Chest pain in women can be a confounding symptom, sometimes raising fears about heart disease, but it can be caused by a range of factors, some significant, others less so. Understanding these factors is critical for determining when to seek medical attention and how to manage or avoid potential health problems. In this article, we’ll dig into what causes chest pain in women, including insights into symptoms, diagnosis, and therapies.

What Causes Chest Pain in Women?

Chest discomfort or pain can range from severe, piercing pains to mild, dull aches. It can be continuous or intermittent, and its characteristics can help determine its cause. While chest pain in women is frequently associated with cardiac problems, it can also be caused by the digestive system, respiratory tract, musculoskeletal system, or even psychological causes.

Heart-Related Causes

1. Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD) is a serious cardiac illness that arises when plaque forms in the coronary arteries, which are responsible for providing blood to the heart muscle. This buildup can obstruct blood flow, resulting in angina, which causes chest pain or discomfort. It’s crucial to note that angina can appear differently in women than in males, with women reporting more pressure or tightness in the chest rather than severe pain.

Should You Be Concerned?

Angina, especially if it is a new symptom or has altered in pattern, should be treated seriously because it may signify an approaching heart attack. Any unexpected, inexplicable, or severe chest pain or discomfort, whether perceived as pressure, squeezing, fullness, or agony, requires immediate medical attention. 

Furthermore, if angina is accompanied by additional symptoms such as shortness of breath, nausea, sweating, dizziness, or fainting, it is critical to seek emergency medical attention because they could indicate a heart attack. Remember that prompt action can save lives when it comes to cardiac problems.

2. Myocardial Infarction (Heart Attack)

A myocardial infarction, often known as a heart attack is another one of the serious conditions that causes chest pain in women. It occurs when blood supply to a section of the heart is restricted for an extended period, causing damage or death of the heart muscle. It’s critical to understand that heart attack symptoms can vary greatly between people, and women frequently feel them differently than males. 

In women, the symptoms can be subtler, not always appearing as characteristic chest pain. Women experiencing a heart attack may describe their chest discomfort as a sense of tightness, pressure, or fullness. They may also report pain in locations other than the chest, such as the back, neck, jaw, or stomach, which can lead to misinterpretation of these symptoms.

Should You Be Concerned?

Heart attack symptoms, regardless of how they appear, always require rapid medical attention. If you or someone else suffers symptoms such as chest pain, pain in other areas of the upper body, shortness of breath, cold sweat, nausea, or lightheadedness, contact emergency services immediately. Early therapy improves survival rates and reduces cardiac muscle damage. Remember that heart attacks are medical emergencies, thus every minute matters. Delaying medical care might be lethal or cause serious problems.

3. Pericarditis

Pericarditis is a disorder characterized by inflammation of the pericardium, the sac-like membrane that surrounds the heart, resulting in acute, stabbing chest pains that frequently worsen while deep breathing or while lying down. Pericarditis is distinguished from other heart illnesses by the intensity of its discomfort and how it is exacerbated by particular actions. The pericardium is essential for keeping the heart’s actions smooth and frictionless; hence, inflammation can drastically impede cardiac function.

Should You Be Concerned?

Given the importance of the pericardium and the extreme discomfort associated with pericarditis, it is crucial to seek medical assistance as soon as you notice symptoms. Sudden, acute chest discomfort, particularly if it worsens with breathing or postural changes, requires immediate medical attention. 

Early diagnosis and treatment can help to reduce symptoms, prevent complications, and address any underlying causes of inflammation. Though it’s not as serious as the first two conditions above, pericarditis is still one of the causes of chest pain in women that needs medical intervention.

Digestive System Disorders

1. Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is a digestive illness defined by the retrograde flow of stomach acid into the esophagus, which causes a unique burning sensation known as heartburn. Because of its location and nature, this discomfort is frequently misdiagnosed as heart-related chest pain. GERD is caused by a dysfunction of the lower esophageal sphincter, which typically works as a valve to keep stomach contents from refluxing into the esophagus.

