Pain under the chest

Chest pain is a relatively common complaint overall. They can be triggered by a wide variety of causes.
It is important to distinguish whether a harmless cause or a disease requiring treatment is responsible for pain under the chest.
The correct therapy is then selected depending on this. In most cases, no special treatment is necessary. However, some causes of pain under the chest require medication or sometimes surgery.

causes

Pain under the chest can originate from almost any structure and organ that is near the chest. The most common causes are listed below:

• Growth melts
• Muscle tension or sore muscles
• Incorrectly fitting bra
• Bruised sternum
• Rib block
• Pinched nerves
• Inflammation of the gallbladder or liver
• Inflammation of the stomach lining or ulcer
• Shingles
• bronchitis
• lung infection
• Heart attack

In addition to the breast itself, which can cause discomfort, especially in women, the pain often comes from nerves, muscles or ribs. It is not uncommon for tension and blockages to occur here, which can cause pain under the chest (see: Chest pain caused by nerves).
In addition, diseases of the lungs and the pleura covering the inside of the chest wall can cause pain under the chest. The heart can also lead to very severe pain through different processes. These can then be found on the left.

In addition to the structures and organs of the chest, organs located in the abdomen can also cause pain under the chest. This is due to the fact that pain is often not only limited to the place of origin, but can also radiate.

Frequently, diseases of the stomach, liver or gallbladder are mentioned in connection with pain under the chest.

In addition to the reasons mentioned, the pain under the chest can also originate from other structures. With bronchitis or chronic heartburn, pain in the sternum often occurs. They can radiate under the breast.

Read more about this at: Heartburn symptoms

In addition, there may be pain under the chest if a malignant tumor forms in the chest. Pain is not typical, but it can lead to further complaints, especially in the later stages.

The most common causes as well as diagnosis and therapy are now explained in more detail below.

For more information on causes of chest pain, also read our article Chest pain!

Chest pain from coughing

Chest pain from coughing is common. Cough is a symptom of various diseases. Typical are chest pain from coughing in bronchitis.
The bronchi split laterally at about level with the sternum, so that the pain is localized under the chest. In some cases the windpipe is also inflamed. Then the pain radiates up to the throat through coughing.

Other causes and the associated cough can also lead to pain under the chest, as the respiratory muscles are overstimulated over time.
If bloody sputum is added to the cough, it can be assumed that the disease is serious. A pulmonary embolism or tumor can hide behind the pain under the chest caused by coughing.

Read more on the subject at: Pain when coughing

Chest pain from a rib block

Pain under the chest is often caused by the ribs. A common reason for this is a so-called rib block. The ribs are attached to the spine by joints. Jerky, incorrect movements or excessive strain can effectively block these joints.
Long-term bad posture, e.g. at the desk are reasons for a rib blockage.

Then there is pain under the chest, which can also appear on the back of the back. In many cases, the pain under the chest is breath-dependent. They are especially amplified when inhaled.
In severe cases, many movements are no longer possible due to pain.

Chest pain from a rib block is treated by releasing the block. This is achieved through moderate physical training and physical therapy exercises. An experienced chiropractor can use specific hand movements to relieve pain under the chest through the ribs.
As a rule, it can be assumed that after a few days of rest or after a visit to the specialist, no further discomfort from the ribs should occur.

Read more about how you can solve a rib block yourself and what causes it in the following articles:
Rib blockage - causes & therapy
This is the correct way to resolve a rib block

It makes sense to check your posture to avoid another rib block.

In addition to rib block, there are other reasons for chest pain caused by ribs. These include blows to the chest or entrapment of nerves. In rare cases, rheumatic disease is responsible for pain under the chest.

You can find more information on this topic here: Rib pain

Pain under the chest through the sternum

Chest pain can also be caused by the sternum.
The most likely cause of chest pain from the sternum is frontal force against the sternum. This happens, for example, during sport or in the event of an accident.
A resulting bruise can cause pain in the sternum for days to weeks.

If the pain is very severe or if it lasts longer, a fracture should be ruled out. Diseases of the attachments of the ribs, which are located on the left and right sides of the sternum, can also appear like pain under the chest.

In addition, excessive strength training can lead to pain under the chest or through the sternum. The reason for this is the attachment of various muscles to the sternum, which can cause pain due to sore muscles.

Pain under the chest through the rib cage

The rib cage consists of the central sternum and the 12 pairs of ribs attached to it. Nerves and blood vessels run between the ribs; the intercostal muscles are also located here and are used for inhalation and exhalation.

All of these structures can be irritated or diseased.Pain under the chest emanating from the chest can be caused by trauma, pinched nerves, blockages, or muscular irritation.

