Chest pain during a workout is alarming and immediately raises concerns about heart health. While any chest pain requires attention, the causes vary widely, ranging from simple muscle strain to serious cardiac events. Understanding the origins of this discomfort is necessary to determine if the pain is minor or requires immediate medical care. This article reviews the common and serious causes of exercise-related chest pain.
Common Muscular and Skeletal Sources
Discomfort originating from the chest wall structure is a frequent, non-cardiac cause of pain during physical exertion. The intercostal muscles between the ribs can be strained or pulled from repetitive or forceful movements, such as rowing or lifting weights. This injury typically results in sharp, localized pain that worsens with deep breathing, coughing, or sneezing.
Costochondritis involves inflammation of the cartilage connecting the ribs to the sternum. This condition presents as sharp, intense pain, but it is characteristically reproducible by pressing directly on the affected joints. Although costochondritis can mimic a heart issue, the pain is generally relieved with rest and anti-inflammatory medication.
A distinct type of musculoskeletal pain is the “side stitch,” or exercise-related transient abdominal pain (ETAP). This intense, stabbing pain typically occurs just under the lower edge of the ribcage, often on the right side. While the exact cause remains unclear, it may involve irritation of the abdominal lining or spasms of the diaphragm muscle.
Airway and Breathing-Related Pain
Chest tightness during exercise can often be traced back to issues within the respiratory system. Exercise-induced bronchoconstriction (EIB) occurs when the airways narrow temporarily during or shortly after strenuous activity. This constriction is triggered by rapidly breathing large volumes of air, especially if it is cold, dry, or polluted, leading to chest tightness, coughing, or wheezing.
EIB symptoms typically begin five to eight minutes into aerobic activity and resolve within 30 to 90 minutes after stopping the exercise. This discomfort is usually accompanied by other respiratory symptoms, such as a whistling sound or unusual shortness of breath. EIB can affect people without a formal asthma diagnosis, though it is more common in those who have asthma.
Hyperventilation, or rapid, deep breathing, is a different issue that causes chest discomfort during high-intensity exercise. This overbreathing leads to a drop in carbon dioxide levels in the blood. Symptoms include lightheadedness, tingling in the hands and feet, and a feeling of chest pain or tightness resulting from the altered blood gas chemistry.
Digestive System Mimics
The digestive tract, particularly the esophagus, can generate pain sensations easily mistaken for cardiac problems. Gastroesophageal Reflux Disease (GERD), or acid reflux, occurs when stomach acid backs up into the esophagus. This causes a burning sensation, known as heartburn, which exercise can exacerbate due to increased abdominal pressure or bending over.
Vigorous activity can provoke reflux in people with GERD by temporarily relaxing the lower esophageal sphincter. Unlike cardiac pain, this discomfort is often described as a burning sensation located behind the breastbone and may be associated with a sour taste or belching. The pain is often relieved by taking antacids.
Another gastrointestinal cause is an esophageal spasm, involving strong, uncoordinated contractions of the esophagus’s muscular wall. These spasms produce sudden, crushing, or squeezing chest pain that is functionally indistinguishable from a heart attack. Differentiation between an esophageal spasm and a heart issue often requires clinical testing due to the similarity of symptoms.
Recognizing Serious Cardiovascular Symptoms and When to Get Help
The most serious cause of chest pain during exercise is ischemia, which is insufficient blood flow to the heart muscle. Angina pectoris is the term for this discomfort, arising when the heart’s demand for oxygen increases with exertion, but narrowed coronary arteries cannot deliver enough oxygenated blood. This pain is often felt as a deep pressure, squeezing, or heaviness in the center of the chest.
Stable angina follows a predictable pattern, occurring consistently at a certain level of physical activity or emotional stress, and typically subsides within five minutes of resting. Unstable angina is a medical emergency because it is unpredictable, occurring even at rest or with minimal effort. The pain is often more severe, lasting longer than 20 minutes. A change in a previously stable angina pattern signals a worsening condition and requires immediate medical attention.
Accompanying symptoms strongly suggest a serious cardiac event and demand an immediate call to emergency services. These warning signs include:
- Crushing or intense pressure that does not abate with rest.
- Pain that radiates to the jaw, neck, back, or left arm.
- A feeling of impending doom.
- Sudden dizziness, lightheadedness, or cold sweats.
- Unusual shortness of breath not linked to asthma.
If chest discomfort is severe, accompanied by fainting (syncope), or persists for more than a few minutes after stopping all activity, seek emergency medical help immediately. Even mild discomfort that is new, different from previous experiences, or accompanied by systemic symptoms like nausea and profuse sweating should be taken seriously. Never attempt to “work through” chest pain that feels deep, heavy, or is associated with these severe symptoms.