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Hidden Causes of Chest Tightness You Must Know
Hidden Causes of Chest Tightness You Must Know
10 May 2023

Hidden Causes of Chest Tightness You Must Know

What causes chest tightness?

Many people feel tightness and heaviness in their chest, and the cause is often unclear. The tightness may also occur at only specific times of the day, but in other cases, it occurs at any time. If you experience this symptom, you may be concerned about having a medical problem. Chest pain can cause concern but doesn't always indicate a serious medical condition.

Most people who experience chest pain immediately think they are having a heart attack. After ruling out other medical explanations, the healthcare provider may often suggest high-stress levels or anxiety. Chest tightness is usually a symptom of anxiety and may occur with other symptoms.

The chest tightness may occur in one spot or different areas of your chest and may also affect all your chest areas. Where the chest pain occurs varies, depending on the person. It may be persistent, frequent or rarely occur. The chest pain may also cause a piercing, dull, sharp or stabbing tightness or pain alongside numbness, fullness, pressure or persistent tightness.

Sometimes, only chest tightness will occur, or with fear, high stress or episodes of anxiety. In a few cases, anxiety gradually leads to a panic attack lasting 10 – 20 minutes.

Why does chest tightness occur?

The medical causes of chest tightness include ulcers, rib fractures, asthma, gastroesophageal reflux disease and muscle strain. Besides medical conditions, chest tightness can result from an active stress response called flight or fight response. During a stress response, the body experiences changes to protect itself from the danger the body senses.

The muscles tightening and contracting are the changes that result from a feeling of chest tightness. The higher your level of anxiety, the tighter your muscles become. Since the level of chest pain people experience differs, most people think they are having a heart attack.

If you are not having a heart attack but think you are, you tend to panic more. The more you panic, the tighter your muscles become.

Stomach and digestive symptoms usually occur in people struggling with anxiety and stress. The stomach and digestive symptoms may also cause pain, pressure and chest tightness.

Other conditions that cause chest tightness

Several conditions may cause chest tightness. They include:

  • COVID-19

COVID-19, which has affected people since 2020, is a viral disease that may be responsible for chest tightness in some people. This requires emergency care, so contact your doctor or healthcare provider if you experience persistent chest tightness.

Other emergency COVID-19 symptoms, as stated by healthcare experts, include:

  • Bluish lips
  • Trouble breathing
  • Persistent drowsiness

Most cases of COVID-19 cause mild symptoms such as shortness of breath, dry cough and fever.

  • Anxiety

Anxiety affects over 40 million people, making anxiety disorder a common condition. Anxiety often causes chest tightness, alongside the following symptoms.

  • Nervousness
  • Aching and tightening muscles
  • Pounding heart
  • Difficulty breathing
  • Breathing rapidly
  • Dizziness

Anxiety may also lead to a panic attack that lasts for 10 – 20 minutes.

  • GERD

Gastroesophageal reflux disease, or GERD, occurs from stomach acid travelling back to the oesophagus, the tube connecting your stomach and mouth.

In this case, chest tightness may occur with:

  • Chest pain
  • Difficulty swallowing
  • A burning sensation in the chest
  • A sensation of a lump in the throat

Many people experience a form of acid reflux often, but people with GERD experience these symptoms at least two times weekly or more serious symptoms once every week.

You can treat GERD with lifestyle changes and over-the-counter medications. Prescribed medications and surgery are usually options for people with severe GERD symptoms.

  • Muscle strain

Chest tightness often occurs from muscle strain. This symptom is common when you strain your intercostal muscles. About 21 – 49% of all musculoskeletal chest pain results from staining intercostal muscles – the muscles that attach your ribs to one another. 

Muscle strain is usually from intense activity, such as lifting or reaching when twisting. Other symptoms of muscle strain include:

  • Swelling
  • Tenderness
  • Pain
  • Difficulty breathing

Several at-home treatments are available that you can try before visiting a doctor and getting physical therapy. Although stains usually take some time to health, adhering to your physical therapy regime can improve the stress of the healing process.

  • Pneumonia

Pneumonia can affect one or both of your lungs. Healthy lungs are filled with small air sacs that aid oxygen transportation into the blood, but when this infection occurs, the small air sacs get inflamed or filled with fluid or pus.

