VCS Blog

Reasons for Chest Tightness and What You Can Do About It

By: Dr. William L. Coble, Jr.

The words chest pain and chest tightness are often used synonymously, but it’s the former that represents more of a catch-all terminology.

Chest tightness is generally associated with a heaviness or achy feeling, while a “pins and needles” sensation is usually more indicative of musculoskeletal issues.

Let’s take a closer look at three of the most common causes of chest tightness and explore some tips on dealing with chest tightness, from a doctor’s perspective:

Coronary Disease (Atherosclerosis)

One potential cause of chest tightness is coronary disease. Coronary disease is a blockage or hardening of the arteries that supply oxygen rich blood to the heart muscle.  It takes place when fats, cholesterols and calcium build up in the artery walls and form hard structures called plaques.  Over time, these plaques can block the arteries and lead to chest tightness and pain, or even poor heart muscle function.

Congestive Heart Failure

Congestive heart failure is the result of fluid backup in the lungs.  In these instances, the heart muscle doesn’t pump blood or relax as much as it should.  Chest tightness or shortness of breath is often the presenting complaint.

Many people incorrectly assume “heart failure” means the heart has stopped working when in fact the heart is merely pumping at a weaker level.  Because blood is moving through the heart at a slower rate, pressure in the heart increases.  This pressure, in turn, leads to the chambers of the heart enlarging and resultant fluid building up in the lungs.

There are two types of left-sided heart failure: systolic and diastolic failure. In the case of diastolic heart failure, the heart muscle may become thickened over time.  This is usually a direct influence of poorly controlled blood pressure.  In this case, the heart still has a powerful squeeze but it does not relax as it should.  This inability to relax, or accept new blood from the lungs, causes pressure to build and fluid in the lungs follows. Right-sided heart failure and systolic failure often cause other complications and symptoms.


In cases or pericarditis, there is a swelling or irritation of the pericardium (a thin, sac-like membrane that surrounds the heart) resulting in a sharp chest pain.  Although cases of pericarditis often occur suddenly, they rarely consist of longer episodes.  Most commonly, pericarditis is associated with certain viruses, connective tissue diseases (Lupus) or after a heart attack.

Non-Heart Related Reasons For Chest Tightness

There are a number of non-heart conditions that may cause chest tightness.  These may include but are not limited to:

  • Asthma or lung disease
  • Pneumonia
  • Blood clots in legs 
  • Acid reflux and indigestion 
  • Gall bladder issues 
  • Stomach ulcers 
  • Inflammation of the cartilage
  • Pulled muscles
  • Panic attacks, anxiety disorders and more

What to Do If You Are Experiencing Chest Tightness

When experiencing chest tightness take note of the additional factors around you.  Is the pain better or worse over time?  Is it made worse as a result of cold weather, exercise or eating a specific food?  These might be signs of asthma-induced chest tightness. 

Regardless of cause, chest tightness should always be considered abnormal and you should see you primary care doctor immediately.  If you’re feeling discomfort on the higher end of a 1 to 10 pain scale, I advise you head directly to emergency care.

Remember that risk factors such as high blood pressure, a family history of heart disease, smoking, diabetes and age can indicate a greater likelihood for serious complications.

If you’re concerned with your chest tightness, please contact us immediately to make an appointment.

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Published June 14, 2019

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