Chest Pain
Symptoms, Causes & Treatment
Understanding chest pain: what causes it, how to tell if it is cardiac or non-cardiac, when to call 999, and how to get assessed and treated safely.
What Is Chest Pain?
Chest pain is one of the most common presenting complaints in clinical medicine, accounting for millions of GP and emergency department visits annually. While the immediate concern is always to exclude a cardiac cause, the majority of chest pain presentations – even those initially seen in emergency departments – turn out to have a non-cardiac origin.
Non-cardiac chest pain (NCCP) is broadly defined as recurring chest pain that resembles cardiac pain but for which no cardiac cause can be identified after appropriate investigation. It is estimated to account for 50–60% of all patients admitted to hospital with chest pain who ultimately prove not to have a cardiac cause.
The most common non-cardiac causes of chest pain include gastrointestinal conditions (particularly gastro-oesophageal reflux disease and oesophageal spasm), musculoskeletal conditions, respiratory conditions, and anxiety-related chest pain. Each of these can produce symptoms that range from mild and intermittent to severe and disabling, and that significantly affect quality of life and generate significant anxiety about the heart.
Understanding the likely cause of chest pain – through appropriate clinical assessment – is not only important for the person's physical health but is often profoundly reassuring and reduces anxiety-driven symptom escalation.
What Does Chest Pain Feel Like?
Chest pain varies widely in character depending on its cause. Understanding the pattern of pain — including what makes it better or worse — is important in determining the likely cause.
Central chest pain or tightness · Pain radiating to jaw, left arm, or back · Chest tightness brought on by exertion and relieved by rest (angina pattern) · Sharp stabbing pain worsened by breathing or movement (musculoskeletal) · Burning sensation behind the breastbone (acid reflux / GORD) · Tenderness over the chest wall on palpation · Palpitations with chest discomfort · Anxiety-related chest tightness
Severe crushing chest pain radiating to the arm or jaw — call 999 immediately · Chest pain with shortness of breath, sweating, nausea, or light-headedness · Sudden sharp chest pain with breathlessness (possible pulmonary embolism or pneumothorax) · Chest pain in a person with known heart disease or multiple cardiac risk factors — do not wait
Call 999 immediately if chest pain is crushing, heavy, or pressure-like · If it spreads to your left arm, jaw, neck, or back · If it is accompanied by sweating, nausea, breathlessness, or feeling faint · If it occurs at rest in a person with known heart disease. Do not wait — call 999 now.
What Causes Chest Pain?
The vast majority of chest pain is caused by non-cardiac conditions. Understanding the most common causes helps you communicate effectively with your clinician and receive appropriate treatment.
Angina occurs when the heart muscle receives insufficient blood due to narrowed coronary arteries. It causes predictable chest tightness on exertion that resolves with rest or GTN spray.
Acid from the stomach refluxes into the oesophagus, causing burning chest pain often after eating, lying down, or drinking alcohol. GORD is one of the most common causes of chest pain.
Costochondritis (inflammation of rib cartilage), muscle strain, or rib injury causes chest wall tenderness and pain that worsens with movement or palpation — not related to the heart.
Anxiety, panic disorder, and stress commonly cause chest tightness, palpitations, and shortness of breath. The symptoms are real and distressing but not dangerous to the heart.
Costochondritis is inflammation of the cartilage connecting ribs to the breastbone. It causes sharp, localised chest wall pain that worsens on movement and palpation — typically not related to the heart.
Pulmonary embolism (blood clot in the lungs) causes sudden sharp chest pain with breathlessness. Though an emergency, a previous PE warrants investigation of non-cardiac chest pain presentations.
Key Risk Factors
How Is Chest Pain Investigated?
The investigation of chest pain depends on the suspected cause. A clinician will take a detailed history, examine the chest, and order appropriate tests. For any chest pain with potential cardiac features, investigation is performed urgently.
How Is Chest Pain Treated?
Treatment targets the specific underlying cause. Most non-cardiac chest pain responds well to appropriate medical or lifestyle intervention.
Supportive Measures
For musculoskeletal chest pain, anti-inflammatory medications (ibuprofen), rest, and gentle stretching are usually effective. For GORD, avoiding trigger foods, eating smaller meals, not lying down within 3 hours of eating, and elevating the head of the bed all reduce symptoms. For anxiety-related chest pain, breathing exercises, progressive muscle relaxation, and addressing the underlying anxiety are key.
Recurrent or Unexplained Chest Pain
If chest pain recurs, is not responding to treatment, or cannot be attributed to a clear cause, further investigation is warranted. Cardiac causes should be formally excluded with exercise testing or coronary imaging if there is any clinical suspicion. Non-cardiac chest pain can be challenging to manage and may benefit from a multidisciplinary approach including cardiology, gastroenterology, physiotherapy, and psychological support.
When Should You Seek Medical Advice for Chest Pain?
Chest pain is sudden, severe, or crushing · Pain radiates to your arm, jaw, or back · You are sweating, nauseated, or feel faint · You have known heart disease and new chest pain · You have sudden sharp pain with breathlessness (possible PE or pneumothorax).
You have unexplained chest pain that has not been investigated · Chest pain is worsening or changing in character · You have chest pain with palpitations or dizziness that have not been assessed · You have known angina and your symptoms are worsening despite medication.
How Can You Prevent Chest Pain?