Should You Be Concerned?

While GERD is a chronic condition that often requires lifestyle modifications and medication to treat, not every episode necessitates immediate medical intervention. However, if you have severe, persistent chest pain, especially if it is accompanied by other symptoms like jaw or arm discomfort, shortness of breath, or dizziness, you should seek medical attention right once to rule out a heart attack or other dangerous diseases. Furthermore, if GERD symptoms do not improve with over-the-counter medications, intensify, or interfere with your quality of life, you should see a doctor for a proper diagnosis and treatment plan.

2. Esophageal Spasms

Esophageal spasms are sudden and strong contractions of the esophagus, which connect the throat with the stomach. These spasms can cause severe chest pain, which may be mistaken for a heart attack due to its intensity and fast onset. The pain may feel like a squeezing or crushing sensation, creating substantial agony and concern.

Should You Be Concerned?

While esophageal spasms are usually not life-threatening, the chest pain they induce might be similar to that of a heart attack, therefore it is critical to distinguish between the two. If you have sudden, severe chest discomfort for the first time, seek medical assistance right away to rule out any cardiac problems. Healthcare professionals can run tests to discover the source of the pain and administer necessary treatment. Once esophageal spasms are diagnosed, subsequent episodes may not necessitate emergency care; rather, continuing management and treatment plans should be addressed with a clinician to reduce symptoms and enhance quality of life.

3. Gallstones

Gallstones are hardened deposits that can form in the gallbladder and cause cholecystitis, which is a gallbladder infection. This illness, known as a gallbladder attack, can cause severe pain that radiates to the chest and is similar to heartburn. The discomfort is usually felt in the upper right abdomen but can move to other locations such as the chest, back, or shoulder blades, and is frequently accompanied by nausea and vomiting.

Should You Be Concerned?

While gallstone pain may not usually require emergency care, there are some cases that do. If you have severe abdominal discomfort that lasts longer than a few hours, fever, chills, yellowing of the skin or eyes (jaundice), or any combination of these symptoms, you should seek immediate medical attention. These could be indicators of complications such as a gallbladder infection, bile duct blockage, or pancreatitis, all of which require immediate treatment to avoid serious consequences. As a result, separating gallstone pain from heart pain is critical for providing appropriate and timely medical therapy.

Respiratory Conditions

1. Pulmonary Embolism

Pulmonary embolism (PE) happens when a blood clot travels to the lungs and stops one of the pulmonary arteries, causing intense, stabbing chest pain and, in many cases, sudden shortness of breath. Additional symptoms may include bloody coughing, a fast heart rate, and feeling lightheaded or faint. This disorder affects the flow of blood to the lungs, reducing oxygen exchange and potentially damaging lung tissue.

Should You Be Concerned?

Pulmonary embolism is a medical emergency that requires prompt treatment. If you suffer PE symptoms, particularly sudden chest discomfort and difficulty breathing, get immediate medical attention. Quick treatment is required to remove the clot and restore blood flow to the lungs, avoiding future difficulties and potentially saving your life. Delays in treatment can have serious implications, such as lung injury, low oxygen levels in the blood, and death.

2. Pneumonia

Pneumonia is an infection that causes the air sacs in one or both lungs to become inflamed and filled with fluid or pus, resulting in chest pain that is sometimes increased by coughing or heavy breathing. Other symptoms may include fever, chills, a phlegmy cough, shortness of breath, and exhaustion. The severity of symptoms can range from minor to severe, and pneumonia-related chest pain is commonly misdiagnosed as another ailment, such as a heart attack.

Should You Be Concerned?

While mild cases of pneumonia can usually be treated at home with rest, water, and antibiotics (for bacterial pneumonia), other instances necessitate rapid medical intervention. If you have severe chest pain, difficulty breathing, a persistent high fever, confusion or disorientation, or a bluish tint to your lips and fingertips, get immediate medical attention. These symptoms may indicate a severe infection or consequences necessitating more extensive treatments, such as hospitalization and intravenous antibiotics. It is especially important for high-risk patients, such as the elderly, babies, and those with compromised immune systems or chronic illnesses, to seek immediate medical assistance if pneumonia is suspected.

