In short
Chest pain has many causes, from strained muscles and reflux to problems with the heart or lungs. Because some causes are serious, new, severe or unexplained chest pain should always be taken seriously. Sudden chest pain with warning signs needs emergency care, not an appointment.
When to seek emergency care
Do not wait for an appointment and do not use the appointment request link if you have any of the following. Seek emergency medical care immediately.
- Chest pain, pressure, tightness or heaviness that comes on suddenly or does not settle
- Pain spreading to the arm, jaw, neck, back or stomach
- Chest discomfort with breathlessness, sweating, nausea, light-headedness or fainting
- Sudden severe breathlessness, collapse or a very fast, irregular heartbeat with feeling unwell
Busamed Hillcrest 24-Hour Emergency Unit: 031 768 8911. This information must never delay emergency care.
Why chest pain needs careful attention
The chest contains the heart, lungs, oesophagus (food pipe), large blood vessels, muscles and ribs. Pain from any of these can feel similar, which is why chest pain cannot be reliably diagnosed from a description alone.
Many episodes turn out not to be heart-related. However, the heart causes that do occur — such as reduced blood flow to the heart muscle — can be time-critical, so it is safer to be assessed than to guess.
Possible heart-related causes
Discomfort linked to the heart is often described as pressure, squeezing, heaviness or tightness rather than a sharp pain. It may be brought on by exertion or stress and ease with rest, or it may come on at rest.
- Angina — chest discomfort caused by narrowed coronary arteries reducing blood flow to the heart muscle, often with exertion
- Heart attack — a sudden blockage of blood flow to part of the heart muscle; a medical emergency
- Inflammation around the heart (pericarditis), which can cause sharp pain that changes with breathing or position
- Heart valve or heart muscle conditions, which can cause chest discomfort alongside breathlessness or tiredness
Common causes that are not the heart
Chest pain is also commonly caused by muscle or rib strain, acid reflux or indigestion, anxiety or panic, and chest infections. Some non-heart causes, such as a blood clot in the lung, are also emergencies. If you are unsure, seek medical advice.
How a clinician assesses chest pain
Assessment usually begins with a detailed history: what the pain feels like, when it started, what brings it on or relieves it, and other symptoms. Your risk factors — such as blood pressure, cholesterol, diabetes, smoking and family history — are also considered, followed by a physical examination.
Depending on the findings, a clinician may recommend investigations. In general medicine these can include an ECG, blood tests, an echocardiogram, an exercise stress test or imaging of the coronary arteries. Which tests are appropriate is an individual decision; at this practice, consultations, echocardiography and exercise stress testing are offered, and the cardiologist will explain whether further tests are needed and where they would take place.
Treatment depends on the cause
There is no single treatment for chest pain. Care is directed at the underlying cause and may include lifestyle changes, medicines, or — for some coronary artery problems — procedures such as coronary angiography and stenting. Your treatment plan is discussed with you individually.
Questions to ask your clinical team
- Based on my symptoms, how likely is it that my chest pain is coming from my heart?
- Which tests do you recommend, and what will each one tell us?
- Which symptoms should make me seek emergency care before my next appointment?
- Which of my risk factors can I work on now?
Common questions
Can chest pain be caused by stress or anxiety?+
Yes, anxiety and panic can cause chest discomfort. But anxiety and heart disease can occur together, so it is not safe to assume chest pain is stress-related until a clinician has assessed you.
If my chest pain has gone, do I still need to be seen?+
Pain that has settled can still be important, especially if it came on with exertion or had warning features. Arrange a medical assessment; if the pain returns with warning signs, seek emergency care.
Should I request an appointment if I have chest pain right now?+
No. If you have chest pain now, particularly with any warning signs above, seek emergency medical care immediately. Appointments are for non-urgent assessment.
Sources and further reading
General patient education written in plain language and informed by the sources above. It is not a substitute for an individual assessment, and does not describe practice-specific fees, referral rules or preparation — please confirm these with the practice.