Heartache when breathing or under stress • What to do?


Author: Claudia Urban, medical author
Last update:
January 23, 2020

Heart pain is a symptom that can be triggered by a disease of the heart and blood vessels that supply the heart (coronary arteries). Heartache can manifest itself differently depending on the cause.


The pain, such as a heart attack, can occur suddenly and trigger a feeling of a life-threatening situation and panic in those affected.

Heartache from heart attack and angina pectoris

The key symptom of myocardial infarction is a sudden, usually severe, dull and oppressive pain in the chest area, which is often associated with tightness, lasts for more than 20 minutes and can radiate into the arms, shoulders and lower jaw. Heart pain is often associated with a heart attack: early warning signs are accompanied by sweating, nausea, possibly vomiting and dizziness. The pain in angina pectoris also presents itself. However, it usually disappears after a few minutes or after taking nitroglycerin, while it lasts longer during a heart attack and leads to cardiac tissue death and permanent damage to the heart.

This is how a heart attack manifests itself in women

Lifeline / Wochit

Heartache and chest pain – a difference

But there is not always a heart problem or a problem behind the supposed heartache cardiac cause (cardiac = affecting the heart), There are many causes outside the heart that cause chest pain (chest pain) and which people sometimes classify as supposed heart pain. These can be diseases of the lungs, stomach and esophagus or the muscular and skeletal system, for example. Doctors then speak of chest pain extracardiac causes (extracardiac = outside the heart), Sometimes heart pain can also be psychological. According to research, the proportion of causes of chest pain that actually originate from the heart is only up to 16 percent (current guidelines on chest pain).

Even if chest or perceived heart pains do not always originate from the heart, they can sometimes be signs of a serious illness or even life-threatening situation. Therefore, those affected should always consult a doctor to find out the cause.

Heartache: What are the causes?

There can be many causes behind pain that those affected interpret as heart pain. In fact, it is not always diseases of the heart or the cardiovascular system that trigger supposed heart pain. These are the most important heart-related causes for heart or chest pain:

Other causes of heart pain or chest pain

Other than heart-related causes of chest pain, which are sometimes misinterpreted as heart pain, are Digestive tract disorders, For example, gastric acid flowing back into the esophagus can cause heartburn and a severe burning sensation behind the breastbone (gastroesophageal reflux disease). Injuries to the esophagus or gallbladder inflammation can also cause chest pain (cholecystitis).

Next to it Muscle and skeletal system disorders The cause of the chest pain (musculoskeletal cause), such as muscle tension or spinal and joint complaints that radiate into the chest.

Beyond that too Lung and breast disorders (Pleura) as the cause of the chest pain, such as pleurisy (pneumonia or pleurisy) or vascular occlusion in the lungs (pulmonary embolism).

Patients may experience heart pain as a result of panic attacks (panic disorder), anxiety and panic disorders or depression. Doctors refer to this as psychogenic or functional causes of heartache. In addition, other diseases can cause chest pain, e.g. Vascular system disorders such as life-threatening aortic dissection, in which there may be a tear in the wall of the main artery (aorta) and this can lead to reduced blood flow to the heart and heart pain.

Heart disease in women: this is different

Dr. Heart / team of experts

Important differentiation criteria

Typical for heart-related chest pain (Cardiac causes) is a dull pain, coupled with tightness in the chest and tightness, which the affected person feels in the left, but also the right chest behind the breastbone, and that in the (left) arm, the lower jaw, the neck area, between the shoulder blades and can radiate into the upper abdomen. The chest pain of cardiac origin often occurs in connection with physical or psychological stress, after exposure to cold or a meal and lasts for a few minutes, less often more than 20 minutes (heart attack) and can be accompanied by rapid heartbeat, nausea, pallor and circulatory problems.

Breast pain of extra-cardiac origin are usually bright, pin-prick-like and superficial, sometimes burning and often occur after touching or pressing on the chest, while breathing, in certain body positions or when swallowing. Depending on the cause, the pain can last from a few seconds to hours.

