What's Causing That Tightness In Your Chest?
The Different Causes of Tightness In the Chest
It’s difficult to hear the words "chest pain"—let alone experience the sensation—and not immediately think of life-threatening heart conditions. After all, cardiovascular disease is the most common cause of death in the United States, and one of its primary symptoms is tightness in the chest, says Steven M. Goldberg, M.D., chair of the Department of Medicine, ProHEALTH Care, board-certified in cardiology and internal medicine. "Although the death rate [for heart disease] has been declining in the United States in the past 30 years or so, it is still the most common killer in America and most developed countries," says Dr. Goldberg.
But having tightness in your chest is also an extremely common sensation—one that's often tough to attribute to a single, definite cause, he adds.
Regardless, you should always take tightness in your chest seriously. Here's what could be causing that feeling and how to handle it.
Tightness in the chest can sometimes be a sign of a breathing or lung health issue, says Lawrence Shulman, D.O., chief medical officer and chief of the division of pulmonary and sleep medicine at ProHEALTH Care. For example, asthma is a respiratory condition in which chronic inflammation narrows the lungs’ airways, causing shortness of breath and a “general, vague sense of tightness” in the chest and back, explains Dr. Goldberg.
However, there's an important distinction between asthma and more serious causes of chest pain: Asthma-related discomfort is usually fleeting, rather than constant—like when you try to take a deep breath and briefly find yourself coughing or wheezing, explains Dr. Goldberg. And if the tightness in the chest tends to come on when you’re coughing at night, during exercise, and/or when you’re laughing, that’s another probable sign it could be asthma, according to the American College of Allergy, Asthma, and Immunology.
While asthma is a pretty manageable condition, tightness in the chest can also be a potential sign of more serious, progressive lung diseases (such as emphysema), says Dr. Shulman. These conditions are almost always accompanied by other respiratory symptoms, like coughing, wheezing, and general difficulty breathing, he adds. Be sure to see your primary care doctor ASAP if you’re experiencing any of these symptoms. (Related: Is Asthma to Blame for Your Post-Workout Fatigue?)
If you've never experienced it, heartburn is basically as uncomfortable as it sounds. When acid comes back up from the stomach, the nerve endings of the esophagus become inflamed, causing painful, burning sensations in the lower chest, explains Dr. Goldberg.
"Irritation of the lower esophagus can be almost identical to cardiac pain," he says. "But [acid reflux-related] chest tightness is more related to dietary issues and not related to exertion," he adds, meaning you can tell the pain happens soon after finishing a big meal (especially when lying down), as opposed to when you're trying to push open a heavy door. (But FYI: You can also get heartburn when you exercise—here's why.)
Acid reflux can often be treated with over-the-counter meds like antacids, or through changes in lifestyle, diet, and eating habits, according to Harvard Health. (Note: If you get acid reflux on the reg and lifestyle changes aren't helping, you might want to talk to your doctor about whether you have gastroesophageal reflux disease.)
Angina happens when there's an inadequate blood supply to the heart, usually as a result of cholesterol blockages, explains Dr. Goldberg. It can cause central to lower chest tightness, heaviness, pressure, and/or burning discomfort, which may also radiate to the neck or left arm. "If more severe, it may be associated with shortness of breath, nausea, or breaking out in a cold sweat," he adds.
There are two types of angina to know about: stable and unstable. Stable angina means the chest tightness happens with a relatively predictable pattern; for example, it may come on with a certain level of exercise, such as walking up subway steps, then ease up within seconds or minutes of stopping the exercise, says Dr. Goldberg. Treatment usually entails lifestyle changes related to diet, exercise, and stress levels, as well as medications like aspirin (to reduce blood clots), statins (to lower cholesterol), or beta-blockers (to manage abnormal heart rhythms), according to the Mayo Clinic.
Unstable angina, on the other hand, means the chest tightness happens with lower levels of exertion, or even at rest. "This may mean a plaque in the coronary artery is becoming 'unstable,'" explains Dr. Goldberg. Since unstable angina can potentially present a short-term risk of a heart attack, it's best to seek help from a physician ASAP if you have any of these symptoms, says Dr. Goldberg.
While chest tightness is more likely to indicate something like indigestion or a bad muscle pull, it is a "warning sign" for potentially life-threatening cardiac conditions, such as a heart attack, says Dr. Goldberg.
But aside from tightness in the chest, you'd also feel a "persistent heaviness and pressure," likely in the central chest, at times radiating to the neck or down the left arm, particularly upon physical exertion, explains Dr. Goldberg. "Nausea, vomiting, and cold sweat are other warning signs that a heart attack may be imminent, he adds. "Any symptoms of this nature need near-immediate attention if they do not resolve within a few minutes at home or at work," he says.
FYI, though: Chest tightness doesn't always accompany a heart attack, especially in women, according to the American Heart Association. Women are more likely to experience "vague" sensations like shortness of breath, dizziness, lightheadedness/fainting, upper back pressure, and extreme fatigue just before a heart attack, explains Robert Glatter, M.D., an assistant professor of emergency medicine at Lenox Hill Hospital, Northwell Health. (Related: Young Women Are at a Higher Risk of Heart Attack Than Ever Before, Says New Study)
As you have seen, there's a lot of overlap between the symptoms of serious and not-so-serious conditions, particularly those that are cardiac-related. "[That's why] it's imperative to see your doctor or, even better, make a visit to your closest emergency department for rapid more definitive evaluation if the symptoms are progressive and unrelenting," says Dr. Glatter.
