Chest Pain in African Adults: Causes, Symptoms and When to Seek Help

By: Elizabeth Obigwe, B.Sc. Anatomy. Freelance Health Writer. Medically reviewed by: A. Odutola, MBBS, PhD. FRCSEd.

 

A black man with both hands on his chest due to a chest pain

 

Highlights

• Chest pain in adults can be caused by trauma (injury) or not. 

• Depending on symptoms, chest pain can be categorised as mild, moderate and severe. Life-threatening and non-life-threatening. It can also be acute (i.e., sudden) or chronic (progressive).

• 1 in 4 people around the world will experience chest pain in some form and at some point in their lives.

• Common causes of non-traumatic chest pain can be categorised as cardiac and non-cardiac, and these may include lifestyle and environmental factors.

• Cardiac diseases account for only 8% to 18% of all cases of adult chest pain.

• Gastroesophageal reflux disease is the most common cause of non-cardiac chest pain.

• Symptoms of cardiac and no cardiac chest pain differ, but sometimes overlap.

• Chest pain does not always feel painful. It may feel like pressure, tightness, squeezing, or heaviness

 

Introduction

About 1 in 4 people globally will have chest pain at some time in their lives [1]. In Sub-Saharan Africa, where about 13% of deaths are related to cardiovascular diseases, chest pain can be especially worrying because it is a common symptom of these conditions [2]. Thankfully, most chest pain isn’t dangerous, though a few cases can be serious. This article will provide a detailed explanation of the different causes of chest pain, its symptoms and some of the misconceptions you may have about it.

 

What is chest pain?

Chest pain refers to any discomfort in the area between the neck and upper abdomen. The sensation can range from a dull ache to sharp, burning, tight, or pressuring pain. Sometimes, the pain stays in one spot, and other times, it spreads across a larger area. Chest pain can originate from another part of your body and might also move to your back, neck, shoulders, arms, or jaw.

Chest pain isn’t a condition by itself. It is a symptom that can have many causes, some serious and others less so. 

The causes of chest pain can be either

• Traumatic or 
• Non-traumatic. 

Traumatic and non-traumatic causes of chest pain can be:

• Life-threatening or not
• Acute (sudden), sub-acute or chronic (long-lasting/progressive)
• Mild, moderate or severe.

Traumatic causes usually mean that the pain started after an injury, like falling and hitting your chest or after a blow to the chest during sports. 

Non-traumatic causes, on the other hand, aren’t linked to any clear injury or physical impact. These tend to be more confusing or worrying, so we will focus on explaining as many of them as possible. See figure 1 for a simplified classification of the causes of chest pain in adults.

 

Fig. 1: Showing simplified classification of the causes of chest pain in adults. Click on the image to enlarge.

 

What Can Cause Non-Traumatic Chest Pain?

A non-traumatic chest pain can either originate from the heart or from other organs within the body. 

When chest pain is caused by a heart problem, it is referred to as cardiac chest pain (CCP) (or heart-related chest pain (HCP). Whereas when chest pain isn’t caused by a heart problem, it is referred to as non-cardiac chest pain (NCCP). See fig. 1.

Some of the common causes of non-traumatic chest pain are explained below. See Table 1 for a detailed list of possible causes.

1. Heart (Cardiac) Related Causes of Non-Traumatic Chest Pain

These can be due to:

• Ischaemia (i.e., reduced blood flow to the heart), or 
• Non-ischaemia (i.e., other heart problems that are not related to blocked blood flow) [3].

Ischemic Heart-related Causes of Chest Pain

Top causes include:

• Acute Coronary Syndrome (ACS): This describes conditions that involve a sudden reduction in blood flow to the heart (commonly referred to as “heart attack). It often leads to severe chest pain.

• Unstable Angina: Unexpected chest pain at rest. It is a serious condition that may signal an impending heart attack.

• Chronic Stable Angina: Chest discomfort that happens during physical activity or stress when the heart doesn't receive sufficient oxygen-rich blood.

Non-ischemic Heart-related Causes of Chest Pain

Top causes include:

• Pericarditis: Inflammation of the pericardium (sac-like tissue lining the heart), causing sharp chest pain that worsens when lying down and improves when sitting up.

• Myocarditis: Inflammation of the heart muscle, which can cause tiredness, chest pain, shortness of breath, and heartbeat problems.

• Aortic Dissection: A tear in the aorta (the big blood vessel that carries blood from the heart to the body), causing sudden, severe, tearing chest pain. It is life-threatening.

 

II. Non-Heart (Non-Cardiac) Related Causes of Non-Traumatic Chest Pain

As frequent as chest pain cases may be, cardiac diseases account for only 8% to 18% of all cases. While among non-cardiac (or non-heart) causes of chest pain, gastroesophageal reflux disease is the most common [3]. 

Non-trauma, non-cardiac-related causes of chest pain are not usually life-threatening.

Below are some of the different conditions unrelated to the heart that can also cause chest pain [3, 4, 5]. See Table 1.

