Chest Pain with Movement: Causes & Urgent Action Steps

Chest pain provoked or worsened by movement does not rule out cardiac etiology. It can originate from musculoskeletal, pulmonary, GI, or cardiovascular sources. Always evaluate urgently.

Differential Diagnosis

Immediate Actions

1. Stop activity, rest
2. Call 911 if: crushing/pressure pain, radiation (jaw, arm, back), diaphoresis, dyspnea, nausea, syncope, palpitations, known CAD
3. Chew 325 mg aspirin (if not allergic, no active bleed) while awaiting EMS
4. Loosen tight clothing
5. Do not drive self

If Non-Cardiac Likely (After Evaluation)

• NSAIDs, heat/ice, posture correction, PT for musculoskeletal
• PPIs, dietary mods for GERD
• Treat underlying cause (PE → anticoagulation; pericarditis → NSAIDs/colchicine)

Never self-diagnose chest pain. Time is myocardium.

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Source	Typical Features
Musculoskeletal (costochondritis, rib fracture, strain)	Reproducible with palpation, specific movements, breathing. Localized.
Pleuritic (pleurisy, PE, pneumonia)	Sharp, respiration-linked. PE: sudden, tachycardia, hypoxia, risk factors.
Cardiac (ischemia, pericarditis)	Ischemia: pressure, exertion-linked, radiates. Pericarditis: positional (better leaning forward), friction rub.
GI (GERD, esophageal spasm)	Burning, meal-related, may mimic cardiac. Relieved by antacids.