In these patients, the pain can sometimes be in the form of severe chest wall pain similar to acute myocardial infarction. Most of these patients experience shortness of breath along with pain. Sometimes dry cough, fear and coughing up blood (hemoptysis) can be seen. Respiratory frequency increases and lung listening sounds are impaired. Heart rate also increased.

Most of these patients are bedridden patients who have been immobilized for a long time due to trauma, surgery, hip fracture, heart failure or malignancies some time before this pain complaint. The sudden onset of shortness of breath and chest pain in the patient suggests pulmonary embolism. The risk of thromboembolism is also increased in women who use oral contraceptives for a long time.

How does chest pain occur in acute pericarditis?

Pericardium is the membrane or capsule structure that surrounds the heart. Inflammation of this membrane for some reason is called pericarditis. Almost all patients with acute pericarditis experience chest pain. In fact, the lower part of the outer surface of the pericardial tissue is sensitive to pain. If there is only a pericarditis condition other than this place, there may be no pain. However, pain occurs when the pleura, which is the adjacent pleura, is also inflamed in all parts of the pericardium.

Pericarditis pain can take three forms:

  • Pleural inflammation pain
  • Pain resembling myocardial infarction
  • Pain at the apex of the heart synchronized with the heartbeats. This is rare.

Pericarditis pain is usually sharp. Pain increases with movements such as deep breathing, turning the trunk to the right and left, swallowing or yawning. Therefore, the patient prefers immobility. He tries to stay still. In this respect, it may not resemble acute heart attack pain.



Pericarditis pain is usually worsened by lying on the back. Pain may decrease when the patient sits upright or leans forward.

Other causes of long-term chest pain

Long-term chest pain can have many other causes. We can summarize the most common reasons as follows:

  • Pneumothorax; It is the leakage of air out of the membrane (pleura) surrounding the lung into the chest.
  • Mediastinal emphysema; It is a condition that causes pain in the middle space of the chest where the heart is located.
  • Acute pancreatitis; It is a severely painful picture that occurs as a result of inflammation of the pancreatic gland for various reasons. It gives symptoms with more abdominal pain and this pain can spread to the chest.
  • Acute cholecystitis; It is an inflammation caused by stones or infection in the gallbladder. It can also be confused with stomach pain. In severe cases, the pain may also radiate to the chest.
  • Peptic ulcer; Stomach ulcer pain can range from a mild burning to widespread severe pain.
  • Perforated ulcer; In the advanced stage of stomach ulcer, both chest and back pain may occur.
  • Esophagitis; It is an inflammation of the esophagus.
  • Pheochromocytoma attack; It is a hormonal disorder that generally manifests itself with attacks of hypertension in the adrenal glands due to any reason. The release of adrenaline and noradrenaline increases. Oxygen deficiency due to the development of severe tachycardia and hypertension in the heart leads to ischemia and may initiate chest pain.
  • Methamphetamine and cocaine; It is a toxic picture that occurs with the intake of such addictive substances in high amounts. It causes ischemia in the heart muscles. This condition also presents with chest pain.
  • Achalasia; Situations that cause a curtain or stenosis in the esophagus occur and cause chest pain with meals.
  • Rheumatic diseases; Chest pain may occur with the development of arthritis in the joints of the chest bones in rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, fibromyalgia, rarely systemic lupus erythematosus, polychondrosis.
  • Fibromyalgia; Fibromyalgia patients with widespread muscle pain symptoms may also experience pain in the chest muscles, but it must be proven that such pain is not caused by the heart.



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