What is a heavy chest?
A heavy chest is a common term to describe a feeling of heaviness in the chest often associated with difficulty breathing (dyspnea) or a tight or crushing sensation in the chest (chest pain). Two situations where this feeling occurs repeatedly is with asthma (lung) and angina pectoris (heart) but there are a host of other causes. A heavy chest may be a prelude to a serious condition and other signs and symptoms gradually become evident. Therefore it should be taken seriously as early treatment for some of the more serious causative conditions can avoid a life threatening situation from arising.
Heavy Feeling in the Chest
Since terms such as a heavy chest or heavy feeling in the chest are not actual symptoms or medical conditions, it is difficult to clearly associate it with a specific ailment. It is a subjective term that is often used loosely to indicate some sort of discomfort in the chest or involving the organs in the chest. It is therefore important to understand which organs lie in the chest and its outer structure. The chest is composed of :
- Chest wall – skin, subcutaneous tissue (underneath the skin), muscles, ribs and breastbone (sternum), nerves and blood vessels of the chest wall.
- Respiratory – lungs on either side, bronchus to each lung and trachea (windpipe) and the lining around the lungs known as the pleura.
- Cardiovascular – heart, great blood vessels and the sac around the heart (pericardial sac)
- Esophagus (food pipe)
These are the main structures that may be responsible for a heavy feeling in the chest. Other structures in the chest cavity includes major nerves such as the vagus nerve and sympathetic trunk, major lymphatic vessels and lymph nodes. Although these other structures may also be diseased and cause discomfort, this is not typically described as a heavy feeling in the chest as is the case with the heart and lungs in particular.
Heavy Chest Symptoms
The heavy feeling in the chest is a symptom although it does not accurately describe the exact sensation that a person is experiencing. Similar terms includes tightness, compression, constricting or suffocating. Other symptoms may also be present which is helpful in indicating the most likely cause of a heavy chest. This includes :
- Difficulty breathing, shortness of breath or breathlessness
- Rapid shallow breathing
- Dizziness and fainting spells
- Paleness of the face and lips or even a bluish discoloration
- Chest pain with pain radiating to the back, arms, neck jaw or upper middle abdomen
- Nausea with or without vomiting
- Excessive sweating
- Cold and clammy skin
- Suffocating sensation when lying flat
- Difficulty moving arms
Causes of Heavy Chest
A heavy chest of heavy feeling in the chest in most cases can be attributed to the same causes as :
Lungs and Airways
Any restriction of air into or out of the lungs, either due to a problem within the airways or the lungs itself, may cause a heavy feeling in the chest before actual difficulty breathing or shortness of breath is evident. The main causes of this heavy chest sensation includes :
- Asthma where the airways become narrowed due to swelling as a result of hyperreactive airways. This means that certain triggers causes inflammation of the airway wall. It is a more common condition in children although it can persist throughout adulthood.
- Acute bronchitis where the airways become inflamed often due to a viral or bacterial infection. There is excessive mucus production with bronchial irritation presenting as a persistent productive cough.
- Chronic obstructive pulmonary disease (COPD) where the airflow is permanently affected in conditions such as emphysema or chronic bronchitis. It is commonly seen in long term cigarette smokers.
- Pleural effusion where there is a build up of fluid around the lung in the pleural space thereby hampering normal lung expansion especially in severe cases.
- Pulmonary edema where there is fluid accumulation in the lung impeding the gas exchange between the air in the lung and the bloodstream at the alveoli (air sacs).
Heart and Blood Vessels
The main cardiac causes of a heavy chest arises when the heart muscle has an inadequate supply of oxygenated blood. It is a condition associated with coronary artery disease (CAD) where the coronary arteries that supply blood to the heart muscle are narrowed.
- Angina pectoris is a common symptom of coronary artery disease where the heart muscle is receiving inadequate blood during certain periods leading to chest pain. The heart muscle is injured with the lack of sufficient oxygen but does die (infarct). The condition relieves with rest and the use of nitrates.
- Myocardial infarction (heart attack) is where a portion of the heart muscle dies due to a severely occluded or completed blocked coronary artery. It occurs over hours and a heavy feeling in the chest may sometimes be the initial symptoms.
- Cardiac tamponade where a build up of fluid around the heart in the pericardial cavity compresses the heart thereby impeding its expansion and the filling of blood into the heart.
- Arrhythmias which are an abnormality in heart rate, rhythm and contraction. There are various different types of arrhythmias and most of the time these conditions are asymptomatic. Palpitations are common symptom rather than heaviness in the chest.
- Aortic valve stenosis where a defect in the valve between the heart and aorta leads to a narrowing thereby impairing the outflow of oxygenated blood from the heart. As with most heart valve diseases, it is largely asymptomatic in the early stages.
Muscles and Bones
Conditions affecting the chest wall muscles, particularly the pectoral and intercostal muscles, ribs and breastbones may be responsible for a heavy feeling in the chest. Disorders with the main muscle of respiration – the diaphragm – may also be responsible for this sensation.
- Costochondritis where the costal cartilages between the breastbone (sternum) and ribs are inflamed. It is a common cause of breastbone pain.
- Muscle strain and overuse associated with physical activity (pectoral muscles) and prolonged periods of deep breathing or chronic coughing (muscles of respiration).
- Diaphragmatic paralysis where the diaphragm is unable to contract to allow for expansion of the lung during inspiration. It is mild with minimal symptoms when one side of the diaphragm is affected – unilateral diaphragmatic paralysis (UDP).
- Chest wall bruising that may arise with severe trauma to the chest associated with assault or motor vehicle collisions. Although pain is more common, sometimes with minimal trauma there may just be some soreness with a heavy feeling in the chest.
Esophagus and Stomach
Conditions affecting the esophagus may cause a heavy feeling in the chest when it is mild. This includes :
- Gastroesophageal reflux disease (GERD) or commonly known as acid reflux where stomach acid flows backward into the esophagus (food pipe). Although it typically causes heartburn (burning chest pain), certain cases may cause no symptoms (silent acid reflux) or mild non-specific symptoms such as a heavy feeling in the chest.
- Achalasia is a condition where the lower esophageal sphincter which separates the esophagus and stomach does not open thereby leading to a back up of food within the esophagus.
- Hiatal hernia where a portion of the stomach moves into the chest cavity and is trapped for a period of time in the diaphragmatic – the hole in the diaphragm through which the esophagus passes on its way to the abdomen.
- Non-ulcer dyspepsia (indigestion) where there is no known cause of the indigestion. It is also known as a functional dyspepsia.
Several other causes may also be responsible for a heavy feeling in the chest although other more prominent symptoms may develop thereafter. This includes :
- Psychological factors such as anxiety or depression.
- Raised intra-abdominal pressure which hampers movement of the diaphragm.
- Tight clothing including incorrectly sized brassieres in women.
- Prolonged lying on the chest and abdomen.
- Excessive intestinal gas particularly with air swallowing and carbonated beverages.
Article reviewed by Dr. Greg. Last updated on March 7, 2012