The symptoms often range from mild to severe, depending on your infection. The mild symptoms are similar to symptoms of the common flu. Other symptoms accompanying chest tightness resulting from pneumonia include:

  • Shortness of breath
  • Sweating, chills, fever
  • Chest pain
  • Cough
  • Confusion, especially if you are above 65 years
  • Diarrhoea and nausea
  • Fatigue
  • Lower than normal body temperature

You can develop different complications from pneumonia, so seek urgent medical care.

  • Asthma

Asthma causes the airways to become swollen, narrow and inflamed. These symptoms and extra mucus production can make breathing difficult for people with asthma.

The severity of asthma varies depending on the person, and the symptoms are manageable. Chest tightness is a common sign of asthma, including:

  • Wheezing
  • Coughing
  • Wheezing sound or whistling when exhaling
  • Shortness of breath

These symptoms can also flare up in some people at certain times, like during exercise. Allergy-induced and occupational asthma may also occur where irritants in the environment or workplace worsen the symptoms.

You can manage asthma symptoms with prescription medications. Consult your doctor to determine if you need emergency treatment when you feel shortness of breath.

  • Ulcers

Peptic ulcers occur from a sore on the stomach lining, small intestine or oesophagus. Although stomach pain is the most common symptom of an ulcer, you may also experience chest pain. Other symptoms include:

  • Heartburn
  • Burning stomach pain
  • Burping
  • Feeling bloated or full
  • Nausea

The treatment for ulcers often depends on their cause, but an empty stomach can worsen your symptoms. Eating foods that buffer stomach acids can also aid in relief from painful symptoms.

  • Hiatal hernia

A hiatal hernia results from part of the stomach pushing up through the diaphragm or the muscles separating the chest from the abdomen.

Symptoms are usually noticeable when a hiatal hernia occurs, but a large hiatal hernia will cause acid and food to go back into the oesophagus, causing heartburn.

A large hernia will cause chest tightness, heartburn and the following symptoms.

  • Feeling of fullness
  • Difficulty swallowing
  • Vomiting blood or passing black stools
  • Abdominal and chest pain
  • Burping

The treatment will include medications to reduce heartburn or, in severe cases, surgery.

Concerned about any of the issues raised in this article? It's well worth undergoing a full body health screening to check for underlying issues, with 4 GP appointments included in all Advanced and Elite MOTS throughout 2023.

  • Rib fracture

A fractured rib can result from trauma that causes the bone to crack. Although the pain is usually severe, broken ribs can heal on their own in 1 – 2 months. However, monitoring rib injuries to prevent complications is necessary.

Pain is the most common and severe symptom of a fractured rib. The pain may worsen when you press on the injured area, take a deep breath or twist or bend your body. The treatment may include physical therapy like breathing exercises and medications.

  • Shingles

Shingle is a painful rash from a viral infection. The rash can affect any body part but often wraps around one side of the chest. Although shingles aren't life-threatening, they can be painful.

Usually, the symptoms are present only in the area of the body the rash affects. Other symptoms are:

  • Itching
  • Headache
  • Sensitivity to touch
  • Itching
  • Sensitivity to light
  • Fatigue
  • Pain, tingling, numbness and burning
  • Fluid-filled blisters
  • Red rash

If you think you have shingles, consult your doctor immediately. Shingles have no cure, but you can get prescription antiviral drugs to aid the healing process while reducing your risk of complications. Shingles often last for 2 – 6 weeks.

  • Pancreatitis

Pancreatitis is an inflammation of the pancreas. The pancreas is found in the upper abdomen, behind the stomach. It helps to produce enzymes that regulate how the body processes sugar. Pancreatitis can self-resolve after a few days (acute pancreatitis) or may be chronic, resulting in a life-threatening condition.

The symptoms of acute pancreatitis include:

  • Back pain
  • Fever
  • Upper abdominal pain
  • Nausea
  • Vomiting
  • Rapid pulse
  • Tenderness in the abdomen
  • Pain that worsens after eating

Symptoms of chronic pancreatitis include:

  • Oily, smelly stools
  • Upper abdominal pain
  • Losing weight

The initial treatments may include fasting to reduce the work done by the pancreas, IV fluids and pain medication. Further treatment may be necessary and depend on the underlying cause of the pancreatitis.  

