Chest and Shoulder Pain: Symptoms, Causes, and Diagnosis (2023)

Pain from your chest to your shoulder can have many causes. Your heart, lungs, or other internal organs may be involved. If your pain is sudden or severe, it’s very important to get immediate medical care.

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The pain may also be referred. This means it’s felt in your chest and shoulder but is actually caused by pain in another part of your body.

In this article, we’ll look at some of the most common causes of chest and shoulder pain and the treatment options for these causes.

Pain in the chest and shoulder can have many causes. Some can be more serious than others. The conditions listed below are some of the most common culprits of this kind of pain.

Angina is the name for chest pain that results from clogged and narrowed arteries around your heart. When this happens, your heart muscle isn’t able to get enough oxygen-rich blood.

It’s not a heart attack. Rather, it’s a sign you have a heart condition. Physical activity often triggers the pain, when you need more oxygen. Emotional stress can trigger it, too.

Angina can be stable. This means it follows a predictable pattern and typically occurs when you’re doing something, or when you’re stressed. With stable angina, symptoms usually go away within a few minutes.

Angina can also be unstable. This type of angina tends to occur suddenly or while you’re at rest. With unstable angina, symptoms can last longer than 20 minutes and may return. The pain may also get worse over time.

An unstable angina attack can be life threatening and requires emergency medical attention.


Chest pain is the main symptom of both stable and unstable angina. Pain usually starts behind the breastbone. Pain may be referred to your left shoulder or arms.

Other common symptoms include:

  • fatigue
  • shortness of breath
  • light-headedness
  • nausea or indigestion
  • sweating
  • weakness

A heart attack happens when a blockage in an artery in your heart stops or reduces the blood flow to your heart muscle. It’s also called a myocardial infarction.

Symptoms can start suddenly or come on slowly. People with gradual symptoms may not seek medical care right away.

If you think you’re having a heart attack, call 911 or get emergency medical help immediately.


Heart attack symptoms can vary in intensity.

Common heart attack symptoms include:

  • a feeling of tightness or pressure in your chest
  • chest pain that spreads to your neck, shoulders, one or both arms, or back
  • faintness or dizziness
  • shortness of breath
  • cold sweat
  • fatigue
  • indigestion, stomach pain, or heartburn

While chest pain is the most common symptom for men, women are more likely to have symptoms other than chest pain. Some of the symptoms women often experience that happen less frequently with men include:

  • unusual fatigue that lasts for several days or extreme fatigue that comes on suddenly
  • sleep disturbances
  • anxiety
  • indigestion or gas-like pain
  • jaw or back pain
  • symptoms that come on more gradually

Your gallbladder is a small organ on your right side that sits below your liver. Its purpose is to release bile into the small intestine. Bile helps the digestive process by breaking down the fats in the food you eat.

Gallstones are little masses that form out of hardened digestive fluid in the gallbladder. Gallstones can range in size, from grains of sand to pingpong balls.

Why some people develop gallstones isn’t clear. But risk factors include:

  • being female
  • being over 40 years old
  • having overweight
  • being pregnant


Sometimes gallstones don’t cause any symptoms. But gallstones can cause intense pain when they block a bile duct or when you eat fatty foods. Pain can last up to several hours.

Pain may occur on:

  • your right side, above the stomach
  • in the center of your stomach, below the breastbone
  • in your right shoulder
  • between your shoulder blades

You may also have fatigue, nausea, or vomiting.

Pericarditis is the inflammation of the pericardium, the thin sac that surrounds your heart. The two-layered pericardium protects your heart and holds it in place. Fluid between the pericardium layers prevents friction when your heart beats.

Pericarditis usually starts suddenly. It can last from a few days to a few weeks. A viral infection is thought to cause most cases.


The main symptom is sharp or dull pain in the center of your chest or on the left side.

Other common symptoms include:

  • pain that spreads from your chest to the shoulder blade
  • pain that worsens when you lie down or take a deep breath
  • pain that decreases when you lean forward
  • weakness
  • mild fever
  • fatigue

Your pancreas is located behind your stomach near the first part of your small intestine. It releases fluids that help break down the food in your intestine. It also controls your body’s blood sugar by regulating the release of insulin.

Pancreatitis is an inflammation of the pancreas. It can be chronic or acute. Acute pancreatitis can come on suddenly and usually gets better with treatment. Chronic pancreatitis gets worse over time.

The most common cause of acute pancreatitis is gallstones.


