Crushing Chest Pain – Causes of Tight, Constricting Ache in the Chest

With the rise in heart disease over the past few decades, more people are now aware of the signs and symptoms of cardiac conditions. Public awareness campaigns have focused on the importance of early diagnosis and treatment to prevent complications and even death. Therefore the sudden onset of symptoms like a crushing chest pain raises the concern about a heart attack or similar cardiac condition. While a crushing chest pain may indeed be a heart attack, it can also occur with a number of different conditions that may not be as serious and may not even involve the heart.

Pain is a general term for a number of sensations that causes extreme discomfort and can even be debilitating. However, pain is only a warning signal of some underlying problem. Many conditions present with pain as a symptom. Some of these conditions are serious and others are less son. While the severity of pain can sometimes be an indication of the seriousness of the condition, this may not always be the case.

In other words, severe pain may be due to mild and innocuous conditions while mild pain can occur with serious and deadly diseases. The nature of the pain can also be an indicator of the seriousness of a condition but is also not as reliable. A serious condition like a heart attack can present with a mild chest ache whereas a non-fatal condition like acid reflux can sometimes present with severe chest pain.

Read more on cardiac vs non-cardiac chest pain.

What does crushing chest pain mean?

A crushing, tightness or constricting sensation is usually associated with muscle tissue. Since the heart is almost entirely muscle, it is therefore possible that this type of pain may be associated with the heart, like in conditions such as a heart attack. It is important to bear in mind that the heart is not the only muscle in the chest cavity.

Crushing, tight or constrictive pain is not always a reliable indicator of being associated with muscular conditions or with the heart specifically. It could be due to other problems related to the chest cavity, such as acid reflux which usually causes heartburn but can sometimes feel like “heart attack pain”.

People who are at high risk of heart-related problems need to be cautious when a crushing chest pain arises. In addition, when this pain is accompanied by other serious symptoms like difficulty breathing, dizziness or loss of consciousness then it can also be an important indicator of a serious problem.

Causes of Crushing Chest Pain

These are some of the more likely causes of a crushing chest pain. It is important to consult with a doctor immediately when there are symptoms like shortness of breath and dizziness accompanying the chest pain. There are other less common and less serious causes of chest pain that also needs to be considered. However, it is always advisable to first exclude the more serious conditions, especially in people who are older, overweight or obese, smoke tobacco or have risk factors like coronary artery disease, diabetes, high blood pressure and/or high cholesterol levels.

Read more on squeezing chest pain.

Acid Reflux

This is one of the most common causes of chest pain. It occurs when the stomach contents, including food and beverages mixed with digestive enzymes and acid, flow up into the esophagus. As a result this mixture irritates the lining of the esophagus and may reach as high up as the throat and mouth.

Most of the time acid reflux presents with a burning chest pain referred to as heartburn. However, it can sometimes be atypical and present with a crushing chest pain or a stabbing pain. In addition there are other symptoms like nausea, belching and bloating. Reflux symptoms usually ease with the use of antacids and similar acid drugs.


Angina pectoris is the chest pain that arises when there is insufficient blood flow to the muscular heart wall. It is often a prelude to a heart attack that may persist for months or years. Angina may occur with several problems of the small arteries that carry blood to the heart wall.

These arteries, known as the coronary arteries, usually become narrowed with fatty plaques (coronary artery disease). Sometimes the artery walls may become temporary narrowed when it goes into spasm. It tends to ease with rest or drugs known as nitrates and the chest pain then gradually eases.

Heart Attack

A heart attack is one of the main concerns of most people who experiencing a crushing chest pain. This is where the blood flow through the coronaries arteries are so restricted or even obstructed altogether that parts of the heart muscle are damaged as the cells die in this affected area.

Along with the typical crushing chest pain, there are usually other symptoms like shortness of breath, excessive sweating, nausea, dizziness and chest pain that radiates to the left side, usually to the left arm and jaw. While these symptoms may be similar to angina, it does not ease with rest or nitrates in a heart attack.


Cardiomyopathy is a group of conditions where the heart muscle becomes weakened or is abnormal. Some of the causes of cardiomyopathy includes genetic factors, high blood pressure, diabetes, thyroid problems, obesity, certain medication, illicit substances, alcoholism, nutritional deficiencies, pregnancy and other conditions.

However, the cause of cardiomyopathy is not always known. Irrespective of the cause, the heart is unable to pump blood properly in cardiomyopathy. Difficulty breathing, fatigue, swelling of the legs and dizziness are some of the possible symptoms that accompany the chest pain.


Asthma is another relatively common condition where there may be a tightness or constricting sensation in the chest. Sometimes this may be described as a crushing sensation. It is more likely to occur in asthmatic attacks among people who are known to have asthma.

The problem in asthma is that the bronchi become narrow due to spasm of the muscles in its walls. Apart from the discomfort, there are other symptoms like difficulty breathing, wheezing, dizziness and paleness of the skin. However, in milder attacks there may only be wheezing and shortness of breath.


Anxiety is another major cause of chest pain and often this chest pain may feel like a tightness or crushing pain. It is more likely to arise with acute anxiety episodes and in people suffering with anxiety disorders. Even a situation that causes intense nervousness may lead to this ache or pain.

Most of the time the chest pain is not related to any physical problem. However, anxiety can cause the heart to work harder and this may lead to cardiac pain if there is some underlying heart-related problem. It may also be accompanied by nausea and shortness of breath.

Other Causes

  • Arrhythmias
  • Bronchitis
  • Cardiac tamponade
  • Chest wall pain
  • Heart valve disease
  • Pericarditis
  • Pneumonia
  • Tuberculosis

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