Feeling tightness in your chest can be an unsettling experience, particularly when it comes on unexpectedly. Experiencing tightness in the chest can be scary but doesn’t necessarily mean it is a serious medical problem.

Chest tightness is common and can be attributed to several different causes, including infection, pulmonary (lung) conditions, gastrointestinal (digestive system) conditions, psychological/emotional reasons, and injury.

What Is Tightness in the Chest?
Chest tightness describes any discomfort that occurs between your lower neck and upper belly area. Tightness in the chest may be felt all over the chest area or located in one spot or several spots in the chest.

Chest tightness can occur in any age group. It is sometimes described as chest pressure, chest pain, or a feeling of fullness or weight in the chest.

The sensation of chest tightness varies from person to person in terms of how it feels and how often it occurs. Some people may experience chest tightness only once, while others with certain conditions (e.g., asthma) may experience it more frequently.

Many people assume they are having a heart attack when they experience chest tightness, but there are many reasons why you may be having it.

When to Call 999/911 for Chest Tightness
Call 999/911 if you or someone you are with is experiencing unexplained chest tightness along with:

· Burning

· Cold sweats

· Crushing feeling of weight on your chest

· Difficulty breathing

· Nausea

· Pain radiating to your jaw, shoulder blades, or left arm

· Shortness of breath after a period of inactivity (e.g., bedrest), as it may be a sign of pulmonary embolism

Causes of Chest Tightness
In order to know if your chest tightness requires medical attention, it’s important to understand what conditions may bring on this feeling. Research suggests the most common causes of chest pain and tightness are musculoskeletal issues, followed by cardiovascular disease and respiratory conditions.1 Causes may include the following.

Infectious Causes
Congestion

If you’ve come down with a cold or the flu, you may be experiencing chest congestion that feels like tightness in the chest. This is caused by excess mucus in your airways, which can restrict breathing and trigger coughing, wheezing, and chest tightness.

In most cases, plenty of rest, drinking fluids such as hot tea or water, and over-the-counter (OTC) medicines (e.g., Robitussin, Mucinex, nasal spray) can help relieve the congestion.

COVID-19

COVID-19 is a viral infection that causes symptoms such as fever, dry cough, runny nose, congestion, and shortness of breath. Some people with COVID-19 may experience tightness in the chest.

According to the Centres for Disease Control and Prevention (CDC), you should seek immediate medical attention if your COVID-19 symptoms include chest tightness accompanied by trouble breathing, bluish lips, confusion, or the inability to stay awake.2

Pneumonia

Pneumonia due to infection causes inflammation of your lung’s air sacs. These sacs may fill with fluid or pus and cause symptoms such as fever, cough, chills, shortness of breath, and chest pain and/or tightness.3 It is important to see your doctor for a pneumonia diagnosis and treatment plan to treat the condition.

Shingles

Shingles is an infection caused by the varicella zoster virus, the same virus that causes chickenpox. Shingles causes a painful rash on the body, most commonly on the torso. In some cases, the pain caused by shingles can be so intense that it may lead to feelings of tightness in the chest.

Antiviral medications and analgesics (e.g., nonsteroidal anti-inflammatory drugs—NSAIDs) are often prescribed to help reduce the pain, and topical antibiotic creams are often prescribed to prevent secondary bacterial infection.4

Pulmonary and Cardiac Causes
Asthma

Tell-tale symptoms of asthma include shortness of breath, chest tightness, wheezing, and cough. If you have asthma and are exposed to lung irritants or allergens, these triggers may cause the muscles in your airways to constrict and narrow, leading to chest tightness, pain, and pressure.5

You may be advised to use an inhaler to relieve your airways and reduce your symptoms. Studies show that albuterol inhalers can effectively ease chest discomfort and eliminate symptoms of an asthma attack.6

COPD

If you have chronic obstructive pulmonary disease (COPD), you may experience occasional chest tightness. While the primary symptom of COPD is shortness of breath, you may feel chest tightness or a sensation that something is wrapped around your chest even while at rest.7

COPD is often treated through the use of inhalers and nebulizers to help improve breathing. Corticosteroids and phosphodiesterase-4 inhibitors are often prescribed to reduce lung inflammation and reduce COPD flare-ups.8

Coronary Artery Disease

Coronary artery disease (CAD) is caused by the narrowing of large blood vessels—known as coronary arteries—that supply oxygen to the heart. Arteries that have become narrow can cause shortness of breath and angina (chest pain). Angina may also be characterized as chest tightness, heaviness, pressure, fullness, or squeezing.

