When to See a Doctor About That Weird Chest Tightness

Many conditions can cause this stuck-in-a-vise feeling.

By Korin Miller

When you suddenly experience chest tightness, it’s easy to jump to the most extreme conclusion: This is it, you’re having a heart attack. But there are plenty of conditions that can make it feel like an elephant’s sitting on your chest, some of which are as serious as a heart attack while others are nowhere near that dire. Here’s some information about what might be causing your chest tightness, plus when you should see a doctor.

In order to know when chest tightness is an emergency, you have to understand a little bit about the conditions most likely to bring on this symptom.

Here are some of health issues that often cause chest tightness to alert you that something’s up:

1. Acid reflux

This condition, also known as gastroesophageal reflux (GER), happens when bitter acid from your stomach basically trespasses and goes into your esophagus where it doesn’t belong, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). If you get mild acid reflux at least twice a week or more severe instances of it at least once a week, you might have gastroesophageal reflux disease (GERD), the more intense form of this condition.

No matter the severity of your case, when your stomach acid bubbles up into your esophagus, the irritation can cause the tight, burning, painful sensation in your chest that you may know as heartburn. You may also be able to taste food or stomach acid way back in your mouth and experience additional symptoms like bad breath, nausea and vomiting, a hard time swallowing, respiratory problems, and the erosion of your teeth over time due to all that acid, according to the NIDDK.

2. Asthma

Asthma screws with the passages that transport air into your lungs to supply your body with oxygen. If you have asthma, encountering certain triggers can cause these airways to misbehave more than the most rambunctious of toddlers.

Exposure to a trigger like pet dander, pollen, mold, cold air, or even exercise can cause your airways to swell, making the muscles around them tighten, according to the National Heart, Lung, and Blood Institute. At the same time, your panicky airways pump out more mucus to try to help the situation. (Fun fact: Mucus is supposed to ensnare any dangerous substances you’ve inhaled so they’re easier to cough out.)

This cascading series of events can lead to chest tightness because when your airways constrict, you can’t get as much air in and out as usual, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, tells SELF. This difficulty inhaling and exhaling can make your chest feel tight from built-up pressure, he explains.

Beyond that shortness of breath, if you have asthma-induced chest tightness, you may also experience wheezing (a high-pitched noise when you breathe), coughing, and trouble sleeping, according to the Mayo Clinic.

3. Panic attacks

Experiencing anxiety at some point is part of being human. But if you have an anxiety disorder, then you’re likely very aware that the excessive, persistent worry about everyday situations that characterizes anxiety disorders is completely different.

Although various anxiety issues can manifest with physical symptoms such as a racing heartbeat, panic attacks in particular can lead to chest tightness and pain.

Panic attacks are bouts of acute fear that usually come on suddenly and can be completely debilitating. They can cause a range of symptoms like terror over the loss of control, sweating, trembling, and trouble breathing, according to the National Institute of Mental Health. The chest tightness is linked to that last one.

The rapid breathing that typically comes along with panic attacks can escalate to the point where you’re hyperventilating, or breathing too quickly and deeply, according to the U.S. National Library of Medicine. If you’re not expelling as much air from your lungs as usual, you may feel a sense of tightness and discomfort in your chest, Dr. Casciari explains. This can be so intense that it might make you think you’re having a heart attack.

4. A collapsed lung

There’s a fancy name for this—pneumothorax—and it happens when air seeps into the space between your lung and chest wall, according to the Mayo Clinic. This air then applies pressure to the outside of your lung, forcing it to collapse.

Among other causes, your lung can collapse because of something like a chest injury or a lung disease such as pneumonia or chronic obstructive pulmonary disease (COPD, this is a long-term lung disease that most often happens because of smoking), the Mayo Clinic explains.

Whatever the reason, the main symptoms of a collapsed lung are sudden chest pain and shortness of breath. The pain tends to be pretty sharp and located in the area where the lung has collapsed, and in some cases, people register it as chest tightness instead, Dr. Casciari says.

5. A pulmonary embolism

A pulmonary embolism happens when something blocks one of the arteries in your lungs that transports blood, the Mayo Clinic explains. That something is usually a blood clot that, after forming in your legs (this is called deep vein thrombosis), broke off and traveled to your lungs.

