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- Heavy, tight, crushing or like a band or pressure across the centre of the chest;
- Spreading to the arm(s), jaw, neck, throat or back;
- Coming with sweating, nausea, breathlessness, dizziness or a feeling of doom;
- Lasting more than 10 minutes, or not relieved by rest or your GTN spray;
- Sudden and severe with breathlessness or collapse.
Do not drive yourself. Sit or lie down, stay calm, and if prescribed, take your GTN as below. Chew 300 mg aspirin only if advised by the ambulance call-taker and you are not allergic. When in doubt, call 000 — heart attacks are treatable, and minutes matter.
Chest pain has many causes — some are emergencies, many are not. Pain from the heart is usually a central heaviness or tightness brought on by effort; pain from the lungs' lining is sharp and worse when you breathe in; pain from the muscles, ribs and joints of the chest wall is usually tender to press and changes with movement. This page helps you tell them apart and act safely. The golden rule: if pain could be your heart, treat it as an emergency until proven otherwise.
Cardiac pain: angina vs a heart attack
Angina is chest discomfort caused by the heart muscle not getting enough blood, usually because of narrowed coronary arteries. It typically feels like pressure, heaviness, tightness or squeezing in the centre of the chest, may spread to the arm, jaw or back, and is brought on by exertion, cold or emotion and eased by rest within a few minutes. This is stable angina.1,2
A heart attack (or unstable angina — together called acute coronary syndrome) is when the pain comes at rest, is more severe, lasts longer, and is not relieved by rest or GTN. It is often accompanied by sweating, nausea and breathlessness. This is a 000 emergency (see the box above). Note that some people — particularly women, older people and those with diabetes — have atypical or subtle symptoms such as unusual fatigue, indigestion-like discomfort or breathlessness without dramatic pain.
Only if it has been prescribed for you, and always follow your own action plan. A typical plan is:
- Stop and sit down (GTN can drop your blood pressure and make you light-headed).
- Take one spray or one tablet under the tongue.
- Wait 5 minutes. If pain remains, take a second dose.
- Wait another 5 minutes. If pain is still there after the second dose (about 10–15 minutes total), call 000 immediately — treat it as a heart attack.
A short-lived headache or flushing after GTN is common. Store the spray as directed and check the expiry. If you are using GTN more often than usual, tell your doctor — it can be a warning that your angina is becoming unstable.
Non-cardiac chest pain
Once the heart is excluded, several other structures can cause chest pain. Physiotherapists see these often — but the heart must always be considered first.
Pleuritic (pleural) pain
A sharp, stabbing pain that is clearly worse on breathing in, coughing or laughing and eases when you hold your breath. It comes from inflammation or irritation of the pleura — the lining around the lungs. Causes include chest infection/pneumonia, pleural effusion, and two emergencies: a pneumothorax (collapsed lung) and a pulmonary embolism (clot on the lung). Sudden sharp chest pain with breathlessness needs urgent assessment — call 000.
Musculoskeletal & intercostal pain
Pain from the chest wall itself — the ribs, the intercostal muscles between them, and the joints where ribs meet the breastbone (costochondritis) or spine. The clues are that it is usually reproducible when you press on the spot, changes with posture, twisting or reaching, may follow a cough, strain or unaccustomed activity, and is often a localised ache or catch rather than a deep central pressure. It is common and usually benign — but it remains a "diagnosis of exclusion," made only once more serious causes are ruled out.
Other common causes
- Reflux / indigestion — a burning discomfort behind the breastbone, often after meals or when lying down, sometimes with an acid taste. It can closely mimic cardiac pain.
- Anxiety or dysfunctional breathing — tightness, sharp catches or a dull ache with fast, shallow upper-chest breathing. See Dysfunctional Breathing.
- Shingles — a band of burning pain in one strip of skin, before a blistering rash appears.
Telling the types apart
| Type | How it feels | Brought on / eased by | Concern level |
|---|---|---|---|
| Cardiac (angina / heart attack) | Central pressure, heaviness, tightness; may spread to arm/jaw/back | Exertion; eased by rest/GTN (angina). At rest & unrelieved = emergency | High — 000 if severe, prolonged or unrelieved |
| Pleuritic | Sharp, stabbing, localised | Worse on breathing in & coughing | High if sudden with breathlessness (PE / pneumothorax) — 000 |
| Musculoskeletal / intercostal | Localised ache or catch, tender to touch | Movement, twisting, pressing the spot | Usually low — but confirm the heart is not the cause |
| Reflux | Burning behind the breastbone | Meals, lying down; eased by antacids | Low–moderate; can mimic cardiac pain |
This table is a guide to help you describe your pain — it is not a way to diagnose yourself or to talk yourself out of calling for help. If in doubt, assume the heart and call 000.3
How physiotherapy helps
Once serious causes are excluded, physiotherapy is central to managing musculoskeletal and pleuritic chest pain, and to limiting its knock-on effects. Options include gentle positioning and supported-cough techniques so pain doesn't stop you clearing your chest, breathing retraining to restore a relaxed pattern, graded movement and manual therapy for rib and muscle pain, pacing, and pain-relief adjuncts. Effective pain control is not just for comfort: unrelieved chest pain makes people breathe shallowly and avoid coughing, which leads to lung collapse (atelectasis) and retained secretions.
Cardiorespiratory physiotherapists assess every patient against six core problems: reduced lung volume, sputum retention, increased work of breathing, impaired gas exchange, reduced exercise tolerance and pain. Chest pain is the clearest example of the pain problem — and, left unmanaged, it drives the others by causing shallow breathing and a weak cough. See Cardiorespiratory Physiotherapy, Coronary Artery Disease and Post-Myocardial Infarction.
References & evidence base
- National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart Lung Circ 2016;25(9):895–951.
- Therapeutic Guidelines. Angina: management. Melbourne: Therapeutic Guidelines Ltd, 2025. Available at: tg.org.au
- National Institute for Health and Care Excellence. Chest pain of recent onset: assessment and diagnosis. Clinical guideline CG95. London: NICE, 2016 (updated 2020).
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.
Supervised exercise, breathing technique and self-management education are the mainstay of cardiorespiratory physiotherapy for this condition.
Corrections: If something on this page is wrong, out of date or unclear, we want to know. Email reception@inspireclinic.au with the page name and what you believe is incorrect. Substantive corrections are made promptly, and the guide’s version and last-updated date are changed to reflect it.