The chest houses many of the vital organs such as the heart and great blood vessels as well as the lungs and airways. The sturdy ribcage, breastbone and vertebrae at the back protect these organs. Breathing and pumping of blood never ceases and these vital organs are working throughout life. Normally a person is not  aware of sensations such as expansion and contraction of the lungs or the beating of the heart, except when these organs are working at full capacity usually as a consequence of strenuous physical activity. Therefore any sensation within the chest is always a cause for concern especially when one is not undertaking strenuous activity as it may be a symptom of some underlying disorder of the vital organs.

What is a tight chest?

A tight chest is a common term to describe a constricting sensation within the chest. It is often associated with difficulty breathing which is known as dyspnea. Although these are several organs in the chest cavity from which tightness may emanate, it is a tight chest with restricted breathing that is more likely to be associated with the vital organs – heart and blood vessels or lungs and airways. Therefore the simultaneous presence of a tight chest with restricted breathing should be seen as a serious symptom that requires an immediate medical assessment. It is sometimes the first symptoms of life-threatening conditions such as a heart attack, pulmonary embolism (blood clot in the lung) or dissecting aneurysm.

Warning Signs

Tightness in the chest along with restricted breathing should be considered as serious symptoms particularly in people at risk of heart disease, pulmonary embolism or aortic dissection. The elderly are always considered to be a high risk group. Warning signs that may accompany a tight chest and restricted breathing includes :

  • Loss of consciousness
  • Bluish tine of fingers and lips
  • Cold and clammy skin
  • Bleeding from the mouth
  • Blood-stained mucus
  • Concomitant unintentional weight loss
  • Excessive sweating

Causes of tight chest and restricted breathing

The main organs of the cardiovascular and respiratory system lie next to each other in the chest cavity and are closely linked in terms of functioning. Blood low in oxygen returns to the right side of the heart and is then routed to the lungs. Here it is re-oxygenated and the blood returns to the left side of the heart. It is then pumped out to the rest of the body. It is these actions of the heart and lungs that are essential for life. Failure of one of these systems will ultimately lead to death. It is, however, difficult to isolate symptoms like a tight chest and restricted breathing to a specific condition solely based on these two symptoms.

Cardiovascular Causes

A tight chest sensation and restricted breathing is present in all of these conditions. Additional symptoms are discussed with each disease.

  • Heart attack or myocardial infarction is death of a portion of the heart muscle due to an interruption of its blood supply via the coronary arteries. Other symptoms include :
    - Chest pain that radiates to the neck or jaw, down the arms especially the left arm, to the back of upper middle abdominal region.
    - Excessive sweating
    - Nausea and sometimes vomiting
    - Dizziness
    - Fainting
    - Anxiety
  • Angina pectoris is a constricting chest pain associated with physical activity and eased with rest and nitrates. It is a symptoms of coronary artery disease and many of the other symptoms of a heart attack may be present except for fainting. Angina pectoris can exist for months or years prior to a heart attack.
  • Pericarditis is inflammation of the lining that forms a sac around the heart. Other symptoms include :
    - Chest pain
    - Fatigue
    - Fever
    - Persistent dry cough
    - Swelling in the abdomen and legs
    - Pericardial friction rub
  • Arrhythmia is a disruption of normal heart rate and rhythm often associated with a problem of the heart’s electrical conduction system. Most arrhythmias are asymptomatic. Other symptoms when present includes :
    - Chest pain
    - Fluttering in chest
    - Abnormal heart rate
    - Dizziness
    - Fainting
  • Heart valve disease is a problem with the valves between the heart chambers or between the heart and great blood vessels that prevents backward flow of blood when the heart contracts and relaxes. Other symptoms that may be present depending on the type of heart valve disease includes :
    - Chest pain
    - Palpitation
    - Cough
    - Dizziness
    - Rapid breathing
  • Pulmonary embolism where a blood clot, usually from the leg veins, causes a blockage of the arteries of the lungs. It is a life-threatening condition. Other symptoms includes :
    - Cough
    - Cyanosis
    - Cold clammy skin
    - Excessive sweating
  • Aortic dissection is where a tear forms in the inner wall of the major blood vessel from the heart known as the aorta. It is more commonly seen in the elderly. Other symptoms includes :
    - Fainting
    - Excessive sweating
    - One-sided paralysis
    - Difficulty speaking
    - Loss of vision

Respiratory Causes

Other symptoms are discussed with each disease where tightness of the chest and restricted breathing are present.

Picture of trachea, bronchi,

terminal airways and lungs.

  • Asthma is a condition marked by episodic narrowing of the airways. It is one of the most common chronic respiratory disorders in children and milder symptoms may persist throughout adulthood. Additional symptoms of asthma includes :
    - Wheezing breathing sound
    - Restless
    - Difficulty sleeping
    - Occasional cough
  • Bronchitis is inflammation of the bronchi and bronchioles most commonly due to infection in acute cases or cigarette smoking in chronic cases. Other symptoms include :
    - Productive cough
    - Mucus may be temporarily dark brown
    - Mild fever
    - Fatigue
  • Emphysema is one type of chronic obstructive pulmonary disease (COPD) with the other type being chronic bronchitis. These diseases are often seen with long term cigarette smoking. Although breathing is severely restricted as emphysema progresses, the sensation of chest tightness is not as prominent as it is in chronic bronchitis.
  • Fluid in the lungs describes a condition known as pulmonary edema although it may confused with a pleural effusion which is fluid accumulation around the lungs. Other symptoms include :
    - Abnormal breathing sounds like crackling
    - Dry cough
    - Pleural friction rub

Other Causes

  • Anxiety is one of the common mental health conditions known to present with symptoms such as a tight chest with restricted breathing.
  • Chest wall injury and bruising.
  • Non-traumatic musculoskeletal disorders of the chest wall.
  • Raised pressure within the abdomen.
  • Hiatal hernia.
  • Acid reflux although it does not usually cause restricted breathing.

Article reviewed by Dr. Greg. Last updated on April 2, 2012