Other Heart Conditions
Tightness in the right side of the chest (and/or the middle of the chest) can be a sign of a pulmonary embolism, a blood clot in one of the arteries that go from the heart to the lungs, says Amnon Beniaminovitz, M.D., a cardiologist at Manhattan Cardiology.
"A pulmonary embolism may lead to chest pain associated with deep breathing," adds Dr. Glatter. You may also experience swelling or pain in the leg a few days or weeks before the chest pain begins.
Another common cardiac condition marked by tightness in the chest is aortic dissection, aka a tear in the wall of the major artery (aorta) that carries blood out of the heart, according to the U.S. National Library of Medicine. Tightness in the chest and back—classically described as ripping or tearing—is usually associated with elevated blood pressure, says Dr. Glatter. "There may also be weakness of the arms, legs, or other stroke-like symptoms," he adds.
To be clear, any of the above symptoms warrant a trip to the doctor or an emergency department as soon as possible, especially if they stick around longer than a few minutes, says Dr. Glatter. That way, you can get a careful medical examination and specialized tests to determine what's causing your chest tightness.
"Given the overlap between deadly and benign chest pain, it is often difficult, even for physicians and health care professionals, to distinguish between the two," explains Dr. Beniaminovitz. "It is better to err on the side of caution and be evaluated immediately."
Musculoskeletal Chest Pain
When cardiac-, diet-, and lung-related causes of chest tightness have been ruled out, musculoskeletal issues—meaning discomfort that affects the bones, muscles, ligaments, tendons, and nerves—are likely to be the culprit, says Dr. Goldberg.
"Musculoskeletal chest tightness is often related to the position of your chest," he explains. In other words, if you're experiencing tightness specifically when bending over, standing up, turning left, turning right, and/or raising your arms, it's probably musculoskeletal. Plus, if you can pinpoint the discomfort with your finger, and massaging the area makes it feel better, then it's likely a musculoskeletal issue, he adds. (Related: 8 Unconventional Ways to Treat Sore Muscles)
This type of chest tightness is also likely to develop after heavy lifting, straining, pushing, or after strenuous exercise, explains Dr. Glatter. "The pain is reproducible, and it occurs when touching the chest wall or ribs," he adds. "It may improve with heat and anti-inflammatory medications known as NSAIDs."
On the bright side, musculoskeletal chest tightness is pretty common and usually doesn't warrant emergency medical attention, says Dr. Goldberg. But the chest wall contains a huge range of bony and soft tissue structures (including the spine), according to the Royal Australian College of General Practitioners (RACGP). This means it can be extremely difficult to narrow down the exact source of musculoskeletal pain, let alone treat it.
The RACGP categorizes musculoskeletal chest pain into three main categories: isolated conditions/injuries that cause the pain (car accidents, falls, fractures, sprains, dislocations, direct blows to the chest, overuse of the chest muscles, and/or poor posture), rheumatic diseases (such as fibromyalgia or different forms of arthritis), and less commonly, systemic non-rheumatological conditions (such as osteoporosis-related fractures, or neoplasms, aka abnormal tissue growth characteristic of cancer).
Diagnosing any of these conditions is tricky; there aren’t really any "gold standard" diagnostic tests to confirm the cause of musculoskeletal chest pain, the RACPG notes. The best thing you can do is see your primary care doctor, who can help you differentiate and treat your symptoms, and refer you to other specialists if necessary, says Dr. Goldberg.
Anxiety has its own unique symptoms, but it can also "mimic" symptoms of almost any other medical condition, says Dr. Goldberg.
"Stress can cause the muscles between the ribs to tighten up, causing our brain to feel a sensation of tightness," he explains. Combine that with the fact that anxiety can also lead to hyperventilating, rapid breathing, shortness of breath, tunnel vision, difficulty swallowing, and tension/tightness in the muscles in the back of the throat, and it's easy to see why extreme stress is often confused for more serious, life-threatening health issues, adds Dr. Goldberg. (Related: This Woman Bravely Shows What an Anxiety Attack Really Looks Like)
Then there are full-on panic attacks, which happen when heightened anxiety leads to "sudden, disproportional" increases in stress hormones and activity in the sympathetic nervous system (aka the fight-or-flight part of the nervous system), explains Dr. Beniaminovitz. "When people are having a heart attack, the same stress hormones and sympathetic nervous system get activated,” he says, meaning the symptoms between the two overlap a lot: chest pain, breathing difficulties, a racing heart, general weakness, faintness, dizziness, tingling or numbness in the hands and fingers, a sense of terror or impending doom, chills, and cold sweat. (Related: Try This Easy Trick to Stop a Panic Attack Before It Starts)
The good news: Anxiety—and the panic attacks that might happen as a result of the condition—can be treated with therapy and/or medication. But if you're even the slightest bit unsure about whether you're experiencing a panic attack or something more serious, it's always better to err on the side of caution, says Dr. Beniaminovitz.
"Frighteningly, the symptoms of a panic attack are almost identical to a heart attack," he explains. "I would caution against taking chest pain symptoms lightly and I would seek medical attention if you have any chest pain or pressure."