Chest pain causes: from heartburn to heart attack and when to call 999

Chest pain is one of the most common reasons for seeking urgent care, and it has many different causes. The NHS says most chest pain is not a sign of anything serious but advises getting medical advice just in case, and to get immediate medical help if you think you are having a heart attack. The difficulty is that heart-related and harmless causes can feel alike, which is why a pain that is new, severe or comes with other symptoms should not be dismissed.

The sections below set out the causes the NHS describes, grouped by whether they usually come from the digestive system, the chest wall, the lungs or the heart. They are not a substitute for assessment.

The NHS says to call 999 if you get sudden pain or discomfort in your chest that does not go away, and that the pain can feel like squeezing or pressure inside your chest, burning or indigestion. Call 999 too if you get pain that spreads to your left or right arm, or your neck, jaw, stomach or back, or if you have chest pain and you feel sweaty, sick, light-headed or short of breath. You could be having a heart attack and need immediate treatment in hospital.

The NHS heart attack page adds further triggers for 999: chest pain that feels tight or like squeezing, pain spreading to the arms, neck or jaw, severe difficulty breathing, pale, blue or grey lips or skin, or someone who has passed out and is not responding normally. While waiting for help, sit and rest in a comfortable position, take aspirin (300mg) if you have it and are not allergic, and use your GTN spray if you have angina. Do not drive yourself to A&E.

The NHS gives a table of symptoms and possible causes. In the digestive system, heartburn or indigestion starts after eating, with bringing up food or bitter-tasting fluids and feeling full and bloated. In the chest wall, a sprain or strain starts after a chest injury or exercise, may get worse when you breathe in and feels better when resting the muscle.

• Anxiety, depression or a panic attack: an often sharp, continuous pain triggered by worries or a stressful situation, with a faster heartbeat, sweating and dizziness.

• Chest infection, pneumonia or pleurisy: pain that gets worse when you breathe in, with coughing up yellow or green mucus and a high temperature.

• Shingles: a tingling feeling on the skin, then a rash that turns into blisters.

The NHS says the most common heart problems that cause chest pain include pericarditis and angina or a heart attack. You are more likely to have heart problems if you are older or at risk of coronary heart disease, for example if you smoke, are living with obesity, have high blood pressure, diabetes or high cholesterol, or have a family history of heart attacks or angina under the age of 60.

Angina is a feeling of pain or tightness, usually in the chest, that happens when the heart does not get enough blood, most often because coronary heart disease has narrowed the arteries. The NHS says attacks are often brought on by exercise, stress, emotion or cold temperatures, usually last less than 10 minutes and should stop after resting for a few minutes or taking angina medicine.

A heart attack happens when blood flow to the heart is blocked. Its symptoms may include crushing or squeezing chest pain that spreads to the arm, neck and jaw, shortness of breath, nausea, an indigestion-like burning feeling, sweating and pale, blue or grey skin.

Pericarditis is inflammation of the lining around the heart. The NHS says the chest pain usually feels sharp or stabbing, may spread to the shoulders, arms or tummy, gets worse when you breathe in deeply, swallow, cough or lie down, and gets better when you lean forward. It often follows a viral infection and most people feel better within a few weeks.

A pulmonary embolism is a blood clot blocking a blood vessel in the lungs and can be life-threatening if not treated quickly. The NHS lists difficulty breathing that comes on suddenly, chest pain that is worse when you breathe in and coughing up blood, and sometimes pain, redness and swelling in a leg, usually the calf. It advises calling 999 or going to A&E if you have severe difficulty breathing, pain in the chest or upper back, a very fast heartbeat or someone has passed out.

What happens depends on how urgent the situation seems. For suspected angina, the NHS says a GP will refer you to a heart specialist (cardiologist) and you may have blood tests, an electrocardiogram (ECG), a check of the oxygen level in your blood, and scans such as an angiogram, MRI or CT. For a suspected heart attack you need an ECG and blood tests, and if those show a heart attack you may have an echocardiogram and a coronary angiogram, with the blockage sometimes treated at the same time.

For pericarditis a GP will listen to your heart, since it can change the sound it makes, and may arrange blood tests, a chest X-ray, an ECG or an echocardiogram. For suspected pulmonary embolism you are sent to hospital for tests and treatment, and given an injection of anticoagulant medicine before test results.

See a GP if you have chest pain that comes and goes or that goes away quickly but you are still worried. The NHS says it is important to get medical advice to make sure it is nothing serious. For angina it advises contacting NHS 111 if you have symptoms that come and go, or if diagnosed angina feels worse, is happening more often, lasts longer or happens when you are resting.

For a sharp or stabbing pain that gets worse with a deep breath, swallowing, coughing or lying down, the NHS advises an urgent GP appointment or NHS 111, since this pattern is typical of pericarditis. Chest pain with feeling sick, or with a racing, slow, skipping or fluttering heartbeat, also warrants a call to NHS 111, according to the NHS heart attack guidance.

The NHS lists factors that raise the likelihood of angina, including smoking, drinking more than 14 units of alcohol a week and living with obesity. Stopping smoking, keeping to a healthy weight and having blood pressure, cholesterol and diabetes managed are the main ways of lowering the risk. If you have been diagnosed with angina, keep your medicines with you and follow the plan you have been given for an attack.