Chest Pain When Breathing: Causes and When to See a Doctor

If your chest hurts when you breathe, it can be a sign of numerous conditions, some of which can be serious. This is true whether it happens with regular breathing or when taking a deep breath.

Issues like muscle strains, panic attacks, or infections may be to blame, but chest pain when breathing can also be a sign of asthma, heart problems, or cancer.

You should always see a healthcare provider if you experience chest pain when breathing. And if chest pain and shortness of breath come on suddenly, call 911. You may be having a heart attack.

This article discusses the conditions that may lead to chest pain when breathing, including specific situations like chest pain when lying down or at rest, plus how these conditions are diagnosed and treated.

When Is Chest Pain When Breathing Serious?

Chest pain when breathing isn't always an emergency, but it can point to a serious problem. That's why it's a good idea to seek medical care if you experience this symptom, especially if it's severe, ongoing, or occurs with other symptoms.

Chest pain when breathing can be triggered by a number of different medical conditions or injuries involving the heart, lungs, or nearby tissues or organs, including the following:

• Pleura (a pair of membranes surrounding the lungs)
• Ligaments, muscles, and other soft tissues of the chest
• Thoracic spine (between the neck and waist)
• Pericardium (lining of the heart)
• Esophagus
• Breast

Other symptoms that accompany chest pain when breathing often point to the underlying cause. They include:

• Coughing
• Shortness of breath
• Pain spreading to the back or shoulder
• Fever and/or chills

If you have this type of pain, you may only experience it when taking deep breaths, or it may be present all the time but get worse when you take a deep breath. It tends to be sudden, sharp, stabbing, and intense.

Heart-Related Causes

Chest pain when breathing may be caused by heart conditions. That's because the heart lies near and works closely with the lungs.

Myocardial Infarction (Heart Attack)

Myocardial infarctions happen when something cuts off the flow of blood to a part of the heart muscle. That means the heart isn't getting oxygen. Without prompt treatment, the muscle will start to die.

Getting fast treatment for a heart attack helps limit the damage. Any time you have symptoms that could point to a heart attack, you should get emergency medical help. Common symptoms include:

• Chest pain or discomfort, often in the center or on the left side, that feels like pressure, squeezing, fullness, heartburn, or indigestion; it may go away and come back
• Shortness of breath, usually before or during pain/discomfort, often during rest or small amounts of physical activity
• Radiating pain/discomfort in the arm(s), shoulders, jaw, back, neck, or upper abdomen

You may also have:

• Dizziness
• Feeling weak
• Cold sweats
• Nausea and vomiting (especially in those assigned female at birth)
• Unexplained fatigue (especially in those assigned female at birth)

These symptoms always warrant a call to 911.

Other Cardiac Causes

Other heart-related conditions that cause this type of chest pain include:

• Pericarditis: The membrane lining the heart (pericardium) is inflamed. Causes include infection, lung and breast cancer, and cardiovascular disease related to cancer treatments.
• Aortic dissection: A weak aorta (artery) allows blood to spill into its inner lining. It often causes severe, tearing pain in the chest and back. This is a medical emergency.
• Pulmonary (lung) hypertension: This is high blood pressure in the pulmonary artery. Causes include heart disease, lung disease, connective tissue disorders, and some medications.
  

Lung-Related Causes

The lungs don't have pain receptors. Still, medical conditions involving the lungs can cause pain in several ways. Often, the pain comes from pleurisy, which is irritation of the pleura.

Pain related to the pleura is called pleuritic chest pain. It can be caused by many different conditions, including some that are cancerous or infectious.

Cancer

Cancerous causes of pleurisy include lung cancer, mesothelioma, and malignant pleural effusions.

Lung Cancer

The most common type of lung cancer is lung adenocarcinoma. It tends to grow around the edges of the lung near the pleura.

It's most common in:

• People who've never smoked
• People assigned female at birth
• Young adults

The earliest symptom may be pain from cancer reaching the pleura.

Mesothelioma

Mesothelioma is a type of cancer that arises in the pleura itself. It's most common in people who've been exposed to asbestos.

You can be exposed to asbestos at work or when remodeling homes or other buildings built before asbestos was banned.

Malignant Pleural Effusion

Malignant pleural effusions cause fluid to build up in the pleura. The fluid contains cancer cells. Effusions can occur due to lung cancer, breast cancer, or cancers that spread to the lungs.