  • Pulmonary hypertension

Pulmonary hypertension (PH) is hypertension within the arteries on the right part of the heart and lungs.

An elevation in blood pressure is due to the changes in the cells lining the pulmonary arteries. The changes stiffen, inflame, tighten and thicken the walls of the arteries, which reduces or blocks blood flow and raises the blood pressure in the arteries.

This condition may go unnoticed for many years, but the symptoms are more obvious after a few years. The other symptoms are:

  • Chest pain or pressure
  • Shortness of breath
  • Chest tightness
  • Dizziness
  • Fatigue
  • Racing pulse and heart palpitations
  • Bluish colour on the skin and lips
  • Swelling of the legs, ankles and abdomen

A cure for pulmonary hypertension isn't available, but medication and possibly surgery can help you manage the condition. Identifying the underlying cause of PH can aid in its treatment.

  • Gallstones

Gallstones are small solid materials in the gallbladder, the small organ found under the liver. It stores bile, a green-yellow liquid that aids digestion. Most times, gallstones form from excess cholesterol in the bile. It can cause symptoms, but some people may not experience symptoms.

However, some people need treatment for gallstones, if sudden pain occurs in the centre or upper right part of the abdomen, alongside

  • Back pain
  • Vomiting or nausea
  • Right shoulder pain

This may need surgery to remove the gallbladder. If you cannot undergo surgery, you may try taking medications to dissolve the gallstones, but surgery is usually the first course of action.

  • Costochondritis

This condition is an inflammation of the cartilage in the rib cage. The condition often affects the cartilage connecting the upper ribs attached to the sternum or breastbone.

The pain from the condition:

  • Worsens with severe cough and deep breaths
  • Affect more than one rib
  • Occur in the left side of the breast
  • Is a sharp aching and feels like pressure

Chest pain due to costochondritis ranges from mild to severe. In mild cases, the chest pain feels tender to touch, but in more severe cases, you may experience shooting pain in the limbs.

There is no known cause for costochondritis, so the treatment aims to relieve pain. The pain can also subside after several weeks without treatment.

  • Coronary artery disease

Coronary artery disease occurs from damage or disease in the major blood vessels that supply your heart with oxygen, blood and nutrients. The damage is usually due to the build-up of a waxy substance known as plaque and inflammation in the arteries.

This inflammation and build-up narrow the arteries, reducing the blood flow to the heart, leading to pain and other symptoms, including:

  • Chest pain – angina
  • Chest tightness or pressure
  • Shortness of breath

If your artery is completely blocked, you can have a heart attack from coronary artery disease. This will need immediate medical treatment.

Different lifestyle changes can prevent and treat coronary artery disease. However, some medications and procedures are available, depending on the severity of the condition.

  • Oesophageal contraction disorder

Oesophageal contraction disorder causes painful contractions in the oesophagus. The oesophagus is a muscular tube connecting the mouth and stomach. The spasms often feel like sudden, severe chest pain lasting from a few minutes to a few hours.

Other symptoms are:

  • Regurgitation of liquids or food
  • Difficulty swallowing
  • The feeling of an object stuck in the throat

If your oesophagus spasms occasionally, you may not want to get treatment, but if the condition prevents you from drinking and eating, you may need to see a doctor. Common recommendations include:

  • Medications to relax the oesophagus
  • Avoiding certain drinks or foods
  • Managing the underlying conditions
  • Surgery
  • Oesophageal hypersensitivity

This condition causes extreme sensitivity to conditions that may affect the oesophagus. People with this condition may have more frequent and intense symptoms like heartburn and chest pain. In most cases, oesophageal hypersensitivity is not a problem, but the pain can be excruciating if it occurs with conditions such as GERD.

Symptoms of oesophageal hypersensitivity are usually the same as GERD symptoms. The initial treatment often includes acid suppressants. Surgery and other medications may be necessary.

  • Oesophageal rupture

Oesophageal rupture is a hole or a tear in the oesophagus. The oesophagus is the tube connecting the mouth to the stomach, where liquids and food pass through.

