Chest pain may arise and subside every few minutes or over several days. Chest pain on and off, or chest pain that comes and goes, may be related to the heart, the muscles, the digestive system, or psychological factors.
Underlying causes of chest pain may be mild, as in the case of acid reflux. Or, they may be serious and indicate, for example, a heart attack. It is important to recognize warning signs and look for accompanying symptoms.
In this article, we explore the possible causes of chest pain that comes and goes. We also describe how to tell when the pain is heart-related, and when to see a doctor.
Pain in the chest that comes and goes may signal a problem with the heart, respiratory system, or digestion. Also, in some people, it occurs during panic attacks.
There is no way to accurately self-diagnose chest pain based on symptoms alone. See a doctor if chest pain keeps coming back, gets worse, or accompanies other symptoms.
Pain that lasts for weeks or months is unlikely to be caused by a life-threatening emergency. The issue is more likely related to the muscles or skeletal structure.
Heart problems are
- lasts for only a few moments
- is relieved by taking medication
- goes away when taking a deep breath
- only affects a specific point on the chest
- is relieved when the area of the chest is massaged
Many types of chest pain come and go. Even the pain of a heart attack may temporarily get better, then return.
To better understand the cause of chest pain, look carefully for other symptoms, and keep in mind any risk factors for medical conditions.
Below are common causes of chest pain:
A wide variety of gastrointestinal problems can lead to pain in the chest or near the ribs. For example:
- Acid reflux can cause a burning sensation in the chest.
- Gallstones can cause sudden, intense pain that lasts for several hours, disappears, and returns.
- Ulcers can cause pain that comes and goes.
When a person has acid reflux, chest pain tends to be more intense shortly after a meal. Also, it may be worse after consuming alcohol or fatty foods.
If a person suspects that chest pain is related to a stomach or liver issue, it is important to see a doctor. However, this type of pain does not usually signal an emergency.
Muscle pain caused by tension, an injury, or a chronic pain syndrome often underlies chest pain.
Symptoms of muscle pain vary greatly. The pain may be:
- sharp or dull
- shooting or throbbing
- radiating outward or concentrated in one spot
Chest pain is more likely to be muscle-related if it:
- gets better with massage
- gets worse when a person inhales sharply and suddenly
- feels similar to muscle pain experienced in the past
Chest pain can be a frightening symptom of a panic attack, and it may make a person feel more anxious. The pain can be similar to that of a heart attack. Some people with panic attacks may feel as if they are dying.
These attacks often go away with deep breathing. In some cases, they may last for only a few minutes.
If the pain does not go away, it can be difficult to distinguish a panic attack from a heart attack without the help of a doctor.
Respiratory infections can cause chest pain, especially when they also cause frequent coughing.
Some people develop a condition called pleurisy following a respiratory infection. Pleurisy is inflammation of the pleura, which is the tissue that wraps around the outside of the lungs.
See a doctor if chest or lung pain lingers after a respiratory infection.
Angina is pain or discomfort in the chest that occurs when the heart does not get enough blood. People with angina may feel tension, pressure, or a squeezing sensation in the chest. The pain may also radiate to the jaw.
The pain of angina is similar to that of a heart attack, and angina one risk factor for the condition.
Angina is usually a symptom of coronary heart disease (CHD), which occurs when the arteries become clogged. CHD is also a risk factor for a heart attack. Anyone who suspects that they have it should see a doctor.
Sudden, intense pain in the chest may indicate a heart attack or cardiac arrest. These result when faulty electrical impulses or blockages stop blood from reaching the heart.
Warning signs of a heart attack include:
- pain in the center of the chest
- a feeling of crushing pressure on the chest
- pain that lasts longer than a few minutes
- pain that radiates to the shoulder, neck, arms, back, or jaw
- nausea, dizziness, or shortness of breath
Symptoms may differ, based on sex. Women tend to experience nausea and dizziness, shortness of breath, and back or jaw pain more frequently than men, for example, and they may not have the classic symptom of pain in the center of the chest.
A heart attack is a medical emergency. If a person suspects that they are having one, or if they experience any new, unexplained chest pain, they should contact emergency services right away.
Individuals with cardiovascular risk factors, such as CHD, a history of heart attacks, obesity, or diabetes, are more likely to have heart attacks.
Problems with the lungs, including infections and pneumonia, can lead to chest pain and shortness of breath.
Lung disorders are serious. Anyone who suspects that they have one should seek medical care within 1–2 days. However, being unable to breathe or experiencing intense, lung-related chest pain is considered a medical emergency.
This refers to an infection in breast tissue. Mastitis can be intensely painful. A person may experience swelling, shooting or sharp pains in the breasts or chest, and a fever.
Mastitis is common during breast-feeding. The infection may clear up on its own, though some people require antibiotics or a hospital stay.
A pulmonary embolism is a blockage in a blood vessel that leads to the lungs. An embolism occurs when a blood clot has broken loose, often from the legs. If a person has a blood clot in a leg, they may experience pain in the area.
Pulmonary embolisms can result in intense chest pain and shortness of breath. They are life-threatening medical emergencies.
This can lead to pain in the chest and around the breasts. The following factors may be responsible:
- enlargement of the breasts
- the let-down reflex
- hearing a baby cry
Some people experience breast or nipple pain as the body adjusts in the first few weeks of breast-feeding. If the pain is mild and comes and goes, waiting it out is fine.
Talk to a doctor if the pain is intense or lasts for several weeks.
Chest pain should be evaluated by a physician. It is not always possible to self-diagnose the cause based on symptoms alone.
Chest pain is more likely to be heart-related if a person has:
- cardiovascular risk factors
- a history of heart disease
- shortness of breath
- pain that does not improve with medication or massage
- pain that gets worse over time
Heart issues are unlikely to cause chest pain that:
- improves with massage or painkillers
- feels similar to earlier pain that was not heart-related
- occurs with symptoms of problems unrelated to the heart
A doctor should evaluate any recurring chest pain. If the pain keeps coming back, see a doctor within a few days.
Chest pain that disappears may have been caused by a minor infection, a muscle spasm, or a similar issue.
Seek emergency medical care if the pain is:
- intense and does not go away
- getting gradually worse
- accompanied by dizziness, trouble breathing, or shortness of breath
- accompanied by a squeezing or crushing sensation in the center of the chest
- lasting for more than a few minutes
Most chest pain is not caused by a heart attack. However, prompt medical care can be lifesaving. Even when the cause is a minor issue, seeking immediate care can eliminate any anxiety.
Only a doctor can accurately identify the cause of chest pain, so it is essential to seek a diagnosis.