Chest pain

Chest pain is an enigma that baffles the understanding but can be explained.

Are you in a hurry? Come back later, as this page is going to take at least twenty minutes to digest. It's a busy page! Chest pain is a vital subject, and it behooves you to do it justice... Certainly pain in the chest is not uncommon and, of course, it may be serious.

Unless you are ABSOLUTELY SURE to the contrary, it is best to assume that you are having a heart attack. After all, 50% of persons having their first heart attack will die very suddenly within a short period of time, with no prior warning, and if you are wrong ...

Heart attack man.

This page was last updated by Dr Barrie Lewis on 29th May, 2021.

However, there are many other causes of pain in the chest. Here we will discuss a few that are relevant to chiropractic, since about 25% of these complaints stem from the joint between the ribs and the breastbone.

Harvard University reports that 6 million Americans with chest pain were seen in hospital emergency departments in 2009. Only 20% of them were having a heart attack. So what about the 80%?

Certainly it is best to consider whether your chest pain could be coming from source other than your heart before having expensive, and sometimes unnecessary procedures, like having a stent fitted, should you be experiencing pain in the chest.

But first, what ARE the symptoms of an impending heart attack?

HEART ATTACK aka Myocardial Infarction or MI.

Painful chest may be caused by a blockage in the heart's arteries which reduces or completely cuts off the blood supply to a portion of the heart muscle.

This can cause a blood clot to form and totally stop the blood flow in a coronary artery, resulting in a heart attack usually with much associated chest pain (also called an acute myocardial infarction or MI).

Irreversible injury to the heart muscle usually occurs if medical help is not received promptly. Unfortunately, it is common for people to dismiss heart attack symptoms. Doctors use two blood tests, looking for Creatine kinase and Cardiac troponin, that are a sure sign of heart muscle damage.

So, what are the warning signs of a heart attack?

EVERYONE should know these signs. Print this out and stick it up on the fridge.

Key signs are...

  • The gradual onset of pain over the course of a few minutes and
  •  pain that appears during or after physical exertion or emotional stress are also red flags. On the other hand, sharp or stabbing pain lasting only a few seconds, or pain confined to one small spot is less likely to be a heart attack. For example, sharp pain or a dull ache over a rib-breastbone joint is more likely to be Tietzes syndrome (more lower down).
  • You should also keep in mind that pain from a heart attack isn’t always confined to the area around the heart. For example, a heart attack may cause pain, numbness or other unusual sensations in
  •  one or both arms,
  • the back,
  • neck,
  • jaw or
  • stomach.
  • Other symptoms that can accompany a heart attack include nausea, dizziness, shortness of breath and breaking into a cold sweat.
  • Remember, too, that a person can have a heart attack without any pain. In particular, women often have symptoms of stomach distress or back pain instead of chest pain.


In all of health,"Prevention is better than a cure", but nowhere more so than in regard to heart disease. For starters, think delicious fish soup ... the Heart Foundation recommends "fatty" fish AT LEAST twice a week. Read more: FISH SOUP ... loaded with Omega-3 fatty acids.

Read more: SMOKED SALMON DIP RECIPE ... also full of those Omega-3 fatty acids.

Perhaps you're a vegetarian, or even a red meat consumer who wants even more omega-3:

While it is common knowledge, it is worth repeating: obese persons, particularly fat around the belly, and smokers are at high risk. As are diabetics who are not disciplined. Are you an obese, smoking diabetic? A medical disaster waiting to happen, I'm afraid. You should be afraid too!

Should you be in this high risk category we strongly recommend you visit our olive garden nutrition page for a few things that could put off the impending disaster. It's surely the desire of each and every one of us to go to our graves smiling, in our dotage, rather than, in our prime, leaving broken hearts behind. Yes? Read more about how the olive can help you. OLIVE GARDEN NUTRITION ....

Just as important make a decision as to when you are going to stop smoking. Put a date to it. January 1 is a good day to turn over a new leaf. Otherwise it may well be the last leaf. Read that delightful story? Take this little cul-de-sac - I'll be waiting for you to finish our Chest Pain tour! The last leaf by O Henry/1303 ... My favourite short story[1].