One skin-related cause of chest pain is shingles. This virus-borne illness causes pain in a belt-shaped area, which can also appear under the chest.
The appearance of small blisters in the affected area suggests shingles.

However, the structures within the rib cage can also cause pain under the chest that appears to originate from the rib cage.
Lung diseases are common here. Pneumonia, for example, can lead to chest pain. Especially when the lungs are involved, every breath causes sharp pain under the chest.

Read more on the subject at: Signs of pneumonia

A collapsed lung (pneumothorax) or a pulmonary embolism (a blood clot in a blood vessel in the lungs) is rarely the cause of the symptoms.

Chest pain can also be related to the heart. An insufficient supply of the heart leads to severe pain, usually under the left breast. In the worst case, a heart attack is the cause.

Read more on the subject at: Symptoms of a heart attack

Mostly, however, it is a harmless cause of pain under the chest that originates in the chest.

Read more about this under: Chest pain from organs in the rib cage

Pain under the chest from a bra underwire

Quite a few women complain of chest pain caused by bra underwires. This is because some bras have rigid underwires to support the chest. These lie under the chest and press on the skin, especially when worn for a long time. This causes pain under the chest.
Here it is advisable to check the bra size and possibly buy a larger model. If the bra underwire is still a problem, you should resort to bras without underwire. Although these do not support the female breast as well, they are much more comfortable to wear and therefore longer to wear.

Pain under the chest from upper abdominal pain

Chest pain can be caused by upper abdominal pain, as described above. The reason for this is that some abdominal organs are high up in the abdomen and sometimes reach behind the lower ribs. This anatomical proximity leads to pain under the chest due to upper abdominal pain.
In addition, many organs project their pain to another part of the body. This is due to the complex interconnection of the nerve tracts.
Most commonly, the stomach, gallbladder, liver, and intestines are the triggers for pain under the chest caused by upper abdominal pain.
The symptoms of epigastric pain are often accompanied by nausea and vomiting.

Examinations such as ultrasound, X-rays and blood tests can help pinpoint the exact cause. The correct therapy is then initiated. For example, chest pain caused by organs in the upper abdomen is usually good to treat.

You can find more information on the most common causes of upper abdominal pain here: Causes of Upper Abdominal Pain

Causes of Right Breast Pain

The pain under the chest is often one-sided. There are causes for the complaints that occur on this side for no specific reason.
There are also special, one-sided causes.

Right chest pain can have many causes.
For example, an irritated nerve or muscle in the right side can cause pain under the right chest.
Unilateral pneumonia with lung membrane involvement on the right side can also cause pain under the chest.
Likewise, a blocked lung vessel can cause severe pain under the right breast.

Problems with the heart or stomach are unlikely. These cause pain under the right breast less often, but more on the left.

One cause that occurs slightly more frequently on the right than on the left is a collapsed lung (pneumothorax). This can only be partially collapsed, so that there are almost no complaints. In some cases, a lot of tissue is affected, causing severe pain under the chest and back. It often affects young, slim and tall men. However, a pneumothorax can also occur on the left.

In addition, right-sided abdominal organs can often be responsible for pain under the right breast. These include the gallbladder and liver.

Further information on this topic can be found at: Right chest pain

Pain under the right chest from the liver

The liver sits in the right upper abdomen and extends under the ribs. If it causes pain, it can pull under the right breast.
Since the liver itself does not cause pain until its capsule is stretched, pain under the chest from the liver is a late-stage symptom.

An underlying disease can be cirrhosis of the liver, for example. It mainly occurs after years of alcohol consumption.
Infectious causes such as inflammation of the liver (hepatitis) can also cause pain under the chest if they are severe. In rare cases, a malignant tumor is hidden behind it.

Pain under the right breast from the gallbladder

In contrast to the liver, the gallbladder is relatively often responsible for pain under the chest on the right side. It sits at the back of the liver and affects up to 15% of the population at some point in life.
A distinction is made between gallstone disease and inflammation of the gallbladder.
The latter is usually caused by gallstones, which can prevent the bile from draining. Gallbladder diseases lead to severe, cramp-like pain in the right upper abdomen.
These often radiate to below the right breast. The therapy of both the inflammation and the stones formed in the gallbladder is the surgical removal of the organ.

Read more on the subject at: Gallbladder pain

Causes of pain under the left breast

As on the right side, there can also be unilateral pain under the left breast.
Of course, pain under the left breast can be caused by the diseases mentioned above. Muscular or nervous complaints, trauma and diseases of the lungs are the most common.

In contrast, pain under the left breast is rarely caused by the liver or gallbladder.
If organs outside the chest are the cause, a problem with the stomach or spleen is more likely.