Although oesophageal rupture isn't common, it is life-threatening. Its first symptom is usually intense pain from where the rupture occurred, but general chest pain may also occur. Other symptoms are

  • Fever
  • Chills
  • Increased heart rate
  • Trouble swallowing
  • Stiffness or pain in the neck
  • Low blood pressure
  • Vomiting, which may include blood

Immediate treatment can help prevent infection and other complications. It is important to prevent the fluid travelling through the oesophagus from leaking. If the fluid becomes trapped in the tissue of the lungs, infections and breathing difficulties can occur.

Many people will need surgery to close the rupture. Immediate treatment is necessary if you have trouble swallowing or breathing.

  • Mitral valve prolapse

The mitral valve is between the left ventricle and the heart's left atrium. When the left atrium fills with blood, the mitral valve opens, allowing blood to flow into the left ventricle.

However, if the mitral valve does not close properly, mitral valve prolapse occurs, resulting in a condition known as floppy valve syndrome, Barlow's syndrome, or click-murmur syndrome.

 When the mitral valve does not come completely, the leaflets of the valve prolapse or bulge in the left atrium – the upper chamber.

Many people who experience a mitral valve prolapse do not experience symptoms, but symptoms may occur if blood leaks back through the valve (regurgitation). The symptoms vary between people and may worsen over time.

The symptoms include:

  • Chest pain
  • Fatigue
  • Shortness of breath
  • Difficulty breathing
  • Lightheadedness or dizziness
  • Irregular or racing heartbeat

Only a few cases of mitral valve prolapse need treatment, but your doctor may recommend surgery or medication, depending on the condition's severity.

  • Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is a disease that makes the heart muscles abnormally thick or hypertrophied. This often makes it more difficult for the heart to pump blood.

Many people do not experience symptoms and can live without a diagnosis. However, if symptoms occur, they may include the following.

  • Fainting
  • Chest pain and tightness
  • Shortness of breath
  • Heart murmur
  • Pounding heartbeats and the sensation of rapid fluttering

The treatment for this condition depends on the severity of the symptoms. Medications to slow the heart rate and relax the heart muscles, or surgery or to implant a small device (implantable cardioverter defibrillator - ICD) into the chest. An ICD monitors the heartbeat and fixes any dangerous abnormal heart rhythms.

  • Pericarditis

The pericardium is a thin, sac-like membrane around the heart. Irritation and swelling in this membrane are known as pericarditis. Different types of pericarditis affect people, and the symptoms usually vary depending on the type you have.

Generally, pericarditis symptoms include:

  • Heart palpitations
  • Low-grade fever
  • Shortness of breath, especially when reclining
  • Leg or abdominal swelling
  • Cough
  • An overall sense of fatigue, weakness and feeling sick
  • Piercing and sharp chest pain in the left side or the centre of the chest

Chest pain from pericarditis occurs when the irritated layers of the pericardium brush against each other. This condition can happen suddenly and last for a short time called acute pericarditis.

When the symptoms are gradual and persistent, chronic pericarditis may be responsible. Most cases improve without treatment, but treatment for the more severe cases may include medications and surgery.

  • Pleuritis

Pleuritis, sometimes called pleurisy, is an inflammation of the pleura – the membrane lining the inner side of the chest cavity and surrounding the lungs. Chest pain is the primary symptom of pleuritis. The pain may also affect the shoulders and back. Other symptoms are:

  • Fever
  • Cough
  • Shortness of breath

  Several conditions can cause pleuritis, and the treatment focuses on treating the underlying causing and controlling pain.

  • Pneumothorax

Pneumothorax occurs when one of the lungs collapses, and air enters the space between the chest wall and your lungs. Air pushing outside the lungs can cause the lung to collapse.

Most times, a pneumothorax results from a traumatic chest injury. It can result from damage in the underlying chest disease or some medical procedures.

The symptoms include shortness of breath and sudden chest pain. Although pneumothorax is life-threatening, some cases self-resolve. The treatment may involve inserting a flexible tube or needle between the ribs to eliminate the excess air.