3. Asthma

Asthma is a chronic disorder characterized by airway inflammation and narrowing, which causes symptoms such as wheezing, shortness of breath, and coughing. In extreme situations, asthma can induce chest tightness and pain as a result of the strain on respiratory muscles and the tension of breathing via narrowed airways. These symptoms range in severity from slight discomfort to acute, devastating bouts known as asthma attacks.

Should You Be Concerned?

Severe asthma symptoms or an asthma attack necessitate emergency medical care. If you or someone else is experiencing quickly worsening breathing difficulties, an inability to speak in complete sentences owing to shortness of breath, a major rise in wheezing or coughing, or a sense of severe chest tightness or pain, get emergency medical attention. Additionally, if symptoms do not improve after using a quick-relief inhaler (such as albuterol), this suggests the need for immediate medical attention. Early and efficient treatment of severe asthma symptoms can save lives and improve disease management.

Musculoskeletal Sources

1. Costochondritis

Costochondritis is an inflammation of the cartilage that links the ribs to the breastbone (sternum), resulting in severe chest discomfort that can be increased by physical activities like bending and twisting or putting pressure on the rib cage. The discomfort, which is often intense and concentrated to the front of the chest wall, can occasionally mimic that of a heart attack or other cardiac disorders, which can be concerning.

Should You Be Concerned?

While costochondritis is not life-threatening and does not cause permanent damage to the heart or lungs, identifying it from more serious illnesses, such as a heart attack, is critical. If you have sudden, unexplained chest pain, you should seek emergency medical assistance to rule out any potential heart conditions. However, if costochondritis is recognized, it may usually be treated with over-the-counter pain medicines, rest, and heat or ice applications to alleviate discomfort. If the pain becomes severe, chronic, or is not eased by typical therapies, a follow-up medical visit may be required to explore other treatment options.

2. Fibromyalgia

Fibromyalgia is a chronic disorder marked by widespread discomfort throughout the body, especially the chest. Fibromyalgia can produce a variety of symptoms, including fatigue, sleep problems, memory and mood issues, and increased pain sensitivity. Fibromyalgia-related chest pain might mimic more acute diseases, complicating therapy.

Should You Be Concerned?

While fibromyalgia does not require emergency medical care, anyone suffering new or severe chest discomfort should seek quick attention to rule out heart diseases or other dangerous reasons. For those who have been diagnosed with fibromyalgia, continued management with a healthcare provider is critical to alleviating symptoms. This usually includes a combination of medication, lifestyle changes, and supportive therapy. If fibromyalgia symptoms worsen or new symptoms appear, talk with a healthcare provider to change treatment plans accordingly.

3. Muscle Strain

Muscle strain in the chest happens when muscles are overused or injured, causing discomfort and soreness that may worsen with movement or heavy breathing. Activities involving repetitive arm movements or heavy lifting can put a strain on the chest muscles, causing intense or agonizing pain in the afflicted area.

Should You Be Concerned?

While muscle strains are typically minor and can be addressed with self-care techniques such as rest, ice, and over-the-counter pain medicines, it is critical to distinguish between this sort of pain and more serious problems. If you experience sudden, intense chest discomfort that is accompanied by difficulty breathing, or if you are unsure of the cause, get emergency medical assistance to rule out heart problems or other grave diseases. Consult a healthcare specialist for more expert pain treatment and rehabilitation procedures if you have a persistent or recurrent muscular strain that interferes with your daily activities.

Stress-Induced Cardiomyopathy

Stress-induced cardiomyopathy, sometimes known as “broken heart syndrome,” is a transient heart ailment that resembles a heart attack. It is usually brought on by great mental or physical stress, such as the death of a loved one, a catastrophic sickness, or a big accident. This illness can cause abrupt and acute chest discomfort, shortness of breath, and, in some cases, heart failure.

