Chest pain


The rib cage consists of:

  • 12 thoracic vertebrae
  • 12 pairs of ribs and
  • the sternum

It serves to protect the organs that are located in it: lungs, heart, thymus and the large blood vessels and pulmonary vessels.

Chest pain can have many causes, including both harmless and serious conditions.

You can read about other causes of chest pain in our article Chest pain!


Diseases of the internal organs such as the lungs and heart must be ruled out as causes of chest pain and therefore require a detailed examination and a precise description of the pain.

In the case of a heart attack, for example, the pain is typically described as a feeling of tightness and pressure and radiates into the left arm.
If the pain is stronger during physical exertion and is associated with shortness of breath, this can be a sign of a circulatory disorder in the heart.

In the case of chest pain caused by diseases of the lungs, on the other hand, the pain is typically breath-dependent.

Please also read: Lung pain

Chest pain can also come from the bony chest itself and the associated muscles, nerves or connective tissue.

Read more on the topic: Pain in the region of the heart

Bruised or broken ribs

At Bruised ribs or even Broken ribs the pain is more likely superficial, but intensify when touched at the injured area. The pain is there breath dependent and stabbing.

At Broken ribs it can be too with movements grinding noises come and the break can be felt.


Cause one Shingles are Herpes zoster viruses, Which along of the Nerves wander and there typical, burning blisters cause. The inflammation attacks the nerves corresponding skin area over. The nerves in the chest run along the Lower edge of a rib cause the typical "belt-shaped" pattern in the case of infestation on both sides. This disease occurs preferentially in the elderly and immunocompromised people on.


Pain from the Muscles will be as selectively and stabbing to boring described. You are perceived in a very specific place.

In comparison, pains are from the connective tissue rather diffuse and larger area. The Pain quality is used as a oppressive and pressing described. Such pain can result from earlier Injuries, scar or Bad posture be that too Tension being able to lead.

Vertebral blockage

A Vertebral blockage can without any apparent cause or through fast and jerky turning movements and lead to sudden onset of pain and restricted mobility. The Pain are common very strong and can thereby affect everyday life, but a vertebral blockage is general not dangerous and often disappears after a few days without any treatment.

Rib block

Rib blockage can result from incorrect posture, tension in the back / chest muscles or from carrying heavy bags on one side.
This leads to a stiffening of the joints between the ribs and the thoracic vertebrae, so that these are expressed as severe pain during certain movements.

You can read how to solve a rib block yourself in the following article: How to solve a rib block correctly

Psychosomatic pain

The Chest pain in connection with mental stress. In stressful situations, breathing is often held in reflex or at least breathing is reduced.
With frequent exposure it can also increase Tension in the Rib cage area come what the Pain can trigger.
Heart phobias also play a major role in chest pain. Many people suffer from great fears that they have heart diseases that are not there. The doctor speaks of heart phobia here.

ankylosing spondylitis

Under ankylosing spondylitis you understand one chronic inflammatory disease With Pain and stiffening from Spinal joints. In the course of the disease it comes to typical changes of the Spinewhereby the backward curvature of the thoracic spine increases and this can lead to pain in the thoracic area.

Tietze syndrome

The Tietze syndrome is a rare disease with unknown cause. The pain is more likely selectively to the cartilaginous transition between the sternum and the first to fourth rib or the Sternum tip. There is no signs for one inflammation and the disease heals within months.
Tietze syndrome only needs to be treated if the level of suffering is appropriate. In most cases, anti-inflammatory drugs from the NSAID group will do.

Read more about this under our topic: Tietze syndrome


Since chest pain can have a variety of causes, a careful history-taking is very important. It is important to:

  • the exact location
  • Radiation / expansion
  • Quality of pain as well
  • knowing the severity of pain.

Depending on the suspected diagnosis, further examinations may be necessary:

  • EKG
  • echo
  • Chest x-ray (chest x-ray)
  • if necessary, CT or MRI of the lungs.

Figure rib cage

Illustration of the skeleton of the rib cage (from the front)

I - XII ribs 1-12 -
Costa I-XII
1st - 3rd sternum -

  1. Sternum handle -
    Manubrium sterni
  2. Sternum body -
    Corpus sterni
  3. Sword extension -
    Xiphoid process
  4. Rib - Costa
  5. Costal cartilage -
    Cartilago costalis
  6. Collarbone - Clavicle
  7. Raven beak process -
    Coracoid process
  8. Shoulder corner - Acromion
  9. Costal arch -
    Arcus costalis

You can find an overview of all Dr-Gumpert images at: medical illustrations


The therapy the chest pain is directed to of the root cause. The best forecast have the Painthat through the skeleton or the Musculature to be triggered.
These are typically the harmless chest pain and can go through conservative therapy how physical therapy usually be cured completely.
This is sufficient Pain medication important so that there is no wrong posture, as the healing can sometimes take months.

Where does your chest pain occur?

Location - middle

Chest pain can arise for a variety of reasons, and it can be helpful to try to identify the location of the main pain.