It is not uncommon for injuries or diseases of the stomach to radiate through the central upper abdomen to below the left breast.

The spleen is rarely the cause of chest pain. If this is the case, however, they originate in the left flank and should be promptly clarified by a doctor.

Read more about this at: Left chest pain and left rib pain.

The main organ that can typically cause pain under the left chest is the heart. Not all pain on the left comes from the heart. Nevertheless, serious complaints should be clarified for safety.

Read more on this topic at: Symptoms of a heart attack

Pain under the left chest through the heart

If pain under the chest is caused by the heart, it very often presents on the left side next to the sternum and under the left chest.
If the pain occurs mainly during exertion and then disappears again, one speaks of angina pectoris. This is due to a temporary lack of oxygen in the heart.
If the pain is acute, with shortness of breath and possibly nausea, an emergency doctor must be called immediately. This could be a heart attack.

Pain under the left chest caused by the heart is different from pain from other causes. They are very strong and are usually accompanied by a sense of fear. In this way, pain under the chest can be differentiated from more harmless causes.

Any new pain under the left breast that is not clearly attributable to a cough or cold should be clarified. If in doubt, the rescue service should be alerted.

Read more on the subject at: Signs of a heart attack

Pain under the left chest from the stomach

The stomach is slightly offset to the left in the upper abdomen. It can also cause pain under the left breast. Reasons for this are an inflammation of the stomach lining (gastritis), a stomach ulcer or chronic heartburn.

Most often responsible for pain under the chest from the stomach is inflammation or an ulcer.
The pain from the stomach occurs mainly after eating. In addition to the pain under the left breast, there is nausea and a feeling of fullness.
Treatment of the inflammation is usually the administration of antibiotics.

In the case of a stomach ulcer and heartburn, the stomach acid production is initially inhibited by drugs. This allows many complaints to be treated.

Read more about this at: Symptoms of inflammation of the stomach lining

Accompanying symptoms of chest pain

Depending on the cause of the chest pain, accompanying symptoms may occur.
Inflammatory processes often lead to fever or chills.
Pneumonia can cause pain under the chest, coughing and shortness of breath. The cough can be dry or accompanied by sputum. Greenish-yellowish sputum is typical of bacterial infections.

Breathing problems also occur with pulmonary embolism (a blocked lung vessel) and heart attack. In addition to severe pain under the chest, the latter often causes accompanying symptoms such as nausea and impaired consciousness.

Nausea and vomiting are also accompanying symptoms of diseases of the abdominal organs. The stomach and gall bladder play a particularly important role here.

A pinched rib nerve can cause pain under the chest as well as accompanying symptoms. Depending on the degree of entrapment, there may be disorders of the sensory perception. Tingling or numbness are the most common accompanying symptoms.

With a rib blockage, certain movements can sometimes no longer be performed.

Read more about this at: Chest pain from nerves

Chest pain when breathing

Chest pain is often seen while breathing. This has to do with the fact that the chest expands and contracts again with every breath. Therefore, pain under the chest caused by nerves or muscles often occurs while breathing.
Inhaling in particular causes pain under the chest by stretching the structures.
Furthermore, pain when breathing can suggest a cause of pain in the lungs.
In some cases, chest pain when breathing occurs even if the cause is in the abdomen. This is because the organs are constricted by breathing.

Mostly, however, chest pain when breathing is caused by a joint blockage, a pinched nerve or bronchitis.

Chest pain when coughing

When coughing, there is an increase in pressure throughout the chest. If the structures are previously damaged, this can cause pain under the chest. Typically, it can affect the muscles, nerves and bones (ribs and sternum) on the chest.

But the lungs themselves are often the cause of pain when coughing. For example, foci of inflammation in the airways can be irritated by the cough and cause pain under the chest. Even small adhesions caused by infections of the lungs or damage to the lung tissue can be painful when coughing.

Chest pain along with back pain

Pain that occurs both in the back and under the chest at the same time usually suggests a muscular origin of the symptoms. Typically, a bad posture or muscular imbalance leads to tension in the back muscles. These are transmitted via the rib cage to the muscles of the rib cage and thus lead to additional pain under the chest.

The symptoms occur less often when there is damage to the spine. This can also cause pain under the chest and chest through circulatory disorders or nerve irritation and entrapment. These then usually radiate into the back.

Also read: Back pain

Intercostal neuralgia

Intercostal neuralgia is a pain syndrome (algie = pain) of the nerves (neuron = nerve) between (= inter) the ribs (= costae). These intercostal nerves are responsible for supplying the intercostal muscles and play an important role in breathing, as they pull the ribs apart or together and thus increase or decrease the volume in the grain of the chest. The intercostal nerves run just below the ribs.