Should You Be Concerned?

Stress-induced cardiomyopathy demands rapid medical attention because its symptoms are identical to those of a heart attack. If you feel acute chest pain, especially during a period of extreme stress, get emergency medical attention to differentiate between this syndrome and more life-threatening diseases such as heart attack. Prompt diagnosis and treatment are critical for managing symptoms, avoiding complications, and addressing any underlying cardiac abnormalities.

Unique Factors in Women

1. Hormonal Fluctuations

Hormonal fluctuations, particularly those related to the menstrual cycle and menopause, can induce chest discomfort in women. These changes can impact breast tissue, causing soreness, edema, and a feeling of fullness or pain in the chest area. While this discomfort is usually minimal and treatable with over-the-counter pain relievers or lifestyle changes, women should be aware of how hormonal changes can affect their bodies, including the possible implications on chest pain.

2. Breast Conditions

Certain breast illnesses, such as mastitis (an infection that usually occurs while breastfeeding) and the presence of cysts, can cause pain that spreads beyond the breast tissue and may affect the entire chest area. These disorders can induce localized discomfort, which might seem like a deep, persistent aching or an acute, stabbing pain, depending on the underlying reason. Understanding these breast disorders and their potential to cause chest discomfort aids in obtaining appropriate examination and treatment, ensuring that symptoms are effectively managed and underlying issues are treated.

Diagnostic Approaches for Chest Pain in Women

When determining the source of chest pain, particularly in women, healthcare experts take a comprehensive approach to ensure precise identification of the underlying problem. This method usually includes:

1. Detailed Medical History

This looks into the patient’s symptoms, lifestyle, and any existing health concerns or family history of heart disease.

• Specific features of the pain (e.g., location, duration, triggers)
• Recent Life Events or Stressors
• Menstrual cycle and hormonal changes
• Previous medical and surgical histories

2. Physical Exam

A comprehensive examination to look for obvious indications and listen to the heart and lungs.

• Assessment of cardiac sounds, rhythms, and respiratory function
• Assessment of pain on palpation
• Examine other possibly relevant locations, such as the belly and lower extremities for swelling or pain.

3. Electrocardiogram (ECG)

An electrocardiogram (ECG) is used to detect abnormalities in the electrical activity of the heart that could signal cardiac disease or a heart attack.

4. Echocardiogram

An echocardiogram is an ultrasound of the heart that allows you to see its anatomy and function, which can help you diagnose problems like stress-induced cardiomyopathy.

5. Stress Tests

Stress tests are used to monitor the heart’s performance during physical activity or under pharmacological stress, to detect probable coronary artery disease.

6. Blood Test

Used to detect cardiac damage markers (such as troponin) as well as other disorders that may cause chest pain.

7. Advanced Imaging

• Coronary CT Angiography: A non-invasive imaging diagnostic that produces comprehensive images of the heart arteries and is used to diagnose coronary artery disease.
• MRI: A detailed assessment of heart and lung structure and function, especially effective for identifying pericarditis or pulmonary embolism.

8. Gastrointestinal Evaluations

Gastrointestinal evaluations may include an endoscopy or pH testing if GERD or other digestive disorders are thought to be causing chest pain.

9. Hormonal Assessments

When disorders like fibromyalgia or hormonal swings are taken into account, hormone levels must be evaluated.

10. Breast Imaging

If breast issues are thought to be causing chest pain, mammography or ultrasound may be recommended.

This multifaceted diagnostic method guarantees that all possible causes of chest pain are thoroughly addressed, resulting in a more accurate diagnosis and treatment plan customized to your individual’s specific needs. Women experiencing chest discomfort should communicate freely with their healthcare professionals about all of their symptoms and concerns to help with the diagnostic procedure.