Gastrointestinal Causes

• Gastroesophageal Reflux Disease (GERD): This is when stomach acid flows back into the food pipe (oesophagus), irritating it and causing a burning chest pain known as heartburn.

• Swallowing Disorders: Diseases that make swallowing difficult or painful, typically related to the oesophagus.

• Peptic Ulcer: Sores in the stomach or the first part of the small intestine, causing burning pain that sometimes radiates to the chest

• Diseases that affect the gallbladder and pancreas

Pulmonary Causes

• Pulmonary Tuberculosis: An infectious disease commonly known as TB. It is caused by a bacterial infection in the lungs and marked by persistent cough, chest pain, night sweats, fatigue, and unexplained weight loss.

• Pneumonia: A lung infection that inflames the air sacs of one or both lungs. This can be caused by different organisms, including bacteria, viruses and fungi. It usually comes with fever, cough, chest pain, and difficulty breathing.

• Pleuritis (Pleurisy): When the tissue lining the lung (pleura) becomes inflamed, causing sharp chest pain that worsens with breathing, movement, or coughing. It often feels like a stabbing pain.

Musculoskeletal Causes

• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, causing sharp or aching chest pain that gets worse with movement, deep breaths, or pressing on the chest.

• Fibromyalgia: A chronic condition that causes widespread muscle pain, tiredness, and poor sleep.

Psychological Causes

• Pain Disorders: In this condition, the brain misinterprets normal signals (e.g., touch) and creates real pain even though tests might not show a clear physical cause. This type of pain disorder is called allodynia.

• Panic Disorder: Sudden, intense fear that causes sharp chest pain, which often feels like a heart attack.

Others  

• Acute chest syndrome: A dangerous sickle cell complication where misshapen red blood cells obstruct blood flow in the lungs. It brings on sudden chest pain, fever, coughing, and breathing problems. It is a medical emergency.

• Zoster infection (Shingles): Shingles is a painful skin rash caused by the return of the virus that causes chickenpox. Before the rash appears, it can cause burning or stabbing pain on one side of the chest. The pain can linger even after the skin rash has cleared.

• Environmental and Occupational Exposures: Exposure to harmful substances like fumes and dust from mining activities can cause chest pain, which could be a symptom of a respiratory tract disease [6].

 

Symptoms Associated with Chest Pain

Typically, chest pain caused by a heart problem feels different from chest pain caused by other conditions [3]. However, the symptoms can sometimes overlap [7]. This is why all chest pain should be treated as a potential warning sign of something and not ignored.

I. Symptoms of Heart-Related Chest Pain

Chest pain related to heart problems often feels like:

• A pressing, tightness, squeezing feeling, or the sensation of something heavy on the chest.
• A dull or crushing pain that is not sharp.
• It radiates to areas like the jaw, arms, neck, shoulders, or back.
• Worsened by physical activity, stress, or even cold weather.
• It is located under your breastbone (sternum)

You may also feel:

• Shortness of breath
• Sweating
• Nausea
• Dizziness.

II. Symptoms of Other Types of Chest Pain

If your chest pain feels this way, it is likely not due to a heart problem.

• A quick, piercing pain that gets more intense when you take deep breaths or cough.
• Aching or stabbing pain that worsens with movement, pressing on the chest, or assuming certain positions.
• A burning or sore feeling in the chest that tends to worsen after eating, lying down, or bending forward.
• Pain is located beneath the breast region.

You may also feel: 

• Sour or acidic taste in your mouth
• Bloating
• Sore throat
• Difficulty swallowing
• Regurgitation (backflow of food)
• Rapid and deep breathing

Note that just because chest pain is not heart-related doesn't mean it can't be life-threatening. Some causes of non-cardiac chest pain, like acute chest syndrome (AChS), pulmonary embolism (PE), tension pneumothorax, and oesophageal rupture, can be life-threatening [5].

 

When to See a Doctor

You should seek medical help immediately if you have chest pain that feels like any of the following:

• Pain that comes on suddenly and feels very intense, like squeezing or tight pressure.
• Pain that moves to the arm, neck, jaw, shoulder, or back.
• You also feel short of breath, dizzy, lightheaded, or faint.
• You have nausea, vomiting, or cold sweats.
• Chest pain that comes and goes.
• The pain does not go away after a few minutes or gets worse with time.
• You have a history of heart disease, high blood pressure, diabetes, or high cholesterol.
• You feel anxious or have a sense of doom along with the pain.
• You are not sure what's causing it, especially if it's your first time experiencing it.

 

Some Misconceptions About Chest Pain

1: Young people don’t get heart-related chest pain

While it is rarer in younger people, they can still have chest pain caused by heart problems. For instance, a study in Sub-Saharan Africa found that some young individuals had acute coronary syndrome, with chest pain being their main symptom and smoking as the leading risk factor [8]. 

