Types of Chest Pain

Experiencing chest pain might trigger a worry loop: Is it the heart? Gas? Heartburn? There are several types of chest pain and just as many causes. Let's look at when you should get help immediately and when you can wait to make an appointment with your doctor.

According to Dr. Numan Khan, an interventional cardiologist at Houston Methodist, discovering what causes chest pain comes down to its location and characteristics, as well as one's personal risk factors, including age and current health.

"I tell my patients that cardiologists are detectives for what's happening in your chest, right? And we're not just thinking about your heart," Dr. Khan says. "In your chest, you have the actual wall, which includes the bones , the muscle, and the cartilage. Then, deeper, you have the lungs, including the linings around your lungs and your heart. And then, even deeper, your esophagus runs right through the middle of your chest. And depending on what's affected, you can absolutely have symptoms that make you concerned about your heart, but the possible explanations are broad."

When thinking about chest pain, you want to ask yourself some questions to help gauge when chest pain is an emergency or when you can wait to see your doctor.

What is my current health like?
Knowing your family health history, your current health status and being honest about your lifestyle habits can be the lens for which you view chest pain or any concerning symptom of heart disease.

"If your dad had heart disease, if your mom had it, grandparents had it — your family risk profile matters," Dr. Khan says. "If your siblings have heart disease, that's even more concerning."

As we age, people may start to experience more chronic conditions that increase their risk of heart issues.

"If you've been told you have high cholesterol, hypertension or high blood pressure, if you have diabetes or even prediabetes, that means that you're at increased risk," Dr. Khan says. "If your doctor has ever diagnosed you with any of these conditions, you're at increased risk. Managing those predisposing conditions is important to lowering your risk, but even if you've been treated and everything's been pretty under control, it could still be that you have coronary disease."

Lifestyle habits such as smoking and eating habits that include saturated fats and lots of meat, dairy and cheese can increase your risk of heart trouble, too.

"When people come in with chest pain, I look at them as a person in terms of who they are and their risk profile," Dr. Khan says. "So, if you're 25, and you're telling me about chest pain, and it's very clearly related to food, then I'm thinking it is more likely to be indigestion and heartburn. If you're in your 40s or 50s, and maybe you do have hypertension, high cholesterol, and a family history — those same symptoms are potentially more concerning, so that's somebody who really needs to get checked out."

Types of chest pain — and what they could mean
Musculoskeletal
Dr. Khan says that if the chest pain you're experiencing can change with movement or any sort of physical maneuver, such as moving your arm or pressing on your chest, the odds that it is related to your heart are low.

"I like to counsel people to really move their arms and shoulders around and check that out," Dr. Khan says. "If you can change it in any way, if you can push on it, and it changes, that's probably something on the musculoskeletal side of your chest. Sometimes, it can mean you have costochondritis, which is an inflammation of the cartilage and the bones in your rib cage. Costochondritis is something that we often see and that can be from people going to the gym and exercising or using their body in a certain way that strains or sprains one of their costochondral joints. This is a common explanation for chest pain."

Inflammatory
If your chest pain changes with breathing or your body position, it may be due to an inflammatory condition. Dr. Khan says that patients often describe chest pain related to inflammation as a very sharp, painful sensation.

"Say you take in a deep breath, and it hurts and makes you say 'Ouch,'" Dr. Khan says. "That's when I start to think about things like pericarditis, which is inflammation of the lining around the heart. Or if you're laying down, and it hurts more, and then you sit up, and that feels better, those kinds of maneuvers are more consistent with an inflammatory kind of chest pain, something that is inflamed. That could be the pericardium, the lining around the heart. There could even be pleurisy. Pleuritis is pain associated with inflammation in the lining of the lungs."