Chest tightness when walking: causes, red flags and when to get it checked

When you walk uphill or climb stairs, the heart needs more oxygen. If a coronary artery is narrowed, the heart muscle becomes short of oxygen and causes a pressure-like discomfort that settles when you stop. Other conditions, including asthma and lung disease, can produce a similar tight feeling.

• Stable angina from coronary artery disease, more likely with age, smoking, high blood pressure, high cholesterol, diabetes or a family history.

• Asthma or exercise-induced bronchoconstriction, with wheeze and cough alongside the tightness.

• Poor fitness or being overweight, giving breathlessness and a heavy chest on exertion.

• Gastro-oesophageal reflux and oesophageal spasm, with burning, relation to meals and relief with antacids.

• Anaemia, which reduces oxygen delivery and can provoke exertional tightness.

• Anxiety and over-breathing.

• Aortic stenosis and hypertrophic cardiomyopathy, which can cause exertional chest pain, breathlessness or faintness.

• Unstable angina or heart attack, if symptoms start at rest or escalate quickly.

Pain at rest or on minimal effort, lasting longer than 15 minutes, with sweating, nausea, breathlessness, light-headedness or collapse, spreading to the arm, neck or jaw, or increasing in frequency or severity, suggests unstable angina or a heart attack.

• Call 999: chest pain or tightness at rest lasting more than 15 minutes, with sweating, breathlessness or radiating pain; or fainting on exertion.

• Urgent same-day GP or rapid-access chest pain clinic: new exertional chest tightness, or a change in your usual angina pattern.

• GP within days: chest tightness with wheeze or cough that fits asthma.

• Routine GP: occasional tightness with a clear non-exertional pattern and reflux symptoms.

Doctors ask what brings it on, how long it lasts, what eases it, where it spreads, breathlessness, risk factors, family history, smoking, cholesterol, diabetes and medicines. They check pulse and blood pressure, listen to the heart for murmurs and lungs for wheeze, and assess for anaemia and leg swelling.

• Resting ECG and blood tests: for anaemia, cholesterol, diabetes and kidney function.

• CT coronary angiography: the first-line test for suspected stable angina in NICE guidance.

• Exercise ECG or stress echocardiogram: to provoke symptoms and look for changes.

• Invasive coronary angiography: for high-risk findings or when treatment such as a stent is anticipated.

• Spirometry or peak flow: if asthma is suspected.

Stop and rest when the tightness starts, and avoid heavy exertion until assessed. Stop smoking, keep to a heart-healthy diet and stay as active as is safe once cleared. If you have been prescribed a glyceryl trinitrate spray, use it as directed. If you have rest pain, do not drive yourself; call 999.

The NHS route is a GP then rapid-access chest pain clinic or cardiology. Private cardiology offers CT coronary angiography and exercise testing directly, usually with a quick turnaround.