Burning pain in the chest or a burning sensation in the chest may be linked to disorders with the chest wall, organs lying within the thoracic cavity, or referred pain from the abdomen, neck or back.
In adults, especially those with risk factors of coronary artery disease, angina or even a heart attack should always be considered. While these serious cardiac conditions often result in pain that is crushing, tight or stabbing in nature, it may also result in a burning pain.
It is not uncommon for heartburn (acid reflux) to be mistaken for cardiac pain and vice versa. Therefore burning pain in the chest requires immediate investigation in order not to miss potentially life threatening cardiovascular conditions.
The origin/site of the burning chest pain, like any other pain, should be clearly identified. The pain may either be centrally located (pain in center of the chest) or laterally (side chest pain). It is also important to be familiar with the nature of cardiac chest pain vs non-cardiac chest pain, especially for a person with a history of cardiovascular conditions or the associated risk factors.
Pain is a non-specific symptom and if the exact position cannot be isolated, it is difficult to identify a cause without further investigation. The presence of other signs and symptoms, trigger or exacerbating factors as well as relieving factors will assist with a possible diagnosis.
Causes of Burning Chest Pain
The most common causes of burning pain in the center of the chest includes :
- Gastroesophageal reflux disease (GERD/acid reflux) – heartburn
- Angina – pain is usually crushing and suffocating but can be burning in nature
- Myocardial infarction (heart attack) – similar to angina
- Pulmonary embolism- similar to angina
- Aortic dissection – similar to angina, sharp pain
GERD , angina or heart attack pain are more likely to occur after eating, exercising or stress. GERD is more likely to start of as a burning sensation or discomfort rather than pain, although severe cases can be painful. Esophagitis is often linked to chronic GERD.
With angina, myocardial infarction, pulmonary embolism or aortic dissection, dizziness, shortness of breath and vagal reactions like sweating may also be present.
In anxiety, palpitations are a common feature along with shortness of breath and it usually precedes or follows a stressful event. Refer to Stress Chest Pain.
Abnormal breathing sounds and a cough, especially with a history of a respiratory tract infection, is more likely to be tracheitis.
Other causes like breastbone pain also need to be considered as well as referred pain from the upper abdominal area. This is further discussed under right upper quadrant abdominal pain, upper middle abdominal pain and left upper quadrant abdominal pain.
The most common causes of burning pain on either side of the chest includes :
- Lung and airway infections like bronchitis, bronchiolitis, pneumonia and pleurisy. Smoke or toxic fume inhalation, bronchiectasis or a collapsed lung also needs to be considered.
- Muscle pain from strain or tears often results in burning pain of varying intensity.
- Nerve pain either from infections like shingles (herpes zoster) or nerve root compression of the intercostal nerve(s).
- Bone, as in rib fractures, and costal cartilages like in costochondritis may also be responsible.
Lung and airway infections are often accompanied by a cough, shortness of breath, difficulty breathing and a fever.
Shortness of breath and/or difficulty breathing should raise the concern of non-infectious causes of lung pain.
Chest wall pain is often more common, especially in cases of burning pain on the side of the chest. Muscle strain should be considered in cases of pain during and after strenuous exercise, especially activities such as weight lifting.
Pain due to nerve root compression (pinched nerve) may run along the entire course of the affected nerve, just as shingles tends to occur in dermatomes.
Bone pain and even pain due to the cartilages is usually preceded by trauma or strain that would have resulted in a fracture of inflammation.
Pain upon movement is more likely to be due to muscle strain, bone or cartilage pain.