  • Coronary artery tear

A tear in the coronary tear requires emergency medical care. In a coronary artery tear, the blood vessel that supplies blood and oxygen to the heart spontaneously tears. This can block or slow blood flow to the heart, leading to sudden heart attack and even death.

A coronary artery tear causes the following.

  • Nausea
  • Chest pain
  • Rapid heartbeat
  • Sweating
  • Shortness of breath
  • Dizziness
  • Extreme tiredness
  • Pain in the shoulder, jaw or arm

When a coronary artery tear occurs, the primary concern in treatment is restoring blood flow to the heart. If restoration of blood flow doesn't occur naturally, a doctor will perform surgery to repair the tear. Surgery may involve bypassing or opening the artery with a stent or balloon.

  • Pulmonary embolism

A pulmonary embolism occurs from a blockage in one of the lung's arteries. This often results from blood clots that travel from the legs to the lungs.

If you experience pulmonary embolism, you will feel chest pain, a cough and shortness of breath. The less common symptoms are:

  • Rapid heartbeat
  • Leg pain and swelling
  • Discoloured and clammy skin
  • Dizziness or lightheadedness
  • Sweating
  • Fever

Although pulmonary embolism can be life-threatening, early detection and treatment will significantly increase your chances of survival. The treatment often involves medication and surgery. The doctor may also prescribe medications to prevent more clot formation.

Diagnosing the cause of chest tightness

Your doctor may first ask questions about your chest tightness. The question may include the following:

  • Have you identified anything that triggers your chest tightness, like eating or physical activity?
  • How long have you been experiencing chest tightness?
  • What is the extent of the pain on a scale of one (mild) to ten (severe)?
  • What have you noticed can improve your chest tightness?

Several tests can help get a more accurate diagnosis. These tests include:

  • Blood tests
  • Chest x-rays
  • A stress test
  • An echocardiogram
  • CT angiography
  • Cardiac catheterisation
  • Coronary angiography

Treating chest tightness

Your doctor will perform some tests to determine why you are experiencing chest tightness. If your tests do not show a heart attack, your symptoms may be due to anxiety.

Discuss your symptoms with the doctor to determine if you need immediate treatment. Your doctor can link the tightness you feel to other symptoms that help diagnose anxiety or a cardiac attack.

If the tightness in your chest is linked to anxiety and high-stress levels, the pain will reduce as your body recovers from the high-stress response, but finding a way to calm yourself is important.

If you regularly struggle with anxiety or have an anxiety disorder, getting coping skills that work for you is necessary. Some coping skills include grounding techniques or deep breathing. Generally, opt for a lifestyle that keeps you relaxed and rested to prevent panic attacks or high-stress responses.

Home treatments

You can try different home remedies if your chest tightness occurs from anxiety. Lifestyle changes can also aid in reducing stress and relieving anxiety. They include:

  • Eating a balanced diet
  • Avoiding caffeine
  • Regular exercise
  • Relaxation techniques such as meditation
  • Avoiding drugs, alcohol and tobacco
  • Eating a balanced diet
  • Socialising regularly
  • Finding hobbies outside of work and school

Avoid ignoring the feelings of anxiety and get medical treatment for this condition. Home-based treatments alone may be insufficient for your anxiety, so visit a doctor to determine if you need treatment.

When to see a doctor about chest tightness

Ensure you seek immediate care from a doctor if you think you are having a heart attack. The symptoms of a heart attack include:

  • Burning
  • Pain
  • Nausea
  • Cold sweating
  • Difficulty breathing
  • Pain that persists for more than a few minutes
  • Pain that travels to other parts of the body
  • Persistent pain in the middle of the chest
  • Squeezing

Are you experiencing any of the symptoms outlined in this article?

Contact the clinic today for a same-day GP appointment.

Outlook for chest tightness

Chest tightness is a serious symptom that requires consulting your doctor, especially if it occurs with other concerning symptoms. It may be a symptom of a serious health issue like a heart attack.

Discuss the symptoms with your doctor if your chest tightness occurs from anxiety. Early treatment for anxiety is necessary to prevent it from becoming worse. Your doctor can recommend a plan to reduce your chest tightness and anxiety, such as lifestyle changes to manage your anxiety from home.