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25th October, 202110 min read

Chest tightness: Causes and treatment

Medical reviewer:Dr Ann Nainan
Author:Dr Roger Henderson
Last reviewed: 26/10/2021
Medically reviewed

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Why does my chest feel tight and heavy?

Chest tightness is a common sensation. It’s often described as a feeling of pressure or heaviness on the chest, discomfort in the chest or throat, a feeling of being short of breath or discomfort after eating.

Chest tightness is linked to a number of possible conditions. Many people worry they’re having a heart attack if their chest feels tight or heavy, but many relatively harmless conditions are more often the cause of this problem.

We look at some of the common causes of chest tightness, when you should see a doctor and how it can be treated.

Common causes of chest tightness

Anxiety

Anxiety can be a very common cause of chest tightness. It can sometimes be so severe that it can feel as if you’re having a heart attack. Other symptoms of anxiety that may occur at the same time can include difficulty breathing or very fast breathing, a very rapid pulse rate, nervousness and aching, or muscle tightness or tension across the body.

Acid reflux

Gastro-oesophageal reflux disease (GORD) occurs when stomach acid travels up from the stomach into the oesophagus (the tube from your mouth to your stomach). It is sometimes also called ‘heartburn’. This can cause chest tightness, as well as a feeling of having a ‘lump’ in your throat, an unpleasant taste in your mouth or a burning feeling in your stomach. Symptoms are often worse when bending or lying down, and after eating.
Most people experience acid reflux at some point during their lives, but you usually need to experience it at least twice a week to be diagnosed with GORD. It can often be hard to pinpoint a cause, but triggers can include smoking, being overweight, spicy or fatty foods, pregnancy, stress or anxiety.

Angina

Angina can occur when not enough blood is sent to the heart muscles. It’s usually caused by a narrowing of the coronary arteries that supply blood to the heart. It can be an early warning sign that you may be at risk of a heart attack or stroke.

The main symptom is chest pain or tightness – sometimes described as a feeling of “heaviness” – that can spread to the arms, neck, jaw or back.

Angina is often triggered by stress, your emotions or physical activity. It usually goes away after a few minutes of rest.

The most common type of angina is stable angina, where attacks have a trigger (such as exercise) and then settle with rest. A less common and more serious type is unstable angina. It can occur at any time and may not go away by resting.

Pulled chest muscle

The muscles involved in breathing run between and around the ribs. They allow the lungs to move in and out. Chest discomfort and tightness can occur if these muscles are stretched or torn due to heavy lifting, unexpected exercise, sudden movement or severe coughing. The discomfort can often be worse when breathing in or when moving.

Asthma

Asthma is a common condition affecting the lungs. It affects more boys than girls, and in adults is more common in women than in men. It can run in families, especially when there is a family history of allergies and/or smoking.

If you have asthma, your airways are particularly sensitive to certain ‘triggers’. These may include colds and viruses, pet hair, cigarette smoke, cold weather and pollen. These triggers can cause your airways to narrow and result in symptoms of asthma such as coughing, wheezing and chest tightness.

Other causes of chest tightness

Most cases of chest tightness are not a sign of anything serious. However, chest tightness and discomfort can also sometimes be caused by heart attacks, pleurisy, peptic ulcers, pulmonary embolism (a blood clot in your lungs) costochondritis and pneumothorax.

When to see a doctor about chest tightness

Fortunately, the majority of cases of chest tightness will either settle by themselves or with the help of treatment from your doctor or pharmacist.

However, always go to your emergency department or call an ambulance if you have sudden chest pain or tightness that:

  • spreads to the arms, jaw, neck or back
  • lasts more than 15 minutes
  • makes you feel sweaty or sick
  • is accompanied by sudden or worsening shortness of breath
  • causes your chest to feel heavy
  • is severe
  • is associated with vomiting blood or dark vomit that looks like ground coffee
  • causes you to cough up a lot of blood
  • makes it hard for you to catch your breath
  • suggests asthma symptoms are not responding to your regular treatment
  • makes you dizzy or faint
  • is accompanied by swelling, pain or redness in your legs
  • is accompanied by signs of sepsis

You should also seek immediate medical attention if you have diabetes and experience chest pain or tightness.

Other symptoms that should always be assessed as a matter of urgency include:

  • coughing up blood
  • chest tightness with a fever
  • persistent vomiting
  • difficulty in swallowing food or drink (dysphagia)
  • unintentional weight loss
  • a feeling of fullness or a mass in your tummy
  • new, persistent and unexplained pain or discomfort in the upper part of your stomach (indigestion or dyspepsia), especially if you’re aged over 55

Always speak to your doctor if you have chest tightness or pain that causes you concern. That includes pain that comes and goes away quickly, or discomfort that appears to have no other symptoms linked to it.

Treatment for chest tightness

The treatment for chest tightness depends on what’s causing it. Your doctor will take a detailed history and examine you. Depending on their initial findings, they may recommend blood tests, an electrocardiogram (ECG) or a chest X-ray.