Asthma

Asthma is a chronic lung condition that involves episodes ("asthma attacks") including:

• Wheezing
• Breathlessness
• Chest tightness, which may be painful
• Coughing, especially at night or early in the morning

Depending on the type of asthma, it may be triggered by allergies, such as hay fever or physical exertion. Asthma can be well managed with medications, including inhalers, and learning to avoid triggers.

Infections

Infectious causes of chest pain with breathing include:

• Pneumonia: A bacterial, viral, or fungal lung infection
• Viral infections: Coxsackie virus, respiratory syncytial virus (RSV), influenza (flu), adenovirus, cytomegalovirus (CMV), and the Epstein Barr virus (EBV)
• Tuberculosis (TB): A bacterial infection that's uncommon in the United States but very common worldwide

COVID-19

About 18% of people with COVID-19 have chest pain with breathing. It may be due to cardiac complications or infection of the pleura and cause breathing difficulty. Chest pain without difficulty breathing may be a symptom of long COVID.

Non-Infectious Causes

Non-infectious causes of chest pain when breathing include:

• Pleural effusion: An accumulation of fluid between the layers of the pleura, it can be caused by lung disease, heart disease, and autoimmune disorders.
• Pneumothorax: A partial or total lung collapse, it can trigger severe chest pain and shortness of breath. This is a complication of emphysema and other lung diseases.
• Pulmonary embolism: A blood clot breaks off and travels to the lungs and is potentially life-threatening. Risk factors include recent surgery, heart disease, and deep vein thrombosis (DVT).
• Pulmonary (lung) infarction: This occurs when a section of lung tissue dies because its blood supply is cut off.
  

Musculoskeletal Causes

Conditions involving bony or soft tissue structures in the chest may cause chest pain when breathing.

Some of these include:

• Rib fractures: Pain develops suddenly, usually as a result of trauma. It may worsen with deep breaths or coughing.
• Costochondritis: Inflammation and pain between the ribs and sternum (breastbone) can mimic a heart attack; it may be a spot or lump along the sternum that's painful to the touch.
  

Panic Attack

Chest pain is one of the most distressing symptoms of panic attacks. Panic attacks are often mistaken for heart attacks due to chest pain symptoms.

An older study found that approximately 25% of patients who present to their physician with symptoms of chest pain are ultimately diagnosed with panic disorder.

Other Causes

Other common conditions that may cause chest pain when breathing usually cause other symptoms, as well, including:

• Hemothorax: This accumulation of blood in the pleural space is usually due to an injury.
• Shingles (herpes zoster): This is a reactivation of the chickenpox virus and may cause chest pain when breathing if it affects the chest. After a few days, chest pain is followed by a painful rash.
• Gastroesophageal reflux disease (GERD): GERD can cause severe acid reflux, heartburn, and sometimes a chronic cough with chest pain.

Diagnosis

Depending on other symptoms you may have with chest pain when breathing, your healthcare provider may order several tests. These include imaging, bloodwork, and more.

Imaging

Imaging studies include:

• Chest X-ray: May show some problems but is of limited use
• Computed tomography (CT): A type of X-ray using multiple images to create three-dimensional pictures.
• Magnetic resonance imaging (MRI): Shows details of the body's soft tissues
• CT lung angiography: Checks for pulmonary embolisms or arteriovenous malformations (abnormal veins) in the lungs
• CT heart: Examines the structure of the heart
• Echocardiogram: Ultrasound test that can show the heart's motion
• Bronchoscopy: A flexible tube with a camera is inserted through the mouth and threaded down into the large airways of the lungs (the bronchi)
• Thoracoscopy: A scope is inserted into the chest cavity to directly visualize the lung (usually to diagnose lung cancer)

Bloodwork

Blood tests your provider may order include:

• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)
• Plasma viscosity (PV)

These look for markers of inflammation. They can help to identify autoimmune diseases and other inflammatory conditions.

Other Tests

You may also be sent for:

• Electrocardiogram (EKG): Used to check for heart rhythm abnormalities
• Thoracentesis: A needle is used to extract fluid from the pleural cavity to diagnose (and treat) pleural effusion
• Lung tissue biopsy: A tissue sample is taken and examined by a pathologist. Often used to diagnose cancer
• Oximetry: A non-invasive test to measure blood oxygen levels
• Pulmonary function tests: Measures lung capacity and performance

Summary

Many things can cause chest pain when breathing, including heart conditions, lung conditions, infections, and musculoskeletal problems.

Diagnosing the cause of chest pain when breathing can be done using a wide array of imaging studies, bloodwork, and other tests. You should always treat breathing-related problems as a medical emergency and get immediate help.