Symptoms of a pulmonary embolism can change depending on the size of the clot and how much of your lung it’s affecting. Chest pain and tightness that won’t go away even when you take it easy are one common sign, according to the Mayo Clinic. A pulmonary embolism might actually kill parts of your lungs, making it harder than usual to breathe, Jennifer Haythe, M.D., co-director of the Women's Center for Cardiovascular Health at Columbia University Irving Medical Center and cardiologist at NewYork-Presbyterian/Columbia, tells SELF. This can lead to a tight-feeling, painful chest.

Other symptoms generally include out-of-the-blue shortness of breath that intensifies when you push yourself physically and a cough that may be bloody. You should also keep an eye out for issues like fever, heavy sweating, dizziness, and leg pain or swelling.

6. A heart attack or angina

OK, sure, having chest tightness could signal that you’re having a heart attack or angina, which is chest pain caused by reduced blood flow to your heart (and a possible warning of a future heart attack), per the Mayo Clinic. But if you’re an otherwise healthy person, it’s more likely that your chest tightness is due to something less serious like acid reflux, Dr. Haythe says. Still, let’s go over the basics.

Symptoms of angina and a heart attack are pretty similar. They usually include pain, squeezing, pressure, or tightness in your chest, pain in your arms, neck, jaw, shoulder, or back, nausea, fatigue, shortness of breath, sweating, and dizziness. The chest tightness comes from the fact that your heart isn’t getting enough blood, Dr. Haythe explains, so it’s setting off alarm bells to alert you to the emergency.

Again, if you’re healthy and young, it’s unlikely that your chest discomfort is due to a serious heart problem. That doesn’t mean you can just put off persistent chest tightness, though.

You should talk to your doctor about chest tightness, no matter how it presents, but there are a few red flags that you need to seek help immediately.

“I always tell people that, no matter what, if you are having chest tightness you need to see your doctor. It’s never really normal,” Dr. Haythe says.

But there’s a big difference in urgency when it comes to acid reflux-induced chest tightness because you ate a bunch of spicy nachos and tightness that’s due to something like a heart issue or pulmonary embolism. A lot of how you handle when to see a doctor depends on what you already know about your health, Dr. Haythe says.

For example, if you know you have asthma and your chest tightness gets better when you use your prescribed medication, you can consider checking in with your doctor in a few days, Dr. Casciari says. Having well-controlled asthma means you shouldn’t need to use your short-acting rescue medications often. Even if your symptoms respond to the drugs, this could be a sign that your asthma action plan needs tweaking. But if your chest tightness and other asthma symptoms aren’t getting better in response to your medications, you may need to go to the emergency room.

Another possibility is that you’re aware that you have panic attacks, but you don’t know how to stop them. Totally normal—this is not something many people can overcome on their own. Treatment methods like cognitive behavioral therapy may help, and many drugs, like selective serotonin reuptake inhibitor antidepressants, are meant to relieve panic attack symptoms, according to the Mayo Clinic.

When you’re less sure about what exactly is going on, you can glean clues from when your chest tightness happens and any symptoms that occur with it. If you get burning chest tightness like clockwork after you eat certain foods and it’s especially prone to striking at night, you probably don’t need to rush to the doctor super-concerned. But for comfort’s sake, see your doctor soon and ask if you may have acid reflux that’s causing heartburn. If you do, treatment methods like antacids to neutralize your stomach acid may help.

Other symptoms are more worrisome, Dr. Haythe says. If you’re suddenly having chest tightness that sticks around whether you’re exerting yourself or resting, shortness of breath, or pain happening in parts of your body like your jaw and shoulder, get to the emergency room immediately. We can’t diagnose you through the screen, especially since so many things can cause this combination of symptoms, but that could point to an issue like a collapsed lung, pulmonary embolism, or heart problem.

Of course, these are loose guidelines. No matter when your chest tightness happens or how intense it feels, seek medical help if you’re concerned. A few of your most important organs are packed in there, so it’s OK to play it safe.

https://www.self.com/story/when-to-see-doctor-chest-tightness