What to know about chest pain when breathing

Key takeaways

• There are many reasons why you might be experiencing chest pain when you breathe. Some causes are mild, such as anxiety or muscle pain, but others may be more serious — like if you’re having a heart attack.
• If you think you’re having a heart attack, this is a medical emergency. Call 911 or get to the nearest emergency room as soon as possible.
• Most causes of chest pain when you breathe aren’t dangerous. However, you should still consider speaking with a doctor who can assess your condition and find the right treatment for you.

Overview

Chest pain is very common and usually nothing to worry about.

According to data from 2018, chest pain is the third most common cause of emergency room admissions in the United States. Common causes of chest pain include acid reflux, muscle injuries, and chest infections.

Though most causes aren’t dangerous, it’s important to consider serious conditions. Chest pain that worsens when breathing deeply — or pain that occurs with shortness of breath and chest tightness — can indicate a heart problem or inflammation around the lungs, known as pleurisy.

If you have unexplained chest pain, consider talking with a doctor. They can help you find the cause and recommend the best treatments.

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When is chest pain an emergency?

Chest pain can signal a heart attack. According to the American Heart Association (AHA), it’s important to call 911 for the following symptoms:

• Chest discomfort: For example, pressure, squeezing, pain, or fullness in the center of the chest that either lasts several minutes or comes and goes.
• Upper-body pain or discomfort: For example, in the neck, jaw, arms, back, or stomach.
• Shortness of breath: This can be with or without chest discomfort.
• Other signs: These can include a cold sweat, nausea, or lightheadedness.

Types of chest pain

The type of chest pain you’re experiencing can give you clues about its cause. For example:

• Muscle or bone issues can cause sharp, stabbing, or poking chest pain.
• Chest pain related to the heart or lungs can feel like a deep, dull pressure or a squeezing sensation.
• Lung problems can cause sharp chest pain that worsens when you breathe and may also cause coughing or breathlessness.
• Heart problems can cause jaw, arm, and shoulder pain, along with breathlessness.

1. Anxiety or panic attacks

Everyone experiences anxiety at times. Some people have physical symptoms like headaches, nausea, and sweating. The physical symptoms of panic attacks can mimic a heart attack.

Symptoms of a panic attack include:

• a racing heart
• lightheadedness
• chest pain
• nausea
• difficulty breathing
• feeling disconnected or dissociated

Some people use deep breathing exercises and grounding techniques to manage anxiety and panic. Others use anti-anxiety medications, like antidepressants or beta-blockers.

If you’re not sure whether someone is having a heart attack or a panic attack, it’s best to be cautious and talk with a medical professional.

2. Asthma

Asthma is a lung condition that causes inflammation in the airways, making it hard to breathe. Many people have chest discomfort when asthma symptoms flare up.

The symptoms of asthma can include:

• coughing
• wheezing
• difficulty breathing
• chest tightness
• shortness of breath

There’s no cure for asthma, but many people can manage their symptoms using treatments like:

• inhaler medication
• tablets
• breathing exercises
• injections

3. Heartburn

Gastroesophageal reflux disease (GERD) is a common cause of chest pain. The National Library of Medicine (NLM) states that GERD accounts for 30% of emergency room visits for chest pain.

GERD causes acid reflux or heartburn, which can feel like pressure or burning in the chest. Some people also have wheezing, asthma, or a cough with GERD.

Effective treatments for heartburn can include proton pump inhibitors and H2 blocker therapy.

4. Muscle injuries

According to the NLM, around 28% of emergency room visits for chest pain were explained by musculoskeletal issues. This pain can arise after a recent injury or a new exercise routine.

Chest pain when breathing may suggest a rib fracture or injured muscles around the ribs (intercostal muscles). These issues may resolve on their own, but in some cases, medical attention can help you heal.

A medical professional can recommend whether you need rest, ice therapy, or physical therapy for your injury.

5. Angina

Angina is when your heart isn’t getting enough oxygen-rich blood. This may be due to a block or narrowing in one of the heart’s arteries. Angina can be a symptom of coronary heart disease.

The main symptom of angina is squeezing or pressure in your chest, which may radiate into other areas, like your shoulders, neck, jaw, or back.

The AHA says that angina can cause shortness of breath, even without chest pain.

Treatment for angina may involve:

• a medical procedure to open blocked arteries
• drugs to help keep the arteries open
• medication to help you manage risk factors, such as diabetes, hypertension (high blood pressure), or high cholesterol
• lifestyle measures, such as regular exercise and a balanced diet

Medications that may help treat angina include:

• diltiazem (Adizem)
• aminophylline (Norphyll)
• nitroglycerin (Nitrostat)
• griseofulvin (Grifulvin V)

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6. Pleurisy

Pleurisy — also called pleuritic chest pain — is inflammation of the tissue surrounding the lungs. This is a less common cause of chest pain.

Causes of pleurisy include viral infections like the flu or bacterial infections like pneumonia. A pulmonary embolism can also cause pleurisy.

The most common symptom of pleurisy is sharp chest pain when breathing deeply. Chest pain caused by pleurisy may:

• radiate into your shoulder
• worsen with deep breaths
• worsen while coughing or sneezing
• improve when you take shallow breaths
• improve when you lie on the side that hurts

Pleurisy can also cause a dry cough and shortness of breath.

With quick treatment, pleurisy can resolve without any damage to the lungs. Treatment may involve nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or naproxen, to help with pain and inflammation — or antibiotics if the cause is bacterial.

7. Heart attack

A heart attack, also called a myocardial infarction, is a loss of blood flow to the heart. Heart attacks are usually due to coronary artery disease, where fatty deposits build up in the arteries.

The symptoms of a heart attack appear suddenly and can include:

• pressure, fullness, or squeezing pain in the middle of your chest
• discomfort or pain in the arms, back, jaw, neck, or stomach
• shortness of breath with or without chest pain
• other signs, like sweating, lightheadedness, or nausea

The symptoms of a heart attack in women are more likely to include shortness of breath, nausea, jaw pain, and back pain.

Heart attacks are a medical emergency. If you suspect a heart attack, call 911 or your local emergency number right away.

Other causes

Less common causes of chest pain when breathing include:

• Pulmonary embolism: A blocked artery between the heart and lungs causes a sharp, stabbing chest pain that worsens when you breathe in.
• Collapsed lung (pneumothorax): Air around the lungs causes a lung to partly or fully collapse.
• Pericarditis: This is inflammation of the tissue surrounding the heart. It can feel like a dull ache or a sudden, stabbing chest pain and may get worse when you breathe deeply or lie down.
• Aortic dissection: This happens when a tear in the aortic wall in your heart allows blood to flow between the inner and outer layers of the aorta, causing them to separate.

Summary

Chest pain had a wide range of causes — from everyday issues like anxiety to serious conditions such as heart attacks.

If you’re experiencing chest pain with shortness of breath, a squeezing pain, and pain in your left arm, it’s important to call 911 as this may signal a heart attack.

Heart problems are more likely if you have certain risk factors, such as:

• being over 60 years old
• having a family history of heart problems under age 60
• smoking
• having conditions like high blood pressure, diabetes, or high cholesterol

Whatever the cause, it’s worth discussing any unexplained chest pain with a healthcare professional. They can offer reassurance and give you advice on the best treatments available.

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