Treatment and Management for Chest Pain in Women

Treatment and management solutions for women’s chest discomfort are customized to the underlying cause, with choices ranging from pharmaceuticals to lifestyle modifications. The key approaches include:

Medications

• Anti-inflammatories for illnesses such as costochondritis and pericarditis.
• Acid reducers and proton pump inhibitors for GERD.
• Anticoagulants or thrombolytics are used to treat blood clots, such as pulmonary embolism.
• Beta-blockers, ACE inhibitors, and statins are used to treat heart problems.
• Hormone therapy treats pain caused by hormonal variations.

Specific Heart Treatments

• Coronary artery disease treatment options include stenting or angioplasty.
• Surgery is used to treat severe cases of heart disease or structural abnormalities.

Lifestyle Changes

• Dietary changes can help treat GERD and lower the risk of heart disease.
• Regular, moderate exercise helps to enhance heart health and reduce stress.
• Techniques for stress management include mindfulness, yoga, and therapy.
• Quit smoking and minimize your alcohol intake.

Physical Therapy

Used to treat musculoskeletal causes of chest pain, such as muscular strains.

Psychological Support

Involves managing stress and emotional health, particularly for illnesses such as stress-induced cardiomyopathy and fibromyalgia.

Regular Monitoring

For chronic diseases, regular follow-up visits with a healthcare professional are required to check health and change treatment as needed.

Prevention and Awareness

Preventing illnesses that cause chest pain requires a combination of lifestyle changes and regular health checks. Key strategies include:

Healthy lifestyle choices

• Consuming a healthy diet high in fruits, vegetables, whole grains, and lean proteins.
• Engaging in frequent physical activity that is appropriate for your fitness level.
• Maintaining a healthy weight can lessen the strain on the heart.
• Avoiding cigarettes and restricting alcohol consumption.

Stress Management

• Incorporating relaxation practices like yoga, meditation, and deep breathing exercises.
• Seeking help from friends, family, or professional counselors as needed.

Regular Health Screening

• To detect early indicators of heart disease, monitor blood pressure, cholesterol, and blood sugar levels.
• Undergoing recommended breast health screenings, such as mammograms, as directed by healthcare specialists.

Heart Health Awareness

• Understanding and detecting the symptoms of cardiac disease, especially as they can appear differently in women.
• Being proactive in seeking medical attention for uncommon or persistent chest pain.

Medication Adherence

• Those with pre-existing health issues should adhere to their prescribed medication regimes and attend all planned medical appointments.

By focusing on these preventive actions, you can dramatically lower your risk of developing illnesses that cause chest pain, thereby improving overall heart health and well-being.

When To Seek Medical Attention

Recognizing whether chest discomfort requires prompt medical attention is critical, especially in women, as their symptoms can be less common than in males. The key signs and symptoms include:

• Sudden, severe chest pain especially if you experience pressure, squeezing, fullness, or a painful sensation in the middle or left side of your chest.
• Pain spreads to other areas, including the arms, back, neck, jaw, and stomach.
• Symptoms include shortness of breath, dizziness, fainting, cold chills, and nausea.
• Chest pain that occurs or worsens with physical activity.
• Unexplained symptoms include excessive weariness, palpitations, and an erratic heartbeat.

If any of these symptoms appear, especially if they are new, severe, or unusual from previous encounters, you should seek emergency medical assistance. These could be symptoms of a heart attack or another serious ailment that necessitates immediate treatment.

Conclusion

Chest pain in women can indicate a variety of diseases, not all of which are heart-related. Recognizing the many causes and symptoms is critical to seeking appropriate therapy and management. Women who stay informed and actively engaged in their health can navigate the complexities of chest pain more effectively, enhancing their overall well-being and quality of life.

If your chest pain is causing concerns and stress in your daily life, don’t hesitate to give us a call at +65 6235 5300 to speak with one of our heart health experts.

Written by: Dr Michael MacDonald MB ChB, BSc (Hons), MRCP (UK), MD (Research), FESC (Europe).  Dr MacDonald was trained in the UK and is a senior Consultant Cardiologist.