If these nerves become trapped, normal breathing movements can lead to a pull on the affected nerves. This typically manifests itself as nerve pain (electrifying, stabbing). This intercostal neuralgia is particularly pronounced when coughing.

You may also be interested in the following article: Intercostal neuralgia

Breast Pain During Pregnancy

Chest pain can also occur during pregnancy.
First of all, it must be said that in pregnancy all of the above-mentioned causes can be responsible for pain under the breast.
In fact, pregnant women are at increased risk of gallbladder disease.
The risk of a pulmonary artery occlusion, i.e. a pulmonary embolism, is also slightly increased.

Nevertheless, breast pain during pregnancy is usually caused by adjustment processes in the body and the growing baby. This takes up more and more space in the stomach, especially in the third trimester of pregnancy.
This leads to increased pressures around the abdomen. These can also project upwards, which can cause pain under the chest.
Symptoms of this kind occur especially when the woman is pregnant.

Heartburn plays a bigger role in under-breast pain during pregnancy (see: Heartburn during pregnancy). Almost every pregnant woman sooner or later suffers from a backflow of stomach acid into the esophagus. This leads to burning pain in the area of ​​the sternum. However, there may also be side pain under the chest.

Usually, breast pain is harmless during pregnancy. Relief can be achieved by taking a seated position or sleeping with your torso slightly elevated.
If, on the other hand, accompanying symptoms such as shortness of breath, anxiety and nausea occur, this must be clarified by a doctor in order to recognize or rule out a dangerous disease.

Read more on the subject at: Heartburn during pregnancy

Pain under the nipple

Chest pain can cause discomfort not only under the breast but also just below the nipple. The reasons for this are diverse.

Pain under the nipple occurs especially in women. The most common reason for this are processes during the female cycle. The hormones released in the process often cause a feeling of tension under the nipple, which some describe as pain.

Therefore, women who suffer from similar symptoms should pay attention to whether the pain occurs in a cycle-dependent manner.
Similar processes cause pain under the nipple during pregnancy. The remodeling processes affect the growth of fat and mammary glands.

There are also other causes of nipple pain or pain under the nipple.
In some cases these are due to inflammation of the mammary gland. This happens especially in women who are breastfeeding. There is also a reddening of the breast.

In rare cases, a malignant disease is responsible for the pain under the nipple. This is a special form of breast cancer, inflammatory breast cancer.
This is also associated with reddening and skin changes. This condition is rare.

If the symptoms persist, however, it is advisable to see a doctor in order to determine the exact cause.

Read more on this topic at: Painful change in the nipple

therapy

Treatment for chest pain depends, of course, on the cause.
Usually there is a harmless cause behind the symptoms.

Pinched nerves or joint blocks are treated with physiotherapy and mild pain relievers. Muscular pain under the chest can also be relieved through moderate exercise and rest. The therapy also includes massages and heat applications.

Pneumonia must be treated with antibiotics. This can be done at home or in the hospital, depending on the level of discomfort and the patient's condition.

Rapid treatment is important when the heart or an obstructed pulmonary vessel is the cause of the chest pain. In both cases, the therapy consists of reopening the vessel.

A heart attack is usually treated in a cardiac catheterization laboratory. Here the blood clot is removed directly with a catheter. Alternatively, and in the case of a pulmonary embolism, a drug is used that dissolves the clot.

Bruises of the ribs or sternum are treated conservatively with pain relievers. Even broken ribs rarely need surgery.

A collapsed lung (pneumothorax) that causes pain under the chest needs to be treated with suction drainage in the chest.

forecast

Often times, chest pain is short-lived. Blockages and irritation of the skeleton are usually responsible for pain under the chest for only a few days. The prognosis here is very good.
Diseases of the stomach and gallbladder are usually easy to manage.

Pneumonia, on the other hand, can be a serious illness, especially in the elderly and weak.

The prognosis for heart disease is less good. Here the prognosis is directly dependent on the time that has passed between the appearance of the symptoms and the definitive treatment of the problem.

diagnosis

There are many reasons to consider when diagnosing under chest pain. Accordingly, diagnosis can be lengthy.
In most cases, however, an interview and a thorough physical examination are sufficient to classify most of the pain under the chest. This is how muscular problems, blockages and other harmless causes are diagnosed.

If this is not enough, examinations such as X-rays, ultrasound or even computed tomography are used. This can be used to detect diseases of the abdominal organs, the lungs and possibly the heart.

In emergencies such as a heart attack or an acutely occluded pulmonary vessel (pulmonary embolism) that are accompanied by pain under the chest, the diagnosis must be made quickly.
Further methods are then the consideration of certain laboratory results (troponin, D-dimers) and the electrocardiogram.