Chest Pain and Shortness of Breath: Causes, Red Flags, and Urgent Action

When Chest Pain and Breathing Difficulty Signal an Emergency

These symptoms can arise from cardiac, pulmonary, or other systemic conditions. Sudden, severe, or worsening symptoms require immediate emergency care.

Cardiac Causes

• Heart Attack (MI): Crushing/pressure-like chest pain, radiation to arm/jaw/back, sweating, nausea, dyspnea.
• Angina: Exertional chest pressure relieved by rest; may precede MI.
• Heart Failure: Orthopnea, paroxysmal nocturnal dyspnea, fatigue, edema.
• Aortic Dissection: Tearing chest/back pain, often radiating; hypertensive emergency.

Pulmonary Causes

• Pulmonary Embolism (PE): Sudden pleuritic chest pain, dyspnea, tachycardia, hemoptysis.
• Pneumonia: Fever, cough, purulent sputum, pleuritic pain.
• Asthma/COPD Exacerbation: Wheezing, chest tightness, dyspnea.
• Pneumothorax: Sudden unilateral chest pain, dyspnea.

Other Causes

• Anxiety/panic attack (often with paresthesias, palpitations)
• Musculoskeletal strain (costochondritis, rib fracture)
• GERD (heartburn mimicking cardiac pain)
• Herpes zoster (shingles) before rash appears

Action Plan

Call emergency services (911 in US) if: pain is severe, crushing, radiates, accompanied by syncope, diaphoresis, or hemodynamic instability. Do not drive yourself. For less acute but persistent symptoms, seek same-day medical evaluation.