Your doctor may prescribe medications to help improve blood flow, prevent blood clots, and lower your cholesterol or blood pressure. In some cases, you may need an interventional procedure, such as balloon angioplasty (PTCA) or stents.9 These treatments can help reduce plaque build-up in the arteries and prevent future blockages.

Pulmonary Hypertension

Pulmonary hypertension (PH) is a progressive lung disease that causes the arteries that carry blood from the heart to the lungs to become narrowed. Symptoms of PH include shortness of breath from everyday activities (e.g., walking up the stairs), fatigue, dizziness, chest pain, and tightness when strain is placed on the heart through activities.10

Though there is no cure for pulmonary hypertension, there are medications to help manage the condition, including calcium channel blockers to decrease blood pressure and diuretics to rid the body of excess fluid that puts pressure on the heart. Some patients may require a nasal cannula or face mask for oxygen to help them breathe a little easier.11

Mitral Valve Prolapse

Mitral valve prolapse (MVP) is the bulging of one or both of the mitral valves in the heart. When the valves don’t properly close, blood flows backward, which may cause a heart murmur and a number of symptoms, including chest tightness or pain.12

With MVP, you may feel chest tightness or discomfort even when you are at rest. Medications that may be prescribed include beta blockers to lower blood pressure, diuretics to eliminate extra fluids and pressure on the heart, and blood thinners to prevent blood clots.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) causes the heart muscle to become abnormally thick, making it harder for the heart to pump blood. Some people with HCM may experience shortness of breath and chest tightness.13

Your healthcare professional may prescribe medications to reduce how hard the heart muscles have to work and to slow your heart rate so the blood can pump more efficiently through the body.14

Pericarditis

Pericarditis is an inflammation of the protective membrane that surrounds the heart. This thin tissue allows the heart to change in size with each heartbeat. When inflamed, it can cause chest pain, which may be worsened when lying down and taking deep breaths.

Some people say this sensation feels like pressure on the chest or a dull ache. Sitting up and leaning forward can often relieve the pain.

Medications such as ibuprofen and aspirin can help reduce pain and inflammation caused by pericarditis. Depending on the cause of the condition, your doctor may prescribe an antibiotic or antifungal medication.15

Pleuritis

Pleuritis (also called pleurisy) is a condition that causes the pleura, the large, thin layer of tissue that separates your lungs from your chest wall, to become inflamed. Symptoms include sudden and sharp pain in the chest when inhaling or exhaling.

This condition is often treated with NSAIDs such as ibuprofen. Your doctor may prescribe steroids to reduce inflammation if the pain is severe.16

Pneumothorax

Pneumothorax (collapsed lung) occurs when air escapes from the lung and fills up space outside the lung between the lung and chest wall. The air puts pressure on the lung, so it cannot expand as it should when you take a breath, which causes chest tightness and shortness of breath.

In many cases, collapsed lungs can resolve on their own without major intervention, but it may take several weeks until you heal completely.17

Coronary Artery Tear

Spontaneous coronary artery dissection (SCAD) is an uncommon medical emergency caused by a spontaneous tearing of a blood vessel in the heart. Symptoms include shortness of breath, chest pain, rapid heartbeat, nausea, and dizziness.

Immediate medical attention is required for SCAD. The long-term prognosis of SCAD is positive, but there is a risk of recurrence, and it’s important to be closely followed by a cardiovascular specialist.18

Pulmonary Embolism

A pulmonary embolism is a blockage of an artery in the lungs, most often caused by a blood clot. Symptoms include pain under the breastbone, sharp stabbing pain in the chest, and a heavy tightness in the chest that may worsen when breathing.

Pulmonary embolism requires immediate medical attention. You may be prescribed blood thinners to thin the blood and prevent more clots from forming.19

Psychological Causes

When you feel anxious, it can trigger a stress response in the body, causing your heart rate and blood pressure to elevate, blood vessels to restrict, and chest muscles to tighten. This can give the feeling of someone squeezing your chest and cause tightness and shortness of breath.

