Sharp pain when breathing in
Pain that becomes more noticeable during a deep breath or cough may arise from inflammation or irritation of the pleura. Causes can include pneumonia, pleurisy, pulmonary embolism and pneumothorax.
What is chest pain?
Chest pain means pain, pressure, tightness, burning or other discomfort felt in the chest. It is a symptom rather than a diagnosis, and it can come from the heart, lungs and their lining, chest wall, oesophagus or other structures in and around the chest.
Many people understandably associate chest pain with heart disease, particularly a heart attack. Heart-related causes must be considered because some need emergency treatment. However, chest pain can also have respiratory, musculoskeletal and digestive causes.
Lung-related chest pain often involves the pleura, the thin layers of tissue surrounding the lungs and lining the inside of the chest. Inflammation of these layers is called pleurisy. Pleuritic pain is typically sharp and becomes worse when taking a deep breath, coughing or sometimes moving.
Possible respiratory causes include pneumonia and other infections, pulmonary embolism (a blood clot in the lung), a pneumothorax (collapsed lung), and inflammatory conditions that can affect the pleura. Repeated or forceful coughing can also cause chest-wall pain or contribute to inflammation around the ribs.
Other common non-respiratory possibilities include costochondritis, where the areas joining the ribs to the breastbone become inflamed, and gastro-oesophageal reflux disease (GORD), where acid travelling from the stomach towards the throat can cause a burning sensation in the chest.
Chest pain may be sudden and acute, may come and go, or may persist or recur over time. The pattern offers useful clues, but the cause cannot always be identified safely from the character of the pain alone.
Recognising the pattern
Symptoms of chest pain: what the pattern can suggest
Where the pain occurs, what it feels like, what brings it on and which other symptoms occur alongside it can all help guide the investigation. These patterns are clues rather than a way to diagnose the cause yourself.
Pain with movement or pressure
Muscular strain and costochondritis can cause localised pain or tenderness. It may become worse when moving the upper body, breathing deeply, coughing or pressing on the affected part of the chest.
Pressure, heaviness or tightness
Heart-related pain can feel like pressure, squeezing, heaviness or tightness. It may spread to an arm, the neck, jaw, back or stomach and can occur with breathlessness, sweating, nausea or light-headedness.
Pain with cough or fever
Pneumonia and other chest infections may cause chest discomfort or pleuritic pain alongside cough, phlegm, breathlessness, fever or feeling generally unwell.
Burning behind the breastbone
Acid reflux can produce a burning sensation in the middle of the chest, sometimes with a sour taste, belching or symptoms that are worse after eating, bending over or lying down.
Breathlessness, faintness or coughing blood
Chest pain accompanied by sudden breathlessness, coughing up blood, a very fast heartbeat or fainting needs urgent assessment because serious lung or cardiovascular causes may need to be excluded.
Safety first
When should I seek medical help for chest pain?
Most chest pain is not caused by a heart problem, but potentially serious causes need to be excluded promptly. New, unexplained or concerning chest pain should therefore be taken seriously.
Emergency — call 999
Call 999 if you may be having a heart attack or another serious emergency
Seek emergency medical help for sudden or significant chest pain, particularly when:
- the pain or discomfort does not go away and feels like pressure, squeezing, heaviness or tightness;
- pain spreads to an arm, the neck, jaw, back or stomach;
- chest pain occurs with sweating, nausea, light-headedness or shortness of breath;
- you have severe difficulty breathing;
- you have chest or upper-back pain with a very fast heartbeat;
- you faint, collapse or become unresponsive; or
- you are coughing up a significant amount of blood, especially with breathlessness or chest pain.
Do not wait for a private consultation when emergency symptoms are present. Call 999 and follow the instructions given by the emergency service.
Seek urgent medical advice
Urgent assessment is appropriate for symptoms such as new sharp pain occurring with breathing or coughing, sudden unexplained breathlessness, or coughing up small amounts of blood.
NHS 111 can help direct you to the most appropriate service when the situation does not meet the emergency criteria above but you need urgent advice.
Arrange medical assessment for persistent or recurrent pain
Medical review is advisable if chest pain comes and goes, has resolved but continues to concern you, or is recurring alongside respiratory symptoms such as persistent cough or breathlessness.
A respiratory assessment can be useful when the history suggests the pain may arise from the lungs, pleura or chest wall, or when respiratory symptoms remain unexplained.
Possible causes
What causes chest pain?
Chest pain has many possible causes. Some arise from the lungs or pleura, while others originate in the heart, chest wall, oesophagus or elsewhere. The clinical history and examination help determine which possibilities need investigation.
