Chest Pain

Chest pain is a symptom, not a diagnosis. It can come from the heart, the lungs, the gullet, the muscles and ribs, or from anxiety. Most chest pain is not dangerous, but a few causes, such as a heart attack, a clot in the lung or a tear in the aorta, can kill within hours.

Because the dangerous and harmless causes can feel alike, new, severe or unexplained chest pain should be assessed urgently where you are. Planned investigation is for pain that is recurrent, stable and already known not to be an emergency.

Symptoms

• Pressure, tightness or heaviness in the centre of the chest, sometimes spreading to the arm, jaw or back
• Pain brought on by effort and eased by rest (typical of angina)
• Sharp pain that is worse on breathing in, which points to the lung lining or chest wall
• Burning behind the breastbone after meals or when lying down, which suggests reflux
• Tenderness when the ribs or breastbone are pressed
• Breathlessness, sweating, nausea or faintness along with the pain
• Palpitations or a sense of panic

Causes and risk factors

Heart causes include angina and heart attack from narrowed coronary arteries, inflammation of the heart sac (pericarditis) and aortic dissection. Lung causes include pulmonary embolism, pneumonia, pleurisy and a collapsed lung. The gullet and stomach produce pain through acid reflux, spasm and ulcers. Strained muscles, inflamed rib cartilage (costochondritis) and shingles cause chest wall pain. Anxiety and panic attacks are common and real causes, but are diagnosed only after the others have been considered. Risk rises with age, smoking, diabetes, high blood pressure, high cholesterol and family history.

How it is diagnosed

• History and examination: The pattern of the pain, what triggers it and your risk factors guide everything else.
• ECG and troponin blood test: The essential first tests to detect a heart attack. Often repeated after a few hours.
• Chest X-ray: Shows pneumonia, a collapsed lung or a widened aorta.
• D-dimer and CT pulmonary angiogram: Used when a clot in the lung is suspected.
• Echocardiogram and stress testing: Assess heart muscle, valves and whether effort provokes a shortage of blood supply.
• CT coronary angiography or invasive angiography: Show narrowing of the coronary arteries directly.
• Endoscopy: Considered when reflux or an ulcer seems likely and the heart has been cleared.

Treatment options

• Emergency heart attack care: Aspirin, urgent angiography and stenting, given at the nearest capable hospital.
• Angina treatment: Medicines, risk factor control and, for some, stents or bypass surgery.
• Anticoagulation: Blood thinners for a clot in the lung.
• Acid suppression: A trial of a proton pump inhibitor for reflux-type pain.
• Anti-inflammatories and reassurance: For costochondritis and muscular pain, which settle over weeks.
• Psychological treatment: Cognitive behavioural therapy for panic-related chest pain, once physical causes are excluded.

When it is urgent

Call your local emergency number at once for chest pain that lasts more than 15 minutes, feels crushing or tearing, spreads to the arm, jaw or back, or comes with breathlessness, sweating, vomiting, fainting or coughing blood. Do not drive yourself, do not wait to see if it passes and do not get on a plane. Minutes matter in a heart attack.

Travelling to Türkiye for treatment

Travelling for chest pain only makes sense once emergencies have been excluded at home. A visit can then offer a thorough cardiac work-up in 1 to 3 days, such as echocardiography, stress testing and CT coronary angiography, a second opinion on an angiogram you already have, or a planned stent or bypass. Bring previous ECGs, scans and a medication list. If your pain is new, changing or happening at rest, see a doctor locally before you book anything.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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