Symptoms of pancreatitis can vary, depending on the type of pancreatitis. The main symptom of both acute and chronic pancreatitis is pain in your upper abdomen, as well as pain that radiates to your back.

Acute pancreatitis symptoms include:

  • mild or severe pain that lasts for several days
  • abdominal pain that gets worse after eating
  • fever
  • nausea and vomiting
  • fast pulse
  • swollen or tender stomach

Chronic pancreatitis symptoms include:

  • pain in your upper abdomen
  • nausea or vomiting
  • weight loss without trying
  • oily stools that smell bad

Pleurisy is an inflammation of the thin layer of tissues, called pleura, that separate your lungs from your chest wall.

The most common cause of pleurisy is a viral infection in the lungs.


The most common symptoms of pleurisy include:

  • sharp chest pain that gets worse when you breathe, cough, laugh, or sneeze
  • pain in your shoulders or back
  • shortness of breath
  • muscle or joint pain
  • headaches

Some people may also experience a cough or fever.

Chest pain with shoulder pain isn’t always an emergency, but it can be very hard to tell. That’s why it’s important to pay attention to any other symptoms you may have.

Call 911 or go to an emergency room if you have:

  • severe chest and shoulder pain
  • have an existing heart condition
  • think you’re having a heart attack

Other symptoms that can be a sign you need immediate medical attention are:

  • escalating chest and shoulder pain
  • difficulty breathing
  • fainting or dizziness
  • extreme weakness

A 2019 review looked at the most common causes of chest pain for people who went to an emergency room. The review found that:

  • 31 percent of the causes were due to acute coronary syndrome, which included angina and other heart problems
  • 30 percent of chest pain causes were due to acid reflux
  • 28 percent of causes were due to a musculoskeletal condition

See your doctor if you have unexplained chest and shoulder pain. Any time you have chest pain, it’s important to get a proper diagnosis and appropriate treatment.

Because there are many possible causes for chest and shoulder pain, diagnosis can be challenging.

Your doctor will take a full medical history to find out about any other health conditions you may have. They’ll also ask if your family members have heart disease or other types of conditions.

Your doctor will ask about your symptoms, when they started, how long they lasted, and if they changed.

Once your doctor knows more about your symptoms and any other health conditions, they’ll do a physical exam and listen to your heart and lungs.

There are many diagnostic tests your doctor may use to determine what’s causing your shoulder and chest pain. Common diagnostic tests include:

  • an X-ray of your lungs, heart, gallbladder, or other organs
  • an electrocardiogram (EKG) to look at how your heart is beating
  • an echocardiogram to look at your heart muscle and how it’s working
  • blood tests to look for signs of a heart attack or specific enzyme levels for certain conditions, like pancreatitis
  • a stress test to see how your heart functions when you exercise
  • a coronary angiography to find out if you have a blockage in a coronary artery
  • a heart CT scan, also known as CT angiography, to look at your heart and blood vessels and to check for blood clots or other problems
  • an MRI to look at heart movement and blood flow, or to get a more detailed view of your gallbladder or pancreas
  • a biopsy of lung tissue if pleurisy is suspected
  • a pancreatic function test to see if your pancreas is responding normally to specific hormones

Treatment for shoulder and chest pain depends on what’s causing the pain.

Because there can be so many variables, treatment plans for the same condition may be different from one person to the next. Some factors that may influence your treatment plan include:

  • your age
  • other health conditions you may have, including overweight
  • whether or not you smoke

Heart problems

For heart problems, your doctor may prescribe:

  • aspirin
  • nitroglycerin
  • blood thinners to prevent clots
  • clot-busting drugs (thrombolytics)
  • antibiotics for pain caused by an infection
  • fluid drainage for pericarditis

For life threatening situations, you may need surgery, such as bypass surgery or angioplasty.

Your doctor will likely recommend lifestyle changes, including changes to your diet, physical activity, and stress management.

Gallstone attack

Depending on the frequency of your gallstone attacks, your doctor may recommend surgery to remove your gallbladder. This is usually done laparoscopically.

For a less serious gallstone condition, your doctor may prescribe a drug called ursodiol. This drug may help dissolve the gallstones over time. Your doctor may also put you on a low fat diet to help prevent further gallstone development.

Some people have success with natural remedies for gallstones. Be sure to talk to your doctor before trying any at-home treatments for gallstones.


Treatment for pleurisy will depend on the cause.

Your doctor may prescribe antibiotics if you have a bacterial infection. Viral infections often clear up without treatment. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve chest pain.

