Medically reviewed by Michael Menna, DO
Chest pain when you cough is a common symptom of many health issues. While this problem can often improve without treatment, it can also alert you to a need for urgent care.
When chest pain from coughing is linked to a simple issue—like the common cold or allergies—it often improves when the cause is resolved. Sometimes, these symptoms point to a more severe cause, like heart failure or pulmonary embolism. In these cases, knowing when to seek prompt treatment can often improve your outcomes.
This article describes how to know when having chest pain with coughing is a severe problem. It includes symptoms to observe and the types of treatments that are used at home and in the hospital.
Chest Hurts When Coughing: Emergency Causes
If your chest hurts when coughing, your initial concern may involve a heart problem.
More than 8 million emergency room visits for chest pain occur in the United States annually. However, of these visits, only about 1 million involve acute coronary syndrome, with just 33% of these visits related to a myocardial infarction (heart attack).
In addition to heart-related conditions, coughing and chest pain can be triggered by any organ or tissue in your chest, including your lungs, esophagus, muscles, tendons, ribs, and nerves.
Here are some of the most common emergency causes of chest pain with coughing:
Congestive heart failure is a type of heart failure that requires emergency treatment. It occurs when heart failure allows for the buildup of blood in your lungs, abdomen, feet, or arms. Congestive heart failure requires emergency treatment when medication fails, or the condition progresses without treatment.
In addition to chest pain, symptoms of congestive heart failure include the following:
Persistent coughing, which may include a pink mucus indicative of fluid in your lungs
Bluish or purplish skin at the tips of your lips or fingers
A heart attack, or myocardial infarction (MI), occurs when the blood flow that brings oxygen to your heart muscle is severely reduced or stopped. This can occur due to plaque buildup that narrows your coronary arteries.
A heart attack occurs suddenly and intensely. Symptoms of a heart attack can include the following:
Shortness of breath
Nausea or lightheadedness
Acute Aortic Dissection
When this occurs, blood leaks through the tear, causing the inner and middle layers of the aorta to dissect (separate). The blood flows between tissue layers, stopping or slowing the flow to other parts of your body.
Symptoms of acute aortic dissection include the following:
Acute onset of chest pain described as "tearing" or "ripping" with radiation to the back
Paralysis or loss of your ability to speak
Pericarditis, Pericardial Effusion, and Cardiac Tamponade
Pericarditis is inflammation of the pericardium (the thin sac that surrounds your heart). The condition can have many causes, including infection, chest injury, heart attack, or immune system disorders. It can cause pericardial effusion (a condition in which fluid seeps into the pericardial sac). This can lead to cardiac tamponade (a condition that interferes with your heart's ability to pump blood).
Symptoms of pericarditis include fever and chills. Other symptoms may include the following:
Sharp, tight, or crushing chest pain from the friction of a swollen pericardium against your heart
Leg or foot swelling
Difficulty breathing when lying down
A pulmonary embolism typically occurs when a blood clot in the deep veins in your leg (deep vein thrombosis (DVT)) breaks off and travels to your lungs. The clot causes a sudden blockage in your pulmonary arteries (blood vessels that send blood to your lungs).
The chest pain and cough that occur with a pulmonary embolism can include the following symptoms:
A pneumothorax is a collapsed lung. It occurs when a hole in your lung develops and allows air to escape. This air fills the space outside your lung between your lung and chest wall. This buildup of air exerts pressure on your lung, so it can't expand as much as it usually does when you take a breath.
Symptoms of a pneumothorax occur immediately and include the following:
A sharp chest or shoulder pain made worse by a deep breath or cough
Shortness of breath
Nasal flaring from shortness of breath
A hemothorax is a collection of blood in your pleural cavity (the space between your chest wall and lung). The most common causes of hemothorax include chest trauma, a blood clotting defect, lung infections, heart and lung surgery, and lung cancer.
Symptoms of a hemothorax can include the following:
Pale, cool, and clammy skin
Rapid, shallow breathing
An esophageal perforation is a tear in your esophagus, the tube that links your mouth and stomach. It most often can be traced to medical procedures in which your esophagus is injured. Severe vomiting, ingesting caustic substances, or cancer can also be the cause. This condition is considered a medical emergency.
Symptoms of esophageal perforation include chest pain including the following:
Rapid or labored breathing
Air bubbles under your skin
Chest Hurts When Coughing: Non-Emergency Causes
The following non-emergency conditions can cause chest pain while coughing. In some cases, the persistent coughing caused by respiratory irritation can affect your chest muscles.
Symptoms of acute bronchitis include the following:
Coughing with or without mucus
Mild headache and/or body aches
The common cold is a mild infection of your respiratory tract (your nose and throat). It is most often caused by rhinoviruses, but there are more than 200 different viruses that can cause the common cold.
The following symptoms of a cold can start a few days after you are infected and last for up to two weeks:
Congestion (stuffy nose)
Chest tightness or congestion
Cough that lasts for several weeks or more, often with clear, yellow, or green mucus
Pneumonia is a lung infection resulting from viruses, bacteria, fungi, or other substances entering your lungs. The problem can be mild but can progress to a severe condition in people with weakened immune systems.
Symptoms of pneumonia can vary based on how your body responds to this infection. Symptoms can include the following:
Cough, which may have greenish, yellow, or bloody mucus
Shortness of breath or shallow breathing
Fever, sweating, and shaking chills
Intercostal Muscle Strain
An intercostal muscle strain involves the intercostal muscles that run between your ribs and form your chest wall. This strain typically occurs in athletes due to overstretching or muscle strain. It can also occur due to hard coughing or sneezing during illness, such as a bad cold or bronchitis.