Lung and pleural causes
Respiratory chest pain is often pleuritic — sharp pain made worse by breathing deeply or coughing. Possible causes include:
- Pleurisy: inflammation of the tissue surrounding the lungs.
- Pneumonia: lung infection that may cause cough, fever, breathlessness and chest pain.
- Pulmonary embolism: a blood clot blocking a blood vessel in the lung.
- Pneumothorax: air entering the space around a lung, causing it to partially or completely collapse.
- Inflammatory or connective-tissue conditions: some systemic inflammatory diseases can involve the pleura or lungs.
Cough and musculoskeletal chest-wall pain
Repeated or forceful coughing can strain muscles in the chest wall and make the ribs and surrounding tissues painful. This pain is often influenced by movement, coughing, deep breathing or pressure over the painful area.
Costochondritis is inflammation where the ribs join the breastbone. Tietze's syndrome is another, less common inflammatory chest-wall condition.
Heart-related causes
Heart-related causes include angina, heart attack and inflammation around the heart such as pericarditis. The type of pain varies, and serious cardiac disease cannot be ruled out simply because pain does not seem “typical”.
When a cardiac cause is suspected, emergency or cardiology assessment may be required rather than respiratory investigation alone.
Acid reflux and digestive causes
Heartburn is a burning feeling in the chest caused by stomach acid travelling upwards towards the throat. Recurrent acid reflux may be described as gastro-oesophageal reflux disease (GORD).
Symptoms may be more noticeable after eating, when bending forwards or when lying down. Because cardiac pain can sometimes feel similar to indigestion or burning, unexplained new chest pain should not automatically be assumed to be reflux.
Other possible causes
Other causes include injury, shingles and anxiety or panic symptoms. In some people more than one problem may contribute — for example, chronic coughing may coexist with reflux or underlying respiratory disease.
Identifying the cause therefore depends on the complete clinical picture rather than one symptom in isolation.
Respiratory assessment
How Dr Ricardo José investigates chest pain
The investigation is guided by the pattern of your pain, associated symptoms, examination findings and medical history. The priority is to identify whether there is evidence of a respiratory cause and whether another specialty or emergency assessment is needed.
Detailed clinical history and examination
Dr Ricardo José will consider when the pain started, where it is felt, whether it spreads, how long it lasts, and whether it changes with breathing, coughing, movement, exercise, eating or body position. Associated cough, sputum, fever, breathlessness, wheeze, haemoptysis and other symptoms are also important.
Review of previous records and imaging
Previous chest X-rays, CT scans, hospital assessments and test results may provide important context, particularly when pain has been persistent or recurrent or when there is an established respiratory condition.
Chest imaging when appropriate
A chest X-ray may help identify problems such as pneumonia, pneumothorax, pleural fluid or other abnormalities. A CT scan can provide more detailed information when the symptoms or initial findings justify it. The type and urgency of imaging depend on the suspected diagnosis.
Blood tests and microbiology
Blood tests may be useful when looking for evidence of infection, inflammation, anaemia or other underlying conditions. If a productive cough accompanies the pain, sputum testing may sometimes help identify an infection and guide treatment.
Additional respiratory testing
Lung-function testing may be appropriate when chest pain occurs with unexplained breathlessness, wheeze or chronic respiratory symptoms. Other specialist respiratory tests are selected only when indicated by the clinical picture.
Cardiac or other specialist assessment when needed
Chest pain sometimes requires investigations outside respiratory medicine. An ECG, cardiac blood tests, echocardiography or other cardiac investigations may be needed when a heart-related cause is possible, usually through an acute medical or cardiology pathway. Gastroenterology assessment may be appropriate when a digestive cause remains a concern.
Individualised care
How Dr Ricardo José treats chest pain
There is no single treatment for chest pain because treatment depends on its cause. The aim is to identify and manage the underlying respiratory problem where appropriate, relieve symptoms safely and involve other specialists when the cause lies outside respiratory medicine.
Chest infection and pneumonia
Management depends on the cause and severity of the infection. Bacterial pneumonia may require antibiotics, while antibiotics are not appropriate for every chest infection. Treatment may also include symptom control, monitoring and hospital assessment when clinically necessary.
Pleurisy and pleural inflammation
Treatment focuses on the underlying reason for the inflammation. Symptom relief may also be appropriate, but conditions such as infection, pulmonary embolism or systemic inflammatory disease require their own specific management.
Cough-related or chest-wall pain
When repeated coughing is contributing to muscular or rib pain, treatment may include identifying and treating the reason for the cough as well as appropriate measures to help the chest wall recover.