If you have a lot of fluid buildup, known as pleural effusion, your doctor may want to drain it. This is done with local or general anesthetic. It may require a hospital stay.

A hospital stay may also be necessary if you have other health conditions that make your pleurisy more difficult to treat.


Your doctor will give you medications to help reduce the pain. You may also have to fast for a couple of days to give your pancreas a rest. You may need intravenous fluids to prevent dehydration.

You may be hospitalized if your pancreatitis is severe.

Other treatment may include surgery to drain your pancreas, or surgery to remove your gallbladder if gallstones caused your pancreatitis.

Longer-term treatments may include:

  • diet changes
  • limiting alcohol use
  • taking pancreatic enzyme supplements to aid digestion

Other chest pain causes

For chest pain conditions that aren’t related to your heart or coronary arteries, you doctor may prescribe:

  • acid suppressing drugs to reduce acid reflux
  • antidepressants or therapy to help control panic attacks

Pain in your chest and shoulder can have many causes. Some of the most common include angina or other heart conditions, gallstones, pericarditis, pleurisy, or pancreatitis.

Unexplained pain that occurs in both your chest and shoulder should always be checked out by your doctor.

If the pain is severe or lasts longer than a few minutes, immediately go to the emergency room or call 911. For many conditions, the earlier you receive treatment, the better your outcome is likely to be.


What causes pain in the chest and shoulder? ›

Angina chest pain, called an angina event, can happen when your heart is working hard. It can go away when you stop to rest again, or it can happen at rest. This pain can feel like pressure or squeezing in your chest. It also can spread to your shoulders, arms, neck, jaw, or back, just like a heart attack.

When should I worry about chest and shoulder pain? ›

Call 911 or emergency medical assistance

Shoulder pain accompanied by difficulty breathing or a sense of tightness in the chest may be a symptom of a heart attack and requires immediate medical attention.

What diagnosis can cause chest pain? ›

Heart-related causes of chest pain

angina, which is chest pain caused by blockages in the blood vessels leading to your heart. pericarditis, which is an inflammation of the sac around the heart. myocarditis, which is an inflammation of the heart muscle. cardiomyopathy, which is a disease of the heart muscle.

What are 3 common causes of chest pain? ›

  • Angina. This is chest pain caused by poor blood flow to the heart. ...
  • Heart attack. A heart attack results from blocked blood flow to the heart muscle, often from a blood clot. ...
  • Aortic dissection. ...
  • Inflammation of the sac around the heart, called pericarditis.
Mar 3, 2023

How do I know if my shoulder pain is heart related? ›

The main difference is how pain radiates.
  1. For men: Pain will spread to the left shoulder, down the left arm or up to the chin.
  2. For women: Pain can be much more subtle. It may travel to the left or right arm, up to the chin, shoulder blades and upper back — or to abdomen (as nausea and/or indigestion and anxiety).

What to do when your shoulder and chest hurts? ›

Call Emergency Services if you have sudden pressure or crushing pain in your shoulder, especially if the pain starts in your chest, jaw, or neck. If you fall on your shoulder and feel sudden intense pain, you should see a doctor because you may have torn rotator cuff or dislocated your shoulder.

What are red flags for shoulder pain? ›

Urgent if any red flags are identified: Trauma, pain and weakness, or sudden loss of ability to actively raise the arm (with or without trauma): suspect acute rotator cuff tear. Any shoulder mass or swelling: suspect malignancy.

How do I know if my chest pain is seriously? ›

You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting.

How do you know if chest pain is muscular or heart? ›

Does the pain change while taking a deep breath or exhaling? Cardiac • Cardiac pain does not change during deep breathing. Muscular • Deep breathing can cause sharp, shooting pain (if the discomfort starts in the muscle).

What is the first diagnostic test for chest pain? ›

Some of the first tests a health care provider may order when diagnosing the cause of chest pain include: Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs.

What is the number one cause for chest pains? ›

Chest pain can come from heart, lung, digestive or other issues. GERD, or heartburn, is the most common cause.

What are 4 causes of chest pain? ›

What could cause chest pain? Chest pain can stem from a heart problem, but other possible causes include a lung infection, muscle strain, a rib injury, or a panic attack. Some of these are serious conditions and need medical attention.

What causes chest pain if ECG is normal? ›

The normal EKGs and ECHO that you have had are good indicators that your heart is healthy. The chest pains do have to be addressed because it can be an early sign of narrowing in the arteries of your heart. You should make sure you see your doctor regarding the chest pains.