When the body is in this fight-or-flight mode, cortisol levels are raised, which can lead to chest pains and tightness.20

Gastrointestinal Causes
Gastrointestinal issues can cause tightness in the chest and pain in the chest area.

GERD

Gastroesophageal reflux disease (GERD) is a condition that causes the acid-containing contents of your stomach to leak back up into your oesophagus, the tube that runs from your throat to your stomach.

In addition to heartburn, GERD can cause chest tightness that ranges anywhere from crushing pain to tightness that feels like a weight on your chest.21

There are many OTC medications (e.g., antacids) that can help relieve GERD symptoms. In some cases, your healthcare professional may give you a prescription for stronger medications if OTC formulas are not providing relief.

Peptic Ulcer

In peptic ulcer disease, painful ulcers or sores are found on the lining of the stomach or duodenum (the first part of the small intestine). In most cases, a peptic ulcer causes abdominal pain, but it can sometimes cause chest pain and discomfort.

Peptic ulcers are often treated through antacids to reduce stomach acid, antibiotics to eliminate bacteria that cause the condition, and medications that block the production of stomach acid (e.g., proton pump inhibitors such as Prilosec).22

Gallstones

Gallstones prevent the flow of bile from the liver to the small intestine, which can cause pain that can last hours or even days in severe cases. Most gallbladder symptoms begin with pain in the upper abdomen area, but it can also radiate to the chest, causing chest tightness and pain.

Medical attention is required if you have gallstones, and treatment varies depending on the cause. Researchers suggest that regular exercise and a healthy, nutritious diet are the most important ways to prevent gallstone disease.23

Oesophageal Disorders

The oesophagus is a muscular tube that carries food liquid from your mouth to your stomach. Some oesophageal disorders can cause chest tightness and pain, including:24

Oesophageal contraction disorder
Oesophageal hypersensitivity
Oesophageal rupture
Oesophageal disorders may be treated with medications that reduce stomach acid and relax the muscles in the throat. In some cases, oesophageal disorders that cause chest discomfort may be treated using antidepressants and even behavioural therapy to help manage the pain and discomfort.

As a last resort, some conditions may require surgery to repair the oesophagus and provide symptom relief.

Other Causes
Other causes of chest tightness include:

Muscle Strain

If you’ve pulled a muscle—particularly in your chest, abdomen, or upper/middle back area—you may experience chest tightness and pain when you engage in activities. In some cases, the strain may be severe enough to cause pain when breathing.

Hiatal Hernia

A hiatal hernia can put pressure on your stomach due to the upper part of your stomach protruding into your chest and pushing on the diaphragm. This pressure makes your stomach retain acid, which can flow into your oesophagus, causing chest discomfort, GERD, and heartburn. You may have difficulty breathing or swallowing.

You may take antacids to reduce acid reflux, and you may be prescribed medications to block and/or reduce acid production to give your oesophagus the chance to heal.25

Rib Fracture

A rib fracture is a common injury that occurs when a bone or bones in your rib cage crack or break. Rib fractures can cause severe chest pain, which may worsen when you move or cough. In some cases, the pain may be so intense that it causes chest pain and tightness.

Seek immediate medical attention if your rib fracture causes shortness of breath or a racing heart rate. Rest is important when nursing a rib fracture; it's important not to overdo it to allow the break to heal.26

Costochondritis

Costochondritis is the inflammation of the cartilage in the rib cage, which causes chest pain that may be felt in the middle and upper rib area on either side of your chest. The pain may worsen if you breathe deeply, move, or stretch, and can cause discomfort and tightness in the chest.27

NSAIDs and stretching exercises may provide some relief from the pain. Otherwise, your healthcare professional may prescribe narcotics or antidepressants to control the pain.

How to Relieve Chest Tightness

There are a variety of ways to relieve chest tightness, and the approaches you take will depend on what is causing the sensation. These are not substitutes for the treatment of the underlying conditions but may help ease the tightness.