Prevention depends on the underlying cause. For the most common causes of chest pain, evidence-based lifestyle measures are highly effective.
A heart-healthy lifestyle — regular exercise, no smoking, a balanced diet, healthy weight, and managing blood pressure and cholesterol — is the most effective way to prevent cardiac chest pain.
Losing weight, reducing caffeine and alcohol, avoiding large meals before lying down, and elevating the head of the bed can significantly reduce acid reflux-related chest pain.
Cognitive behavioural therapy (CBT), mindfulness, and breathing techniques reduce the frequency and intensity of anxiety-related chest pain and panic attacks.
Stop smoking — this is the single most impactful intervention for reducing cardiac chest pain risk. Smoking cessation reduces cardiovascular risk by 50% within one year regardless of duration of prior smoking.
Maintain a heart-healthy diet (DASH or Mediterranean), exercise at least 150 minutes per week, maintain a healthy BMI, and limit alcohol. These collectively reduce all causes of non-emergency chest pain.
All adults with known cardiovascular risk factors should take aspirin 75mg daily as advised by their clinician. Statins and antihypertensives should be taken consistently to prevent angina and coronary disease progression.
Speak to a Clinician About Chest Pain
If you have chest pain that has already been assessed as non-emergency, or that you believe is musculoskeletal, acid reflux, or anxiety-related, a licensed clinician at The GP Service can review your symptoms, arrange investigations, and recommend treatment — all from home.
Expert clinical advice, when you need it.
Chest Pain FAQs
You should call 999 immediately if you have chest pain that is crushing, heavy, or pressure-like, especially if it spreads to your arm, jaw, neck, or back — particularly if accompanied by sweating, nausea, dizziness, or breathlessness. These may be signs of a heart attack. Chest pain is common and often not cardiac in origin, but it is always safer to seek emergency assessment when you are in doubt. Never drive yourself to hospital with suspected heart attack symptoms.
The most common non-cardiac causes of chest pain include gastro-oesophageal reflux disease (GORD/acid reflux), musculoskeletal pain (costochondritis or muscle strain), anxiety and panic attacks, and pleuritic pain from respiratory conditions. In fact, the majority of people presenting to their GP with chest pain do not have a cardiac cause. However, chest pain always warrants clinical assessment to exclude a cardiac or serious cause before attributing it to a benign condition.
Pericarditis is inflammation of the sac surrounding the heart, typically caused by a viral infection. It produces a sharp, stabbing chest pain that is typically worse when lying flat and relieved by leaning forward. It may be associated with fever and a pericardial friction rub on examination. Treatment is with NSAIDs (ibuprofen or aspirin) and colchicine for 3 months. Rest and avoidance of strenuous exercise during treatment are important. Pericarditis must be distinguished from myocarditis and aortic dissection, both of which are more serious.
Cardiac syndrome X (also called microvascular angina) causes typical angina symptoms — chest tightness on exertion — with a normal coronary angiogram, in the absence of coronary artery narrowing. It is caused by dysfunction of small coronary blood vessels. It is more common in women, particularly postmenopausal women. Treatment includes nitrates, beta-blockers, and sometimes hormone therapy. It is often undertreated because the normal angiogram can lead to symptoms being dismissed. Referral to a cardiologist is appropriate if symptoms persist despite standard measures.
The relationship between testosterone and prostate cancer has been misrepresented for decades. The fear — based on early case reports — that testosterone causes prostate cancer is not supported by current evidence. The ‘saturation model’ suggests that at physiological testosterone levels, prostate cancer growth is driven by androgen receptor saturation, not absolute testosterone concentration. Current evidence does not show TRT increases the risk of developing prostate cancer. However, TRT is contraindicated in men with active or recently treated prostate cancer, and PSA should be monitored during TRT. Men with a history of prostate cancer require specialist endocrinology review before any TRT is considered.
After vasectomy, some men notice small firm lumps in the scrotal area — often sperm granulomas. These are formed when sperm leak from the vas deferens and provoke a local immune and inflammatory reaction, creating a small nodule. Sperm granulomas are benign, affect around 15–40% of men post-vasectomy, and usually resolve spontaneously without treatment. They can occasionally cause tenderness. If a lump is painful or growing, or if you have any concern about a testicular lump, always have it assessed by a clinician to exclude the extremely small but important possibility of testicular cancer.
Post-vasectomy pain syndrome (PVPS) is persistent scrotal discomfort or pain after vasectomy, lasting more than 3 months, and affects approximately 1–2% of men. It is caused by congestion of the epididymis (build-up of sperm), sperm granuloma formation, or nerve damage during the procedure. Most cases are mild and respond to NSAIDs and supportive underwear. Severe cases may require corticosteroid injections, epididymectomy, or even vasectomy reversal. PVPS is more common in men with a history of scrotal pain or orchalgia before vasectomy. It should be discussed as a complication risk before the procedure.
A stroke is the most serious complication of untreated AF. Additionally, longstanding uncontrolled AF can cause AF-induced cardiomyopathy — a weakening of the heart muscle due to persistently fast, irregular rates. Hypertensive heart disease is the most common cause of hospitalisation in uncontrolled high blood pressure. Aortic dissection (a tear in the main blood vessel from the heart) is a rare but catastrophic complication of chronic severe hypertension. These risks underscore why treating both AF and hypertension is a cardiovascular priority.