But even if you're not in the high risk category a good walk has much benefit, on your bone strength, for your back and on your Exercise and Cholesterol profile.


Research is revealing the importance of what we eat is vital in the management of heart disease. In particular foods that lower homocysteine perhaps even more important than foods that lower cholesterol ... and certainly just as vital as foods to avoid high cholesterol.

Homocysteine? What on earth is that?

  • Homocysteine cardiovascular = heart disease ...

Really, is adding brocooli, eggs florentine, spinach, lettuce, avocado, beetroot and asparagus regularly to your diet that onerous? Read more at heart stroke diabetes; an astonishing 45% is caused by poor diet.

Cholesterol alcohol is one of the more pleasant stories.

Chest pain

Chest pain is common and maybe serious so it is best to assume it is; however there are many other causes of a painful chest than a heart attack. Your chiropractor will most likely be running late; a thorough examination is called for.


'Doctor, I have pain in my chest. It started three months ago.'

'Have you seen your doctor, Mr Jones?'

'Yes, I have had extensive tests. They were all negative. Nobody seems to know what's wrong with me?'

'What made you decide to come here for chest pain?'

'My doctor says that it could be muscular. It cost me a packet, and the pain is getting worse not better ...'

For interesting cases from the Chiropractic Coalface (late on Friday I call it the salt mines! It's hard work being a miner!)

Overweight? Free weight loss programs ... It doesn't take genius to realise that obesity and chest pain are first cousins. There are 101 reasons to lose weight if you are obese.

Terrible knee arthritis, degenerative change  in the ankle joint, chest pain, heart attack and diabetes, just to mention a few. At least one of them will get you, perhaps two-or-three. Cheerful aren't I?!

But seriously, please consider our free weight loss programs ...

It's really not that difficult.


Costochondritis occurs at the breastbone; it's a common cause of chest pain.


(Costo-sternal Syndrome = Tietze's Syndrome)

Chest pain is commonly caused by a subluxation of the joint between the rib and the sternum or breast-bone. In anatomical mumbo-jumbo it's called the costo (rib)- sternum (breastbone) syndrome (mixture of signs and symptoms), or in medicalese just Tietzes syndrome. It may be associated with pain along the course of the rib, and in the midback, but this is not necessarily the case. However on deep palpation, the whole rib is painful, from the subluxated rib between your shouderblades, under the armpit, and finally to the breastbone where you experience the pain. Read more: COSTOSTERNAL CHEST PAIN ...

It is easy to test yourself: Press firmly on the breast bone, and then let your fingers slide right and left over the junction with the ribs. In this syndrome it will be very tender over some of the joints, on one or both sides, if you have this musculo-skeletal, non-heart, condition. You are almost certainly not having a heart attack!

Another term for the costo sternal syndrome is costochondritis; see here more about the treatment for costochondritis.

More about the anatomy of the chest. COSTOSTERNAL ANATOMY ...

Tietze's syndrome

Like many medical conditions Tietze's syndrome is treatable but not curable; it's a non uncommon cause of chest pain.

Tietzes syndrome is frankly a difficult condition with no proven remedy; however it responds reasonably well to a very specific chiropractic regimen that should not include heavy manipulation in the midback.

Just how common are these other causes of musculo-skeletal chest pain, you may be asking?

Deep breathing may aggravate musculo-skeletal chest pain, giving sharp stabs of pain in the midback with every breath.

This is a common condition which responds well, and usually very quickly to chiropractic. While your chiropractor should know it, it may be worth repeating that a heavy adjustment in the middle of the back may well aggravate this problem. It took me quite a few years to work that one out. I was napping the day we had that lecture!

Heartburn and indigestion are a common feature of Tietze's syndrome.

Love to read? Chiropractor Bernard Preston loves to tell intriguing tales that challenge the chiropractor. His books are often described as a fun-read, but simulataneously you will find out much about the private world of chiropractors. Soaring in his glider, trout-fishing, hiking the mountains and his search for the unknown God make these delightful reads. For more about Bernard Preston's books.