Can a blocked artery cause shoulder pain? ›

Plaque is a wax-like substance that prevents these arteries from sending oxygen-rich blood to the heart. Angina usually feels like pressure or squeezing in your chest. The NHLBI notes that you may also feel pain and discomfort in nearby areas, including: Shoulders.

Can shoulder pain be a symptom of something else? ›

Shoulder pain may also be caused by: Arthritis in the shoulder joint. Bone spurs in the shoulder area. Bursitis, which is inflammation of a fluid-filled sac (bursa) that normally protects the joint and helps it move smoothly.

Can heart blockage cause shoulder pain? ›

During a heart attack, women are less likely to experience the crushing chest pain that some men describe as an elephant sitting on their chest. Instead, women may feel a persistent pain in the back, neck, jaw, or even shoulder blades.

When should you not ignore shoulder pain? ›

JOI Identifies 5 Shoulder Symptoms You Should Not Ignore

Persistent shoulder pain that intensifies with use. Shoulder Pain that keeps you from sleeping or awakens you. Stiffness and/or the inability to raise your arm above your head. Numbness, tingling or burning sensation.

Can stress cause chest and shoulder pain? ›

Stress can trigger the release of hormones, like adrenaline and cortisol. This can increase your heart rate and blood pressure as well as make breathing difficult. Your throat may also constrict and your chest muscles might tighten. All of these can cause pain in the chest.

What is pericarditis pain? ›

Pericarditis is inflammation of the lining around the heart. The most common symptom of pericarditis is chest pain or discomfort. Although pericarditis can be long-lasting, most people recover within weeks.

What is the best diagnostic test for shoulder pain? ›

  • X-ray.
  • Arthrogram.
  • MRI.
  • CT scan.
  • Electromyogram.
  • Ultrasound.
  • Laboratory tests.
  • Arthroscopy.

What is the empty can test for shoulder pain? ›

The empty can test is a clinical test used to test the integrity of the supraspinatus tendon. In this test, the patient is tested at 90° elevation in the scapular plane and full internal rotation (empty can). The patient resists downward pressure exerted by the examiner at the patients elbow or wrist.

When is shoulder pain an emergency? ›

If you fall, have a significant strain injury, and/or feel a pop or tearing sensation in your shoulder and then have weakness lifting your arm, seek medical care,” Dr. Diehl advised.

What are the symptoms of a minor heart blockage? ›

Minor symptoms of heart blockage include irregular or skipped heartbeats, shortness of breath and chest tightness. Other symptoms may include pain or numbness in the legs or arms, as well as neck or throat pain.

What is Bornholm's disease? ›

Pleurodynia (formerly called Bornholm disease) is a form of viral myalgia defined by the sudden occurrence of lancinating chest pain or abdominal pain, commonly associated with fever, malaise, and headaches.

What causes pain in chest between breasts? ›

It can be due to heart attack or gastro-oesophageal reflux disease. When a person is obese or have a lax esophageal sphincter there is a chance for stomach juices to get reflexed upto esophagus, causing burning pain or tightness in the middle of the chest.

How can you tell the difference between cardiac and non cardiac chest pain? ›

How It Feels. Chest pain from a heart attack often feels like a large amount of pressure, tightness, burning, or squeezing in the chest. In comparison, chest pain that feels like a sharp or knife-like pain resulting from coughing or breathing is likely not due to a heart attack.

What does fibromyalgia chest pain feel like? ›

This pain feels like an intense stabbing sensation primarily in the center of the chest, around the breastbone and rib cage. Fibromyalgia chest pains can be a frightening and painful experience because the chest pain can mimic a heart attack. Your discomfort can vary depending on how active you are.

What part of your chest hurts with heart problems? ›

Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.

What tests will ER run for chest pain? ›

Tests and Exams for Chest Pain Symptoms

Electrocardiogram (ECG or EKG) Blood work. Chest X-ray. Echocardiogram.

Why can't doctors diagnose my chest pain? ›

Unfortunately, physicians are often unable to make an accurate diagnosis based solely on history because, for example, descriptions of chest pain of cardiac, upper gastrointestinal, or gallbladder origin can be identical.

Does angina show up on EKG? ›

Diagnosing angina

Your doctor can suspect a diagnosis of angina based on your description of your symptoms, when they appear and your risk factors for coronary artery disease. Your doctor will likely first do an electrocardiogram (ECG) to help determine what additional testing is needed to confirm the diagnosis.