Anxiety

Anxiety treatments aim to help reduce symptoms, including chest tightness, to a level where anxiety no longer affects your quality of life. This can be achieved through both non-medication treatments and medication. Examples of non-medication – or psychological – treatments for anxiety include counselling, anxiety management courses and cognitive behavioural therapy (CBT). Depending on your individual situation, your doctor may also prescribe a medication-based treatment to try alongside psychological therapies. Avoiding recreational drugs and alcohol is usually also advised as these can worsen anxiety.

Acid reflux

You can usually take a simple antacid tablet or liquid from the pharmacy to help manage occasional acid reflux. Your doctor may be able to prescribe medication that reduces or blocks acid production in the stomach. Options include proton pump inhibitors or histamine receptor blockers to help with more persistent acid reflux that causes chest tightness. Lifestyle tips include losing weight, stopping smoking and avoiding any foods or drinks – such as caffeine and spicy foods – that may make reflux worse.

Angina

Angina treatment aims to prevent symptoms like chest pain and tightness, but to also quickly ease them if they do occur. Another aim is to reduce heart attack risk.

Lifestyle treatments include:

  • stopping smoking
  • maintaining a healthy weight
  • keeping your cholesterol under control, eating a healthy diet, controlling your blood pressure and taking regular exercise

Medications include:

  • nitrates, which work by relaxing your blood vessels to let more blood pass through them. This lowers your blood pressure and helps relieves heart pain
  • aspirin – a type of medicine that can help reduce the risk of a heart attack and angina by thinning your blood and preventing clotting
  • statins, which help to reduce cholesterol in your blood, making a heart attack and angina less likely
  • beta-blockers, which block the effects of a particular hormone in the body. This slows down your heartbeat and improves blood flow, helping to prevent angina
  • angiotensin-converting enzyme (ACE) inhibitors – these block the activity of a hormone called angiotensin-2, which causes the blood vessels to narrow. ACE inhibitors stop the heart from overworking, while also improving the flow of blood around the body

If angina persists, surgical treatments such as angioplasty may be considered. This is where a balloon is used to stretch open a narrowed or blocked artery. It is often performed at the same time as inserting a short wire-mesh tube, called a stent, into the artery. The stent is left in place permanently to allow blood to flow more freely.

Pulled chest muscle

Simple chest muscle strains and pulls usually settle within one to three weeks. In general, they require little treatment other than occasional painkillers as required.

Asthma

The most common treatments for asthma are inhalers. There are two types of inhalers:

  • reliever inhalers – most people with asthma are given a reliever inhaler, which is typically blue in colour. Reliever inhalers are used to treat asthma symptoms as and when they occur (usually within a few minutes)
  • preventer inhalers – these contain a low dose of steroid and are used to reduce airway inflammation and sensitivity. This helps to stop symptoms before they occur. To be effective, preventer inhalers need to be used every day, even when you do not have symptoms.

If your symptoms persist or remain hard to manage, ‘add-on’ treatments may also be used. These can include ‘combination inhalers’ that, as the name suggests, combine two kinds of medicine in one device: a steroid preventer and a long-acting bronchodilator.

The preventer medicine helps to reduce inflammation in your airways, while the long-acting bronchodilator gives ongoing relief from symptoms, including breathlessness and a tight chest. Your doctor may also prescribe a tablet-based medication if you’re finding it hard to control your symptoms effectively by using inhalers on their own.

In addition to taking your asthma medicines as prescribed, you can help to manage your symptoms if you maintain a healthy weight, avoid smoking and try regular breathing exercises.

Outlook

Your doctor will be able to explain recommended treatment options and the outlook for your condition based on your individual situation. Treatment may involve a range of options, from simple lifestyle changes to medication or detailed treatment plans. More serious medical conditions may need long-term monitoring and treatment. Some causes of chest tightness – such as heart attacks and blood clots – can be life-threatening and require urgent medical attention.

FAQs

  • What could be causing chest tightness after eating?

    Answered by: Dr Roger Henderson

    If you only experience chest tightness after eating, this may be linked to gastroesophageal reflux disease. This results from acid leaking backwards from the stomach into the oesophagus. This acid reflux causes heartburn and chest tightness. Tightness may also occur if you’re anxious about eating, if you eat too fast or too much, if you’re overweight or obese, or if you wear clothes that are too tight while you’re eating. If you regularly experience chest tightness after eating, consult your doctor to find out if you have acid reflux or if there may be another cause.

Key takeaways

  • chest tightness can be caused my many things, the majority of which can be treated
  • many cases of chest tightness can be readily diagnosed and may not require detailed investigations
  • treatment varies depending on your individual situation, but may include lifestyle changes, medication or long-term treatment plans
  • severe chest tightness or pain should be assessed by a healthcare professional as soon as possible
  • do not ignore concerns about chest tightness – always get medical advice, even if you only have mild or occasional chest tightness
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