2: A heart attack comes with chest pain as its only sign

A heart attack does not always cause chest pain alone. It may also bring about pain to the arms, jaw, neck, stomach, or back, along with symptoms like nausea, lightheadedness, sweating, or shortness of breath. Notably, women, the elderly, and patients with diabetes are more likely to experience these atypical symptoms [3].

3: Heart-related chest pain is not an African problem

Some people believe that only wealthy people and those in high-income countries suffer heart problems. On the contrary, cardiovascular diseases (CVDs) are a significant health concern in Africa. Between 1990 and 2019, the raw counts of CVDs in Sub-Saharan Africa increased by 131.7%, with ischemic heart disease being among the most common conditions. [2]

4: Chest pain has to feel like an actual pain

Chest discomfort from heart problems doesn’t always feel painful. They might feel more like tightness, squeezing, pressure, or heaviness. These sensations can also move to the neck, arms, jaw, or back.

 

FAQs

1. Can chest pain kill?

Chest pain is usually a symptom of an underlying condition. Hence, the pain itself cannot kill. However, if the cause of the pain is life-threatening, it can lead to death if proper medical care is not given. 

2. Is chest pain an early sign of pregnancy?

Chest pain is not typically a sign of early pregnancy. However, in pregnancy, the body goes through changes that can sometimes cause chest discomfort and trouble breathing. If chest pain occurs during pregnancy, it's important to consult a healthcare provider to rule out serious underlying conditions [9].

3. How is right side chest pain different from chest pain on the left?

Chest pain on the left side is often associated with heart-related issues, such as heart attacks. In contrast, right-sided chest pain is less commonly linked to cardiac problems and may be due to other causes like musculoskeletal issues, gastrointestinal conditions, or lung problems. Regardless of the side, persistent or severe chest pain should be evaluated by a healthcare professional.

4. Can cold cause chest pain?

Yes, a cold can cause chest pain, often from coughing, congestion, or irritation of the chest lining or muscles.

 

Conclusion

Chest pain causes are mostly benign (simple and non-life-threatening), but they can also be deadly. Regardless of its cause, persistent pain in the chest can significantly impact your quality of life and lead to socioeconomic burden. That’s why any chest pain should be taken seriously and checked by a healthcare provider without delay. 

 

Resources

1. Doku A, Ndanu TA, Edwin F, Entsua-Mensah K, Tetteh J, Ghansah A, Yeboah-Asiamah B, Gyan D, Adzamli I, Sheriff MA, Tettey M. Patterns of acute chest pain at two tertiary centres in Accra, Ghana. Ghana Med J. 2024 Sep;58(3):231-238. doi: 10.4314/gmj.v58i3.8. Available from here.

2. Alhuneafat L, Ta'ani OA, Tarawneh T, ElHamdani A, Al-Adayleh R, Al-Ajlouni Y, Naser A, Al-Abdouh A, Amoateng R, Taffe K, Alqarqaz M, Jabri A. Burden of cardiovascular disease in Sub-Saharan Africa, 1990-2019: An analysis of the Global Burden of Disease Study. Curr Probl Cardiol. 2024 Jun;49(6):102557. doi: 10.1016/j.cpcardiol.2024.102557. Available from here.

3. Coté AP, Hodes JL, Voccia R. Low-risk chest pain: What is the evidence? Physician Assist Clin. 2017;2(3):537–56. doi:10.1016/j.cpha.2017.02.015 Available from here.

4. Frieling T. Non-cardiac chest pain. Visc Med. 2018;34(2):92–6. doi: 10.1159/000486440. Available from here.

5. Rushton S, Carman MJ. Chest pain: If it is not the heart, what is it? Nurs Clin North Am. 2018;53(3):421–31. doi:10.1016/j.cnur.2018.04.009. Available from here.

6. Ekosse G, de Jager L, van den Heever DJ. The occurrences of chest pains and frequent coughing among residents living within the Selebi Phikwe Ni-Cu mine area, Botswana. Afr J Health Sci. 2005 Jan-Jun;12(1-2):37-48. doi: 10.4314/ajhs.v12i1.30799. Available from here.

7. Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil. 2011;17(2):110–23. doi:10.5056/jnm.2011.17.2.110. Available from here.

8. Sarr M, Ba DM, Ndiaye MB, Bodian M, Jobe M, Kane A, et al. Acute coronary syndrome in young Sub-Saharan Africans: a prospective study of 21 cases. BMC Cardiovasc Disord. 2013;13:118. doi:10.1186/1471-2261-13-118. Available from here.

9. Neuberger F, Nelson-Piercy C. Acute presentation of the pregnant patient. Clin Med (Lond). 2015;15(4):372–6. doi:10.7861/clinmedicine.15-4-372. Available from here.

 

Related:

• Chest Infection in African Children
• Cardiovascular Diseases and Heart Attack in Africa

 

Published: May 28, 2025

© 2025. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content freely for non-commercial purposes without alteration or modification and subject to attribution as to source.