What mimics angina? ›

It continues until relieved by rest or special medicine. My best bet from this distance is that your pain results from one of a long list of ailments that can mimic angina. That list includes rib inflammation, spinal arthritis, and pleuritis (lung lining inflammation).

Why does my chest and shoulder hurt on the left side? ›

Pain in your chest and shoulder can have many causes. Some of the most common include angina or other heart conditions, gallstones, pericarditis, pleurisy, or pancreatitis. Unexplained pain that occurs in both your chest and shoulder should always be checked out by your doctor.

What type of chest pain is not serious? ›

Non-cardiac chest pain or NCCP is a type of chest pain that originates from the chest but is not related to the heart. This condition can be caused by a variety of factors, including musculoskeletal issues, pulmonary disorders, esophageal disorders, gastrointestinal problems, and psychological factors.

What does GERD chest pain feel like? ›

Heartburn is a symptom of acid reflux and GERD that causes a painful burning sensation in the center of the chest. This sensation can sometimes feel similar to the chest pain that people experience during a heart attack or attacks of angina.

What does anxiety chest pain feel like? ›

In general, though, anxiety chest pain may feel like: Tension, tightness, and pressure: You might experience a mild, constant tightness or a sudden, intense tightness in your chest. You may also feel like it's difficult to breathe or that your heart is beating out of your chest.

Does chest pain always mean something bad? ›

Sometimes chest pain is just chest pain. Sometimes it's only a muscle strain, heartburn or bronchitis. More often than not there are benign reasons, but you should be evaluated by a healthcare professional if you're worried. Chest pain can signal a serious condition, heart-related or otherwise.

Can a chest xray show heart problems? ›

If you go to your doctor or the emergency room with chest pain, a chest injury or shortness of breath, you will typically get a chest X-ray. The image helps your doctor determine whether you have heart problems, a collapsed lung, pneumonia, broken ribs, emphysema, cancer or any of several other conditions.

What is the best test to check for heart problems? ›

An echocardiogram is a common test. It gives a picture of your heart using ultrasound, a type of X-ray. It uses a probe either on your chest or down your oesophagus (throat). It helps your doctor check if there are any problems with your heart's valves and chambers, and see how strongly your heart pumps blood.

What does myocarditis chest pain feel like? ›

What does myocarditis chest pain feel like? It's common to feel a sensation of tightness or squeezing in the chest, either when at rest or when active. It could also happen if you're lying down. You may have chest pain that feels sharp or stabbing, and chest pain/discomfort may spread to other parts of your body.

What causes pain in upper left chest and shoulder? ›

Pericarditis pain usually occurs behind the breastbone or on the left side of the chest. The pain may: Spread to the left shoulder and neck. Get worse when coughing, lying down or taking a deep breath.

How do I know if my chest pain is serious? ›

You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting.

When should you go to the ER for chest pain? ›

A visit to the ER for chest pain can be life-saving. When your chest pain persists, is severe, or is accompanied by shortness of breath, nausea, radiating pain, and changes in heart rate and blood pressure, call 911 immediately.

What is upper chest pain not heart related? ›

There are many causes of chest pain besides a heart attack. Some of the most common include gastroesophageal reflux disease (GERD), anxiety, muscle strain, costochondritis, pleurisy, pneumonia, hiatal hernia, and panic attacks among others.

What does lupus chest pain feel like? ›

The symptom of pleuritis that you may experience is severe, often sharp, stabbing pain in a specific area or areas of your chest. The pain, which is called pleurisy, is made worse when you take a deep breath, cough, sneeze, or laugh. You may also experience shortness of breath.

What organ causes left shoulder pain? ›

Heart or blood vessel problems in which pain is more often felt in the left arm and shoulder, such as heart attack or inflammation around the heart (pericarditis). A lung problem, such as pneumonia, where pain may be felt throughout the shoulder, shoulder blade area, upper chest, upper arm, neck, and armpit.

How long should chest pain last before going to the doctor? ›

How do I know if my chest pain is serious? Call 911 or have someone take you to the closest emergency room right away if you have chest pain that lasts longer than five minutes and doesn't go away when you rest or take medication. Cardiac chest pain can be life-threatening.

Is it better to go to urgent care or ER for chest pain? ›

Your urgent care physician will take note of your symptoms and run tests if necessary to provide you with a diagnosis. Generally speaking, if your chest pain is new, has changed (i.e., goes away and comes back), or is accompanied by other worrisome symptoms, it's best to go straight to the emergency room.


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