Respiratory Infections
For chest tightness from a respiratory infection:

Drink fluids:

Fluids help thin out mucus that causes chest congestion. Warm fluids, in particular, can help clear mucus from the chest and nose. Try sipping tea, soup broth, or water throughout the day to help relieve congestion.

Use a humidifier:

Steam from a humidifier (or hot shower) can help clear up congestion. Try using it at night near your bed to help reduce congestion so you can sleep better. You may benefit from adding peppermint essential oil to the water in your humidifier to help clear mucus from your lungs.

Take a decongestant:

Decongestants may help break up mucus and clear the congestion in your chest and nose. Though they are not a cure for chest tightness or the virus that may be causing your infection, these medications—available over the counter in liquid, tablet, or nasal spray forms—can help reduce congestion symptoms.

Use vapor rub:

Vapor rubs are topical ointments that you rub on your chest and throat area. Most have a menthol-based ingredient thought to help clear airways, though there is no scientific evidence to prove this. Though it doesn’t clear up congestion, it may help you breathe a little easier and relieve some chest tightness.

Anxiety
For chest tightness due to anxiety:

Breathing exercises:

When you’re feeling anxious, you may take fast, shallow breaths, which can lead to more feelings of chest tightness. Try taking slow, deep breaths, inhaling for five counts and exhaling for five counts. Studies show that slow breathing can provide relaxation and reduce symptoms of anxiety.28

Grounding techniques:

Grounding is a coping strategy that brings your attention to the present moment and your surroundings rather than getting lost in anxious thoughts. Grounding techniques can be as simple as sitting in a chair and focusing on the sensations in your body (e.g., how does your body feel sitting?) to help slow your thoughts and breathing.

Exercise:

Exercise has been shown to be effective at managing symptoms of anxiety, as it can help offset the fight-or-flight response that activates in your body when you feel anxious.29 Try walking, running, or punching a bag to help find an outlet for the response and soothe your body’s response to the anxiety.

Gastrointestinal

To relieve chest tightness from gastrointestinal problems:

Avoid certain foods and beverages: Try avoiding the things you know will trigger acid reflux in your body, including tomato-based foods, soda, fried and high-fat foods, garlic, chocolate, and alcohol.30 Try eating meals rich in whole, nutritious foods that are low in fat and high in protein.
Eat smaller amounts: Rather than eating three large meals a day, try eating smaller amounts of nutritious foods throughout the day. Eating smaller meals puts less pressure on your stomach and prevents acid reflux. Avoid lying down for at least 20 minutes after eating to prevent heartburn.
Take medications: If your healthcare provider has prescribed medication to manage the symptoms of your gastrointestinal condition, it is important to take it exactly as prescribed for as long as your provider recommends.

Quit smoking:

If you use tobacco products, smoking cessation may clear up some of the acid reflux you’re experiencing. Smoking can damage the lower oesophageal sphincter, which prevents stomach acids from backing up and causing reflux.31 Quitting smoking will improve your lung health, reducing chest tightness and shortness of breath.

Pulmonary

For pulmonary causes of chest tightness:

Take medications:

Depending on the pulmonary cause of your chest tightness, you may be prescribed medication by your healthcare provider to reduce the symptoms of the condition. It’s important to take your medication as prescribed to prevent worsening symptoms.

Avoid triggers:

If certain irritants or allergens trigger your chest tightness and shortness of breath, avoid them as much as possible.

Rest:

If your symptoms are worsened by movement or strenuous activity, it is important to rest when your body needs it. If you need exercise, a light walk outside can help you move your body while not putting too much stress and strain on your lungs.

Muscular
For chest muscle strains that cause pain and tightness, the first line of treatment usually involves the RICE method:

Rest:

When you feel chest tightness or pain caused by muscular strain, stop all strenuous activity and rest. You can resume light activity after two to three days of rest, but take more time to rest if the tightness and pain return.

Ice:

Apply an ice pack to your injured/strained muscle for up to 20 minutes, three times a day, to reduce inflammation.

Compression:

Wrapping a compression bandage around your torso can help reduce inflammation and may help provide relief for chest tightness.

Elevation:

Sit upright and maintain good posture. Use extra pillows to prop up your chest at night while you sleep.

READ ORIGINAL ARTICLE