New onset chest pain always requires evaluation by your doctor. If the pain is severe, you should seek immediate medical care.

Even if the chest pain is not severe, emergency care is needed if the chest pain is crushing or squeezing or is accompanied by one or more of the following symptoms

• shortness of breath

• discomfort or tingling in the arms, especially the left arm

• pain in the back

• tightness or pain in the lower jaw

• profuse sweating

• lightheadedness or loss of consciousness.

Are you currently experiencing chest pain with any of the symptoms described above?

Yes, I am experiencing one or more of these symptoms.

No, I do not have any of these symptoms.

Chest pain that is more mild or intermittent can have many possible causes, some of which might be serious.

By answering the following set of questions, you will be guided toward information that applies to you and your chest pain.

First, let's consider how likely the chest pain reflects a serious medical condition, such as coronary artery disease, an enlarging aortic aneurysm, or blood clots in the lung (pulmonary emboli). Coronary artery disease and aneurysm do not usually cause pain that hurts more with breathing. The pain is the same even if you take a deep breath.

An enlarging aneurysm of the aorta will usually cause a constant severe pain in the chest and back, that feels like something ripping. The symptoms of coronary artery disease are highly variable, but chest pain that hurts more with deep breaths is not a typical symptom. When the cause of chest pain is pulmonary emboli, it usually is hard to take a deep breath.

Does it hurt more when you take a deep breath?

Yes, it hurts more when I take a deep breath.

No, it does not hurt more when I take a deep breath.

Doctors use a combination of factors to help diagnose the reason you have chest pain, such as the characteristics of the pain, your age and your risk factor profile for coronary artery disease.

The classic symptom of angina due to partially blocked coronary arteries is pressure-like discomfort in the front-middle part of the chest that occurs with exertion or emotional excitement and is relieved by rest.

Are you experiencing chest pain related to physical exertion or emotion?

Yes, this type of situation causes chest pain.

No, the chest pain is not related to exertion or emotion.

If the chest pain is intermittent but without a consistent relationship to exertion or emotional stress, heart disease could still be the cause. The younger you are and the fewer number of cardiac risk factors, the less likely it is that the chest pain is heart related.

Risk factors for coronary heart disease include

• tobacco use

• family history of heart attack or angina at an early age

• abnormal cholesterol levels, especially a high LDL (bad) cholesterol and a low HDL (good) cholesterol

• diabetes or pre-diabetes

• high blood pressure.

Age and smoking history is a good place to start. Which category are you in?

Under age 30

Age 30 to 39, non-smoker

Age 30 to 39, smoker

Age 40 or older

Your chest pain may be related to coronary heart disease, especially if you are a man, have a family history of heart disease or have one or more of the other risk factors. Call your doctor today.

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Smokers 30 years and older are at risk of early onset of coronary heart disease, especially if you have a family history of heart disease and have other risk factors. Call your doctor today.

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As mentioned at the start of the guide, any new chest pain requires a conversation with your doctor. As a non-smoker younger than age 40 it is unlikely that your chest pain is caused by fatty blockages in your coronary arteries. But if you have a family history of heart disease at an early age or other risks for coronary heart disease, this is a possibility. Also, some people are born with structural abnormalities of the heart that interfere with normal blood flow and cause chest pain.

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As mentioned at the start of the guide, any new chest pain requires a conversation with your doctor. Below the age of 30, it is unlikely that your chest pain is caused by fatty blockages in your coronary arteries. But if you have a family history of heart disease at an early age or you smoke, this is possible. Also some people are born with structural abnormalities of the heart that interfere with normal blood flow and cause chest pain.

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Now let's focus on the quality of the pain. A burning sensation in the middle of the chest could be caused by acid reflux. A burning sensation on just one side of the chest might indicate an irritated or inflamed nerve.

I have a burning sensation in the middle.

I have a burning sensation on just one side.

My chest pain is not a burning sensation.

Gallbladder attacks can cause chest pain that has a pressure or squeezing quality. If a gallstone becomes lodged in the bile duct, you may experience pain in the front of the chest. Usually there is also pain in the right upper section of the abdomen and often this pain continues to the back of the chest. If the stone passes on its own, the pain will resolve. Often it will return on another day, especially after a fatty meal.

You are now finished with this guide. If you have not done so already, you should inform your doctor of your chest pain symptoms.

A nerve that is pinched as it exits from the spine or an inflamed nerve can cause a burning sensation on one side of the chest. If you see a rash with small blisters, you probably have shingles (herpes zoster). Contact your doctor.

You are now finished with this guide.

A burning sensation that starts in the upper abdomen and continues into the area below the breast bone is often a symptom of acid reflux. Acid reflux tends to get much worse with lying down, especially right after meals.

You are now finished with this guide. If you have not done so already, you should inform your doctor of your chest pain symptoms.

Your symptom of exertional or emotional related chest pain relieved by rest is suggestive of angina. Contact your doctor immediately.

You should remain physically inactive until you speak to your doctor.

The most common causes of chest pain that gets worse with deep breathing (called pleuritic chest pain) are a pulled muscle in the chest wall, inflammation of the joints between the ribs and other bones in the chest area, a rib injury, irritation of the lining around the lung or heart and an infection such as bronchitis or pneumonia. Less commonly, pleuritic chest pain is caused by a partially collapsed lung called a pneumothorax or blood clots in the lung (pulmonary emboli).

The presence of shortness of breath in addition to pleuritic chest pain may indicate a problem that needs immediate medical attention, such as a pneumothorax or pulmonary emboli.

Do you have shortness of breath independent of the chest pain?

Yes or I am not sure.

No, I am not short of breath.

Good. Let's move on.

Chest pain with deep breaths associated with a cough, fever, and body aches suggests a bronchial or lung infection. People often refer to this as having "flu symptoms."

In addition to the chest pain, do you feel like you have an infection?

Yes, I think I have a respiratory infection.

No, I have no symptoms of an infection.

So far you have indicated that your chest hurts with deep breaths, but you do not have any shortness of breath, fever, or other symptoms of an infection.

There is a small chance that you could have a blood clot in the lungs. If you have a swollen leg, prior history of blood clots in the leg or lungs, or have recently been immobilized because of injury, surgery or illness, contact your doctor today.

If you have no risk factors for blood clots, chest pain that gets worse when you take deep breaths is most often caused by a pulled muscle in the chest wall, inflammation of or injury to one of the other chest wall structures, irritation of the lining around the lung (pleurisy), or irritation of the lining around the heart called pericarditis.

Call your doctor if the pain gets worse, additional symptoms develop or the pain is not subsiding over a few days.

If your temperature is less than 101F and the chest pain only hurts with deep breaths, start with rest, fluids and over the counter pain relievers. If new symptoms develop or your current symptoms are not improving over the next three days, contact your doctor. Call sooner if symptoms get worse.

For fevers that are higher than 101F, call your doctor for advice. Pleuritic chest pain and higher fever can be symptoms of pneumonia.

When your chest hurts, it can often be difficult to tell if you feel short of breath because the pain prohibits taking deep breaths or if it some other process is making your breathing difficult.

Call your doctor or arrange for transportation to a medical facility immediately. You may have a serious medical condition such as blood clots in the lung or a partially collapsed lung.

Call 911 immediately. You may be having a heart attack. Ask the emergency operator if you should take an aspirin now.