Cover of Frog in my Throat.
Cover of Bats in my Belfry.
  • Frog in my Throat ...
  • Bats in my Belfry ...
Cover of Stones in my Clog.
  • Stones in my Clog ...

His third book, Stones in my Clog, is written from the polders of Holland. Enjoy a freebie: Priest in my Bed ...

Use the site search button in the navigation bar on your left to find these topics shown in bold.

Rib treatment

Rib treatment is not usually painful.

Chest pain is not uncommonly caused by a subluxated rib head. It can sometimes be extremely painful in the midback, between the shoulder blades. Where the rib joins the spine there are three small joints any of which can be sprained, causing severe discomfort.

The common sign is PAIN WITH DEEP INHALATION. In fact it is often described as though someone is stabbing a rusty knife in the back, between the shoulder blades.

The condition is often caused by a violent sneeze, particularly if it is unexpected, and you are twisting or in some unusual posture.

This very painful condition responds very quickly to a gentle highly specific chiropractic adjustment of the rib head.

Home treatment should include an ice pack over the joint for 20 mins (on a dry face cloth) followed by a hot shower. Gentle massage may help too.

More difficult is when the rib treatment involves the lower chest. Patients (and doctors) may think that it is renal colic (eg from a kidney stone). A careful, thorough exam is the only way to differentially diagnose this condition. It is a more difficult area to adjust chiropractically, and may take longer to resolve.

Despite the fact that a subluxation of a ribhead can cause extreme pain in the middle of the back, the treatment is surprisingly not really painful. Relief is often immediate. Not having it properly managed, the acute pain usually recedes, but a dull, gnawing ache often remains.

Pleurisy also causes pain with deep breathing. If you are feeling ill, running a fever or coughing, be sure to alert your chiropractor. When consulting a patient with chest pain, as you can see, he or she will soon be running late; there's much ground to be covered. 

Every chiropractor has had a red face when consulted by a patient with chest pain, it turns out to be the early stages of shingles before the lesions have appeared; what's inexplicable though is that they always seem to recover quickly from what can become a nasty, prolonged period of pain lasting sometimes years. Read more about it at chiropractic shingles.

For more information about chiropractic RIB PAIN TREATMENT ... click here.

This casefile might interest you if you are suffering from rib pain. RIB PAIN TREATMENT CaseFile ...

Thoracic outlet syndrome

This is another perplexing cause of chest (sometimes) and arm pain which confronts the chiropractor on a daily basis. The nerves to the arm and the chest muscles emerge from the lower neck, between the first rib, the collar bone, and some muscles, through a small triangular gap. The so-called brachial plexus of nerves may become entrapped in this triangle causing angina like symptoms, mimicking a heart attack. For more information, click here. THORACIC OUTLET SYNDROME ...

ASBESTOS / MesotheliomaSymptoms / Chest pain

I think we now all know to avoid asbesos like the plague. Mesothelioma is a type of lung cancer caused by exposure to asbestos. MesotheliomaSymptoms ...

Asbestos fibers that are ingested or inhaled can be lodged into the body, causing infections or swelling and ultimately lung cancer. Smoker too? Deadly. Double deadly. On a municipal water supply using asbestos pipes? Mesothelioma Centre ... MaaCenter

Free copies of the mesothelioma book, "Surviving Mesothelioma", are available to newly diagnosed mesothelioma patients. SurvivingMesothelioma ... the free book.


With one in seven women dying in the West of breast cancer it behooves every woman to consider what she can do to help herself.

If ever it was pertinent, with breast cancer an ounce of prevention is worth a couple hundred pounds of cure. Breast cancer and prevention ...

Many women with chest pain think they are either having a heart attack, or have breast tumour. Costochondritis needs to be considered too.


  • Did you know that the humble apple has been SCIENTIFICALLY PROVED to help with heart disease and diabetes? This apple salad recipe explains...
  • Eggplant has been SCIENTIFICALLY PROVED to lower cholesterol. Baba Ghanoush is dead easy to make.
  • These three authors will amuse and entertain you while you learn more about chiropractic. GOOD READS ...

  1. The Last Leaf by O. Henry.

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