Chest pain is a recognized symptom experienced during acute COVID-19 infection and sometimes during recovery. This discomfort can manifest as a dull ache, tightness, or a sharp, stabbing sensation. The pain stems from several distinct sources, including inflammation in the lungs, structural strain in the chest wall, or issues involving the heart and circulatory system. Understanding these origins is important for accurate assessment.
Direct Respiratory and Inflammatory Causes
The most common source of chest discomfort during a viral respiratory illness like COVID-19 is inflammation within the respiratory system. The SARS-CoV-2 virus triggers an inflammatory response in the airways and lung tissues, leading to a sensation of tightness or deep pain. This internal inflammation results from the body’s immune system reacting to the viral presence.
Pleurisy, or pleuritis, is the inflammation of the pleura, the thin layers of tissue surrounding the lungs and lining the chest cavity. When the pleura become inflamed, they rub against each other during breathing, causing a characteristic sharp, stabbing pain. This pain typically worsens when taking a deep breath, coughing, or sneezing, and is often described as feeling close to the surface of the chest.
The infection can also progress to viral bronchitis or pneumonia, where inflammation and fluid build-up occur within the lung tissue. Pneumonia causes a deep, persistent chest pain or tightness, often accompanied by difficulty breathing and a cough. This pain is internal and deep, distinguishing it from superficial pain, and reflects the distress of the infected lung tissue.
Musculoskeletal and Mechanical Sources of Pain
A frequent cause of chest pain with COVID-19 is mechanical strain and inflammation affecting the structures of the chest wall. Repetitive, forceful coughing places stress on the muscles and joints of the rib cage. This mechanical stress leads to muscle soreness and strain, resulting in pain that is typically external and superficial.
Costochondritis involves inflammation of the cartilage connecting the ribs to the sternum. This inflammation causes a sharp or aching pain localized to the front of the chest, often near the center or slightly to one side. A distinguishing feature is that the pain is reproducible; pressing on the affected rib cartilage often causes increased discomfort.
This musculoskeletal pain is caused by the secondary effects of the illness, such as constant coughing, rather than direct viral infection. The pain is usually aggravated by movement of the torso, stretching, deep inhalation, or physical activity. Although alarming, it typically resolves with anti-inflammatory medication and rest.
Cardiovascular and Systemic Concerns
While less common, chest pain during or after COVID-19 can signal serious conditions involving the heart and blood vessels. The body’s systemic inflammatory response can extend beyond the respiratory system to affect cardiovascular structures. Evaluation is necessary when chest discomfort is present, especially if accompanied by other symptoms.
Pericarditis is the inflammation of the pericardium, the thin sac surrounding the heart. It typically causes a sharp, sudden chest pain felt in the center or left side of the chest. The pain often changes with body position, frequently worsening when lying down and easing when sitting up and leaning forward.
Myocarditis, inflammation of the heart muscle, is a serious, though rare, complication of the infection. It presents as chest pain, often a dull ache or pressure, accompanied by symptoms such as an irregular heartbeat, fatigue, or shortness of breath. Inflammation of the heart muscle impairs its ability to pump blood effectively.
Systemic inflammation and altered clotting mechanisms associated with severe COVID-19 increase the risk of a pulmonary embolism (PE). A PE is a blockage in the pulmonary arteries, usually caused by a traveling blood clot. It typically causes a sudden onset of sharp chest pain, sudden shortness of breath, and a rapid heart rate, requiring emergency medical attention.
Recognizing Urgent Symptoms
While many causes of chest pain during COVID-19 are manageable, certain symptoms indicate a potential medical emergency. It is important to distinguish between common discomfort and symptoms suggesting a serious complication involving the lungs or heart. Persistent pain or pressure in the chest should prompt immediate medical evaluation.
Urgent medical care should be sought immediately if chest pain is accompanied by sudden, severe shortness of breath or difficulty speaking. Other symptoms include pain that radiates to the jaw, arm, back, or shoulder, which can indicate a cardiac event. The sudden onset of lightheadedness, fainting, or new confusion also requires emergency intervention.
Physical signs such as the skin, lips, or nail beds appearing pale, gray, or blue require immediate emergency medical services. Waiting for severe symptoms to resolve on their own can lead to significant harm. Any chest pain that is crushing, intense, or persistent and does not improve with rest should be evaluated urgently by a healthcare provider.