Chest pain is pain felt in your upper body, from your shoulders down to your ribs.

Although chest pain can be a symptom of many different conditions, it should always be taken seriously because it could be a sign of a heart attack (see below).

The information and advice on this page should not be used to self-diagnose your condition, however, it will give you an idea of what is causing your chest pain and whether you need to see your GP or seek emergency help. It does not include every possible cause of chest pain, but the most common causes are covered.

When to get help

Chest pain could be heart pain if:

• the pain is triggered by physical activity and relieved by rest
• the pain feels heavy, pressing or tight
• you have other symptoms, such as breathlessness, nausea, sweating or pain that spreads to your arm
• you have a risk factor for coronary heart disease, such as being a smoker or having high blood pressure (hypertension), diabetes, high cholesterol or obesity

Could it be a heart attack?

If your chest pain is triggered by physical activity but passes a few minutes after you stop exercising, it may be angina. The chest pain or tightness may spread from your chest to your left arm, neck and back.

Angina is caused by restricted blood flow to the heart. This is because one or more of the three arteries supplying blood to the heart muscle has narrowed. It causes chest pain because the heart does not get enough oxygen.

If you have the symptoms listed above but the pain lasts more than 15-20 minutes, you could be having a heart attack. A heart attack can feel as if your chest is being pressed or squeezed by a heavy object.

The main differences between angina and a heart attack are: 

• angina is brief, relatively mild, and usually triggered by physical effort
• the discomfort of a heart attack will continue despite medication (glyceryl trinitrate spray, which provides immediate relief from the symptoms of angina). It often occurs at rest or during sleep, is severe and can be accompanied by other symptoms, such as sweating

Dial 999 immediately to request an ambulance if you think that you or someone else is having a heart attack.

Do not worry if you have any doubts about whether it is a heart attack. Paramedics would prefer to be called out to find that an honest mistake has been made than to be called out when it is too late to save a person’s life.

Common causes of chest pain

In most cases, chest pain is not caused by heart-related conditions. Common causes of chest pain include:

• heartburn and gastro-oesophageal reflux disease (GORD) – where stomach acid leaks from the stomach back up into the oesophagus (the tube connecting your mouth to your stomach)
• anxiety 
• a pulled muscle
• chest wall pain

The information below should give you an idea of whether these conditions are causing your chest pain.

However, you should always visit your GP for a proper diagnosis and for advice about how to relieve the pain and tackle any underlying cause.

Chest pain that gets worse when lying down

Chest pain that gets worse when you lie down could be the result of acid leaking from your stomach and into your oesophagus.

This common condition is known as heartburn and gastro-oesophageal reflux disease (GORD). It can be usually be easily treated by making lifestyle changes and, if necessary, using medication.

Read more about treating GORD.

It is important to be aware that heart-related chest pain can sometimes occur while lying down. For example, angina decubitus is a complication of heart failure that causes tightness in the chest and a stitch-like feeling around the heart.

Therefore, you should go to see your GP if you have unexplained chest pain while you are lying down.

Chest pain and a tender chest

There are several potential causes of chest pain and a tender chest.

Chest pain and tenderness without any swelling may be caused by a pulled muscle in your chest wall. This can be surprisingly painful, but with rest, the pain should ease and the muscle will heal with time.

If you have pain, swelling and tenderness around your ribs, you may have a condition called costochondritis. This is caused by inflammation in the joints between the cartilages that join the ribs to the sternum (breastbone). Your symptoms should improve after a few weeks.

Chest pain can also be caused by other problems, such as anxiety. As well as making you feel worried, anxiety can also cause physical symptoms, such as chest pain, shortness of breath and heart palpitations.

If your GP thinks your chest pain is being caused by anxiety, they will discuss with you the possibility of psychological treatments, such as counselling.

Less common causes

Less commonly, chest pain may be caused by one of the conditions described below. See your GP if you think you have one of these.

Pleurisy

Pleurisy is inflammation of the double-layered membrane surrounding the lungs. The two layers rub against each other, causing a sharp, stabbing chest pain that gets worse when you breathe in.

The pain of pleurisy can often be relieved by taking shallow breaths. The pain can be treated with ibuprofen while your GP investigates the underlying cause of your pleurisy.

Read more about pleurisy.

Shingles

Shingles is an infection of a nerve and the area of skin around it. It is caused by the herpes varicella-zoster virus, which also causes chickenpox.

The shingles rash usually affects a specific area on either the left or right side of the body and does not cross over the midline (an imaginary line that runs from between your eyes, down past your belly button).

Read more about shingles.

Mastitis

Mastitis is pain and swelling of the breast which is usually caused by an infection, most commonly during breastfeeding.

Antibiotics may be prescribed to help clear the infection. You may also need to change your breastfeeding technique. Your GP or midwife will be able to advise you about this.

Read more about mastitis.

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: assessment of acute chest pain