If you are over 40, obese, a smoker and/or have other diseases such as high blood pressure, high cholesterol levels and diabetes, then chest pain is particularly worrying in your risk group. It may be the sign of a heart attack. Sometimes a heart attack can be preceded by months and even years of similar symptoms known as angina pectoris.
However, not every cases of chest pain is a cause for concern. It can be less serious conditions like muscle strain or acid reflux. It is only when chest pain is accompanied by symptoms like dizziness, shortness of breath and excessive sweating that medical attention becomes immediately necessary. Furthermore any constricting or squeezing chest pain should be more worrying that other types of chest pain.
There are exceptions to the rules however. Some people may have a heart attack without noticing the chest pain, dizziness, shortness of breath and so on. This is known as a silent heart attack. In these cases the heart attack is only discovered in the future when diagnostic tests are conducted for other reasons. Therefore squeezing chest pain is not always a reliable indicator of a heart attack.
Location of Squeezing Chest Pain
An important consideration when squeezing chest pain arises is where the pain is located. This can greatly assist with a differential diagnosis even before diagnostic tests are conducted. Firstly it is important to differentiate central chest pain (in the middle of the chest) from chest pain towards the sides of the chest.
Central chest pain is more likely to be due to heart conditions whereas pain towards the side may be other organs like the lungs. Pain higher up in the chest is also more likely to be due to thoracic organs like the heart and lungs. Pain lower down the chest could be arising from abdominal organs like the gallbladder or stomach.
Read more on central chest pain.
Chest pain associated with pain at other locations can also be helpful in identifying the cause. For example chest pain accompanied by left arm pain is more likely to arising from the heart. Pain lower down in the chest with right shoulder pain is more likely to be due to the gallbladder as is seen in conditions like gallstones.
Causes of Squeezing Chest Pain
There are various possible causes of chest pain and some of these causes are more likely to cause a chest pain that is squeezing or constricting in nature. However, this can be misleading at times as a heart attack which typically presents with a squeezing chest pain can instead present with a burning chest pain similar to acid reflux. The converse is also true when acid reflux presents with a squeezing chest pain like a heart attack. In fact, sometimes emergency room visits for heart attack symptoms are instead due to acid reflex.
Read more on heart vs non-heart pain.
Angina pectoris is a heart pain due to insufficient blood supply to the heart. It is not a heart attack but can be a prelude to one. The small arteries to the heart, known as the coronary arteries, can constrict for various reasons thereby reducing blood flow through it. Symptoms are similar to a heart attack but is short lived and usually eases with rest or drugs known as nitrates.
Coronary Artery Disease
Coronary artery disease is the most common causes of both angina and a heart attack. Here the coronary arteries narrow over time due to the buildup of fatty plaques. The blood flow to the heart is gradually restricted over time. The symptoms are that of angina pectoris and usually triggered during stress or exertion.
A heart attack is one of the leading causes of death in developed nations. It is mainly due to coronary artery disease where the arteries are narrowed and eventually blocked suddenly by a blood clot. A constricting or squeezing chest pain with pain radiating to the left arm, neck or jaw is a characteristic symptom, along with dizziness, shortness of breath, excessive sweating and confusion.
Pericarditis is a condition where the lining around the heart becomes inflamed. This can occur with infections or may occur after surgery to the chest. The pain in pericarditis can vary in nature and sometimes in can be a squeezing or constricting pain. Apart from the pain there may be shortness of breath, fever, fatigue, coughing and heart palpitations.
Another common cause of chest is acid reflux. Most of the time this causes heartburn which is a burning sensation or burning pain in the middle of the chest. It is caused by the stomach acid entering and irritating the esophagus which lies in the chest. However, sometimes the pain is not characteristic burning but can be a squeezing or constricting pain instead.
Asthma is another common respiratory condition leading to chest discomfort and sometimes even chest pain. It is caused by a narrowing of the lower airways which prevents air from flowing through. This narrowing is usually caused by a combination of mucus buildup and smooth muscle contraction in the airway walls. Wheezing with a difficulty breathing are some characteristic signs.
There are several drugs that can also contribute to a squeezing chest pain, mainly by straining the heart, causing the airways to narrow or even triggering acid reflux. If symptoms like chest pain start shortly after commencing a drug then the side effects of the drug need to also be taken into consideration.
Apart from the various drugs used for different diseases, weight loss drugs may also have this effect especially in people who are known to have pre-existing heart disease, lung disease or gastroesophageal reflux disease (GERD).
Muscle, bone and joint pain is often overlooked as a cause of chest pain since the focus is more frequently on serious conditions like heart problems. Any of these structures can become injured, inflamed or damaged which causes pain, restricted movement and related symptoms. It can range from a blow to the chest or muscle strain with physical exertion to arthritis of the joints and even broken bones.
Other Possible Causes
- Esophageal spasm
- Illicit substances