For example, if severe pain occurs more centrally behind the sternum, the first suspicion is often a heart attack. In this case the pain is independent of the position or the breathing and can radiate into other areas of the upper body, for example the left arm, lower jaw, back or upper abdomen.

Central chest pain can also be an indication of reflux disease. In this disease, acidic gastric juice flows back into the esophagus, which irritates the mucous membrane. Above all, if the symptoms appear after consuming alcohol and nicotine, or if they become worse when lying down, the suspicion is obvious.

With a strong cough, pain in the middle of the chest can also occur. If pain occurs more at night or when the patient is sober, or immediately after eating, it may be a gastric ulcer.

If vomiting occurs at the same time as the chest pain, there are several possible clinical pictures that require treatment at different rates.

A more harmless disease here is the so-called Mallory-Weiss syndrome. The mucous membrane of the esophagus is superficially torn, for example after violent vomiting, due to reflux disease or permanently increased alcohol consumption. If this is suspected, a gastroscopy should be performed to rule out possible bleeding in the esophagus or stomach.

A far more serious problem with similar symptoms is the tearing of the esophagus. The person concerned has often vomited very heavily beforehand, resulting in a massive increase in pressure within the esophagus, which it cannot withstand. There is severe pain and shortness of breath.

Another life-threatening clinical picture is also noticeable through sudden, severe pain in the middle of the chest: aortic dissection. Blood gets through a tear between the layers of the aortic wall, which can lead to a bulging of the wall, the formation of thrombi or tears in the aorta.

In the last two situations listed, there is an acute risk of shock and the need for hospitalization.

For more information, read on: Burning behind the breastbone.

Localization right

When occurring on the right Chest pain Very different diseases come into consideration.

If you can assign the pain to the outer chest and if it occurs independently of breathing, it can be, for example, shingles or muscular tension. Lateral chest pain also occurs when the intercostal nerves are irritated.

If the pain is more internal, it may represent pneumonia or pulmonary inflammation. In many cases, there are also coughing, exhaustion, breathing-dependent pain or even fever.

If, in addition to chest pain, sudden difficulty in breathing occurs, it could be a pneumothorax (a lung partially or completely collapses) or pulmonary embolism (one or more vessels in the lungs are closed by a plug and the subsequent part of the lungs can no longer participate in breathing) act.

Both cases are emergency situations that need to be treated quickly.

Localization - links

If you notice chest pain on the left side, heart disease is often thought of. For example, a heart attack more often causes central pain, but can almost as often cause pain in the left side of the chest. Symptoms very similar to a heart attack are triggered by an attack of angina pectoris. Here, too, there is a feeling of pressure or pain behind the breastbone or left-sided chest pain. Again, it can

  • Restlessness
  • Sweating or
  • nausea

come, these symptoms can also speak for a heart attack.

A Pericarditis, so one Inflammation of the pericardiums, can cause breathing pain, in particular, because the pericardium rubs against the inside of the chest. If the pain increases over a longer period of time, it could also be a tumor.

The symptoms of a tumor or a Pneumothorax, Pulmonary embolism, lung infection, Irritation of muscles or annoy or the Shingles in the case of right-sided chest pain, of course, are not fixed on one side. These diseases can appear on the right as well as on the left.

Chest pain and cough

Coughing represents a protective and defensive reaction of the body. With a strong exhalation, liquids or foreign bodies can be carried upwards from the airways and the lungs. This happens either reflexively, for example when swallowing or breathing in cold air, but it can also be controlled deliberately.

A cough can indicate an acute or chronic illness.

It is important to find the cause, especially if, in addition to coughing, there are other complaints such as fever, shortness of breath, coughing up blood, weight loss, severe chest pain or the cough lasts longer than 3 weeks. Medicines, allergies or nicotine consumption can also lead to a cough.

An infection of the upper respiratory tract, swallowing or inhalation of foreign particles, asthma, but also cardiac decompensation can trigger an acute cough, whereby bronchitis, obstructive pulmonary disease (COPD) or a tumor can be the cause in chronic diseases.

You might also be interested in: Cracking in the chest, cracking in the sternum

Chest pain and back pain

The back of the Rib cage, the upper back, can also be painful for a variety of reasons.

Just as lateral or central chest pain can be triggered by nerve irritation, muscular tension, pneumonia or shingles, this can also happen on the back, depending on the location.

Kick harder Pain between the shoulder blades aortic dissection or myocardial infarction can be the cause here too. Organ diseases such as a pancreatic tumor or a Pelvic inflammation can one Back pain cause.

Specifically for the back, there is also a Herniated disc of the thoracic spine in question, this being more common at the Lumbar- or the Cervical spine occurs.
If you suspect a herniated disc of the thoracic spine as the cause of your chest pain, we recommend our topic: Symptoms of a herniated disc of the thoracic spine

Bony diseases of the spine such as a vertebral fracture, osteoporosis or a narrow spinal canal make themselves felt as pain.

The spine can also be affected by inflammatory diseases, such as Scheuermann's disease or Bechterew's disease. Meningitis can go beyond a stiff neck and affect the back.