Diagnosing heart pain: this is how the doctor proceeds

The diagnosis of cardiac pain must be made very precisely, since the symptoms can sometimes have life-threatening causes. The doctor's first step will therefore be to use a first assessment to identify a possibly immediately life-threatening situation and, if necessary, to arrange immediate hospital admission and, if necessary, to take appropriate immediate measures.


Otherwise, the doctor will first conduct a differentiated survey of the patient (anamnesis), in which he will record exactly the type of heart pain, the circumstances of its occurrence and accompanying symptoms, as well as certain risk factors for heart disease. Are the pains e.g. dull and associated with tightness? When did they first appear? Do they radiate to other parts of the body? Are there family risks for cardiovascular diseases or are there unfavorable lifestyle factors such as smoking, overweight and lack of exercise?

Physical examination

In the subsequent physical examination, pulse and blood pressure are measured, the chest is scanned and breathing and heart murmurs are monitored using a stethoscope. Blood tests to determine the troponin, a protein compound that is released when the heart muscle is damaged, and an electrocardiogram (ECG) that records the cardiac currents can provide information about a possible heart attack.

If there are indications of a heart disease, further examinations can follow, including ultrasound examinations of the heart (echocardiography), a movement or long-term ECG, coronary angiography, a special X-ray procedure for imaging blood vessels that supply the heart, or other imaging procedures such as computer (CT) or magnetic resonance imaging (MRI).

Other diagnostic options

Additional diagnostic procedures are used to check if there are suspicions of diseases of the lungs and digestive system as well as a disease of the muscular and skeletal system as the cause of the chest pain.

In the case of physical accompanying symptoms such as dizziness, shortness of breath and rapid heartbeat for which no physical causes can be found (possibly panic attack), the doctor will check for the presence of a psychological disorder, for example an anxiety disorder. For this purpose, he will, among other things, study the patient's medical history in detail.

Treatment of heart pain: therapy depending on the cause

Therapy for heartache depends on the cause of the pain. If there is an underlying heart disease, drug and surgical procedures can be used. In many cases, changing lifestyle habits towards a healthier lifestyle is the basis for successful therapy.

For example, if you have coronary artery disease (CHD), your doctor will usually prescribe medication such as acetylsalicylic acid (ASA), beta-blockers, or cholesterol-lowering drugs (statins). Taking these medications regularly can reduce the risk of acute heart problems such as an attack of angina or heart attack. In severe cases, additional surgery, such as bypass surgery or the use of supporting grid-shaped implants (coronary stents) in the narrowed coronary arteries, can lead to improved blood flow to the heart muscle and reduce heart problems.

In addition, a healthy low-fat diet, a consequent smoking cessation and regular exercise help to minimize essential risk factors for cardiovascular diseases such as increased blood lipids and obesity and the resulting heart disease.

Acute and emergency therapy

Heart pain that occurs during angina pectoris usually improves after taking nitroglycerin. Patients who are at risk of suffering from an angina pectoris attack due to a severe coronary artery disease, for example, are prescribed nitroglycerin by the doctor. If the symptoms do not improve within a few minutes after application, a heart attack (myocardial infarction) may be present. In this case, the emergency doctor must be called immediately, who can take the necessary emergency measures.

When to call the emergency doctor?

Regardless of whether the pain is based on a heart disease or another illness, the chest pain can be an expression of a life-threatening situation. In addition to a heart attack, emergencies such as pulmonary embolism or aortic dissection can be considered, which can be associated with chest pain and require immediate emergency care.

Affected or present people should always call the emergency doctor if chest pain suddenly and in connection with

  • acute circulatory problems or circulatory failure and / or
  • pronounced fear of the person concerned and / or
  • Shortness of breath and / or
  • There is a loss of consciousness or confusion.

Heartache: More information

Heartache and chest pain can have a variety of causes. Here you can find further information:

German Heart Foundation

Patient Guideline "Chronic Coronary Heart Disease – CHD"