When you experience Tightness in the chest, the first thought is myocardial infarction.

But in some cases it could be a Generalised Anxiety Disorder, gastrointestinal disease or lung disease.

Myocardial infarction is manifested by a feeling of continuous tightness in the chest, in the retrosternal region, which can spread to other areas of the body.

There is also shortness of breath, sweating, nausea and a feeling of imminent death.

However, heart attack is not the only cause for chest tightness. In any case, the conditions listed below.

1. Angina pectoris

Angina pectoris is a coronary disease caused by a decrease in the calibre of the coronary arteries due to the presence of atherosclerotic plaques. The coronary arteries are responsible for transporting blood to the heart, so reduced blood flow causes hypoxia in the heart cells.

It manifests itself as a recurrent tightness in the chest that follows a pattern of duration and intensity. It is sometimes accompanied by shortness of breath.

2. Pulmonary thromboembolism

Pulmonary thromboembolism is caused by the migration of thrombi or clots that clog a pulmonary artery. The thrombus usually originates in the legs in cases of deep vein thrombosis.

It is manifested by sudden shortness of breath, chest constriction and coughing with pink sputum. It may also be accompanied by palpitations, sweating and a feeling of light-headedness.

It is a potentially life-threatening condition that requires immediate medical evaluation. The approach involves antithrombotic drugs, anticoagulants and sometimes surgery.

Coronary thromboembolism among causes of chest tightness.

The formation of a thrombus in a place distant from the lungs, such as the legs, can lead to a blockage of the chest arteries as a result of the migration of the clot.

3. Pericarditis

Pericarditis is the inflammation of the pericardium, the membrane surrounding the heart. When the pericardium becomes inflamed, the layers rub against each other and create tension in the chest. In addition, palpitations, shortness of breath, malaise, fatigue and sometimes fever are present.

Its origin may be a systemic disease or a viral infection. It can develop into the chronic form and requires immediate medical evaluation.

4. Generalised anxiety disorder

Anxiety is a common psychological condition that can give a feeling of tightness in the chest as a symptom. When generalised anxiety disorder appears, it may manifest as:

• Fast and shallow breathing.
• Difficult breathing.
• Feeling of panic.
• Muscle pain.
• Palpitations.
• Dizziness.

5. Infection of the lower respiratory tract

The lungs are made up of bronchi, bronchioles and alveoli. The alveoli are small air sacs that diffuse oxygen with the blood. When an infection of the lower airways is present, they become inflamed and fill with fluid or pus.

Symptoms include those associated with the common cold, such as coughing, malaise, fatigue, fever, chills and nasal congestion. However, shortness of breath, tightness in the chest and rapid, shallow breathing may also occur.

The tightness in the chest caused by a lower respiratory tract infection is sometimes explained by inflammation of the pleura (pleurisy). This symptom may radiate to the shoulders and back.

6. Pneumothorax

Pneumothorax is characterised by the presence of air in the pleural space. It is usually caused by a traumatic injury, but can also be caused by lung disease or medical manoeuvres.

The main symptom is a sudden sharp pain of very strong intensity, which worsens when breathing deeply, with a feeling of constriction in the chest. It requires medical evaluation, as sometimes a needle or tube has to be inserted into the chest to remove excess air.

7. Asthma crises

In asthma, the airways narrow, become inflamed and more mucus is produced. This reduces the flow of air to the lungs, causing shortness of breath.

During an asthma attack, there may be a feeling of tightness in the chest, coughing and wheezing. It is triggered by exposure to allergens or in certain situations, such as strenuous exercise.

8. Gastroesophageal reflux disease

The tightness in the chest caused by gastroesophageal reflux disease occurs because hydrochloric acid rises from the stomach into the oesophagus. Acid regurgitation causes:

• Burning sensation and tightness in the chest.
• Difficulty in swallowing
• Pain in the pit of the stomach.

Symptoms may be occasional or recurrent and are usually treated with gastric protectants. However, evaluation by a gastroenterologist is recommended.

9. Peptic ulcers

When gastric acid attacks the walls of the stomach, oesophagus or first tract of the small intestine (duodenum), the integrity of the mucosa can be lost, resulting in a peptic ulcer.

The most common symptom of a peptic ulcer is a burning sensation in the mouth of the stomach. However, there may also be chest tightness, belching and nausea.

Sense of tightness in the chest: always worth a medical evaluation

Although there may be benign causes, when you experience tightness in the chest a medical evaluation is always necessary. In case of recurrence and suspicion of generalised anxiety disorder, psychological interventions and lifestyle changes are necessary.

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