man holding chest in pain

—Jen U., Laurentian University; St. Lawrence College, Ontario

This question may seem simple, but it’s actually a little complicated. I’ll outline several causes of chest pain. It’s hard to determine if chest pain is worrisome, so if you’re concerned, seeing your family doctor or visiting your on-campus health services may be the best thing to do. If you’re really worried, the emergency room is the place for you.

What’s in the chest?

The structures in or around the chest are the skin, the bones (ribs, sternum, spine), the muscles (pectoralis and intercostal muscles), the lungs, the heart, and the esophagus. A disorder of any of these structures can cause pain in your chest. Other structures that are nearby (like the stomach and liver) or further away (the brain) can also lead to chest pain. Here are some possible causes:

Skin

Shingles is the most noteworthy. This may first manifest as a pain in the chest, followed by an area of redness, then blisters with more pain and itchiness. These episodes can last up to two weeks, and may be shortened if treated early with antiviral medication. So if you have a band of pain followed by redness of the skin, see your doctor. Shingles most commonly occurs in times of stress.

Bones

You’d likely know if this was the issue, but a fracture of the ribs, sternum, or vertebra can result from trauma, such as a motor vehicle accident. Rib fractures can also occur as a result of severe coughing. This will manifest as tenderness when pressure is applied where the pain is felt, or remotely on the broken rib. Nothing can be done except taking pain pills, but it’s good to know that this has happened, as it can take up to six weeks to heal.

Muscles

Muscles can also be damaged during trauma. One of the most annoying effects are cramps in the pectoralis muscles. These will be really painful but short in duration. Stretching the muscle by taking a deep breath will make it disappear, although the pain may get momentarily worse. The tightened muscle will be a palpable, tender knot of varying size. These cramps can occur once or repeatedly.

The esophagus

Acid reflux may sometimes manifest as chest pain. It may be a burning sensation in the chest and occur when lying down. It often happens after a meal, but will be relieved by eating or taking an antacid. It’s also recurrent. This can be easily treated. If you think you have this kind of pain, see your doctor.

The brain

A panic attack may manifest as chest pain, with shortness of breath, palpitations, and a feeling of doom. You may feel really scared. In this case, a physician may be able to help. Treatment may be cognitive behavioural therapy or medication. Panic attacks can happen at any age, and you don’t even have to be anxious on an everyday basis.

The lungs

Three conditions are notable here:

  1. A spontaneous pneumothorax, or a collapsed lung, is caused by the bursting of a bubble in the lung tissue. Air enters through this puncture and lodges itself between the lung and the envelope of tissue around it, preventing the lung from expanding properly. You might feel a sudden sharp pain that you can’t get rid of by pressing anywhere on the chest. It’s frequently followed by shortness of breath. This should be assessed urgently to determine how much lung space is involved. This is more common in tall, thin men.
  2. A respiratory infection may cause pain in part of the chest when breathing. During an infection, the pleura (a membrane around the lung) may become inflamed, causing pain. This should also be assessed to see if treatment with antibiotics is required.
  3. A pulmonary emboli is a blood clot that is formed somewhere else—such as the leg—and floats in a blood vessel to the lung, damaging it. This most often occurs in people taking estrogen, or female-bodied individuals on combined hormonal contraceptives. It’s more likely to occur if the person is a tobacco smoker. This manifests as a sudden, severe chest pain, maybe with shortness of breath and/or coughing up blood. This is an emergency; contact a health professional immediately.

The heart

These two conditions are rare but relevant:

  1. A heart attack is what most people think of when they get a chest pain. This is rare (but not unheard of) in university-age individuals. Characteristically, it’s a gripping or pressure pain of varying intensity, usually on the left side, which may extend to the left arm. It’s often accompanied by shortness of breath and nausea. This is also an emergency.
  2. Myocarditis is an inflammation of the heart. This may result from an infection, some other medical condition, or medication. This is difficult to diagnose. Many patients may never have symptoms except for fatigue. On the other hand, in some cases, sudden death may be the only manifestation. If you have an infection or have been advised that this may occur and you have ongoing fatigue, chest pain, or undiagnosed fever, get an assessment by a doctor.