Underlying respiratory conditions
If chest pain occurs alongside asthma, chronic lung disease or another respiratory disorder, treatment is directed at optimising the underlying condition. This may include inhaled or other medicines, airway-clearance strategies, physiotherapy or monitoring when clinically relevant.
When another pathway is more appropriate
Suspected heart attack, pulmonary embolism, significant pneumothorax or another acute serious condition requires urgent hospital assessment. If evaluation instead suggests a cardiac, gastrointestinal or musculoskeletal cause, Dr Ricardo José can advise on the need for assessment by the appropriate service or specialist.
Treatment is not prescribed on the basis of chest pain alone. The safest approach is to establish the likely cause first and then choose treatment according to the diagnosis, severity of symptoms, medical history and any relevant test results.
Specialist respiratory assessment
Why see Dr Ricardo José for chest pain?
Dr Ricardo José is a Consultant Respiratory Physician in London. A specialist respiratory assessment can be helpful when chest pain occurs with cough, breathlessness, recurrent respiratory infections or other features suggesting a lung, pleural or chest-wall cause.
Detailed respiratory assessment of the chest pain together with cough, breathlessness and other associated symptoms.
Consideration of alternative or overlapping diagnoses rather than assuming that one symptom has a single cause.
Personalised investigation with appropriate respiratory tests selected according to your symptoms and clinical findings.
Review of previous imaging and results where available, helping to place current symptoms in context.
Multidisciplinary or onward specialist care when investigation indicates that cardiology, gastroenterology or another specialty should be involved.
Patient feedback
What patients say about Dr Ricardo José
You can read independently available patient feedback about consultations with Dr Ricardo José through the London Chest Specialist website and his Doctify profile.
London Chest Specialist patient feedback
Read patient feedback published on the London Chest Specialist website about experiences of consultations and respiratory care with Dr Ricardo José.
Read patient feedback about Dr Ricardo JoséIndependent Doctify profile
Dr Ricardo José also has an independent specialist profile on Doctify, where patients can view feedback published through the platform.
View Dr Ricardo José's Doctify profile
Frequently asked questions
Chest pain FAQs
These answers provide general information. New or unexplained chest pain should be assessed according to the symptoms and urgency rather than diagnosed from an online description.
Is chest pain always related to the heart?
No. Chest pain can arise from the lungs and pleura, chest wall, oesophagus and other structures as well as the heart. Common non-cardiac causes include reflux, costochondritis, muscular pain and respiratory infections. However, a heart-related cause may need to be excluded before assuming the pain is harmless.
What does pleuritic chest pain feel like?
Pleuritic chest pain is usually sharp and becomes worse when you breathe in deeply. It may also worsen with coughing or sneezing. Pleurisy itself has several possible causes, ranging from infection to conditions such as pulmonary embolism, so the cause of pleuritic pain matters.
Can coughing cause chest pain?
Yes. Frequent or forceful coughing can strain the muscles of the chest wall and may contribute to pain around the ribs. Coughing can also make pain from pleurisy, costochondritis or an underlying chest infection more noticeable.
Can pneumonia cause sharp chest pain?
Yes. Pneumonia can cause chest pain, and inflammation involving the pleura can result in sharp pain that becomes worse with breathing or coughing. Other symptoms can include cough, breathlessness, fever and feeling very unwell.
How can I tell whether chest pain is from my heart or my lungs?
The pattern can provide clues, but it is not always possible to distinguish heart and lung causes safely from symptoms alone. Pressure or tightness may suggest a cardiac cause, whereas sharp pain on inspiration may suggest pleural irritation, but there are important exceptions. Emergency symptoms should therefore be assessed urgently rather than self-diagnosed.
What tests might I need for chest pain?
Testing depends on the suspected cause. For respiratory chest pain this may include a chest X-ray, CT imaging, blood tests or other targeted respiratory investigations. Cardiac symptoms may require an ECG, cardiac blood tests or specialist cardiology investigations. Not everybody needs every test.
When should I see a respiratory specialist about chest pain?
Respiratory assessment may be useful for persistent or recurrent chest pain associated with cough, breathlessness, chest infections, abnormal chest imaging or features suggesting pleural or lung disease. Emergency chest pain should be assessed through emergency services first.
Private respiratory consultations in London
Arrange a consultation with Dr Ricardo José
If you have persistent or recurrent chest pain that may be respiratory in origin, particularly when associated with cough, breathlessness or other chest symptoms, you can arrange a specialist respiratory consultation with Dr Ricardo José.
For current emergency symptoms, call 999 rather than booking a routine consultation.