Symptoms of intercostal muscle strain include the following:
Sharp, shooting, or achy pain
Pain is unpredictable but can be reproduced by certain actions or movements.
The affected area is tender to touch.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is when stomach acid, food, or other stomach contents frequently flow back out of your stomach into your esophagus.
When the acid reaches your esophagus, it can cause a burning sensation or feeling like your chest burns when you cough. The most common symptom of GERD is heartburn (a burning pain behind your chest that may move up toward your neck, often after you eat).
While chest pain with coughing is not always an emergency, chest pain should not be ignored. If you have a history of heart disease, asthma, or lung disease, and any new chest pain, check with your healthcare provider to determine your next steps.
Additional Symptoms When It Hurts to Cough
Paying attention to additional symptoms when it hurts to cough can serve as guidelines for determining whether coughing and chest pain may involve emergency causes.
Generally, pain from an emergency heart problem like a heart attack is usually characterized by intense agony that lasts five minutes or longer. Pain from a lung issue can cause prolonged chest pain that is worsened by movement or changing positions.
Chest pain when you cough may be related to an impending heart attack. Seek emergency medical treatment or call 911 if you have the following symptoms:
Sudden crushing, tightening, squeezing, or pressure in the center of your chest.
Pain that radiates (spreads) to your jaw, left arm, back, neck, stomach, or jaw
Pain that occurs gradually for a few minutes
Shortness of breath
Lightheadedness or dizziness
Sudden nausea or vomiting
Heat/flushing or a cold sweat
Sudden heaviness, weakness, or aching in one or both arms
Pain or pressure that occurs during or after emotional stress or while you are at rest
The classic feeling of an "elephant on your chest" does not occur in every emergency heart problem. Nausea, shortness of breath, or indigestion may be the most significant symptoms. If you have any new chest pain and have a persistent feeling of being unwell or that something is wrong, you should seek emergency treatment.
Symptoms that occur with chest pain and coughing that are less likely to be an emergency like a heart attack include the following:
Sharp or knife-like pain brought on by coughing or breathing
Sudden stabbing pain that lasts only a few seconds
Pain that occurs on only one side of your body
Localized pain that remains in only one small spot
Pain that lasts for many days or hours without any other symptoms
Pain that can be reproduced by pressing on your chest or with body motion
COVID-19 as a Cause of Chest Pain and Coughing
Chest pain with coughing can occur as a symptom of COVID-19. Like other symptoms of this disease, chest pain with coughing can range from mild to severe, with a wide range of variation.
While most people can allow COVID-19 to run its course with home treatment, you may be at risk of severe outcomes if you are older, have weakened immune systems, heart or lung conditions, or other risk factors for COVID-19 complications.
If you are at high risk of COVID-19 complications and have difficulty breathing, persistent cough, chest pain, or other symptoms of an upper respiratory infection, consult your healthcare provider. Seek immediate attention if your symptoms include difficulty breathing.
How to Relieve Coughing and Chest Pain at Home
You may be able to relieve coughing and chest pain at home if your symptoms are related to a non-emergency cause. Treatment may vary based on the underlying cause. Check with your healthcare provider if coughing and chest pain or other accompanying symptoms do not improve or begin to worsen.
If your coughing and chest pain are linked to a condition like the common cold, flu, or acute bronchitis, these viral infections and their symptoms will not improve with antibiotics. Instead, they have to run their course, which can take seven to 10 days, before you can expect relief. If your infection is caused by bacteria, you may receive antibiotics to eliminate the infection.
As you wait for an infection to clear, the following strategies may help you deal with coughing and chest pain:
Get plenty of rest.
Drink plenty of water to stay hydrated and thin mucus.
Use a clean cool mist vaporizer or humidifier in your bedroom.
Use a saline nasal spray or drops to relieve a stuffy nose.
Inhale steam from a hot shower or a bowl of hot water.
Suck on lozenges. (For adults and children 4 years of age and older.)
Use honey to relieve a cough. (For adults and children 1 year of age and older.)
Use over-the-counter (OTC) pain relievers to relieve pain and fever.
Use cough and cold medicines with an expectorant (a medicine that thins and loosens mucus) called guaifenesin to break up chest congestion.
Position pillows to prop yourself in bed to relieve chest congestion and coughing.
Avoid exposure to secondhand smoke, which could trigger coughing.
Intercostal Muscle Strain
An intercostal muscle strain can usually heal on its own within a few weeks. Depending on the severity of your intercostal muscle strain, your healthcare provider may prescribe the following treatments to do at home to relieve chest pain while coughing:
RICE (rest, ice, compression, and elevation): Rest: Do not participate in activities, especially those that were the source of your muscle strain. Ice: Apply ice packs to reduce pain and swelling in the affected area. Ice can be alternated with heat. Compression: Reduce swelling by wrapping an elastic bandage around your chest without wrapping so tight that it causes additional pain. Elevation: Use pillows or a wedge to keep your chest elevated, especially at night.
Physical therapy when muscle strains do not improve with the RICE treatment
GERD can often be managed at home with a combination of lifestyle changes and medication under the direction of a healthcare provider. The following strategies may be advised:
Avoid eating and drinking items that trigger heartburn.
Limit the use of aspirin, NSAIDs, and other medications that can make symptoms worse.
Lose weight if you are overweight or obese.
Avoid wearing tight clothing and doing exercises that can make reflux worse.
Stop eating three hours before you go to sleep.
Sleep with your head raised 4 to 6 inches.
Hospitalization for Chest Pain and Coughing
The need for hospitalization to treat chest pain and coughing can vary by individual. In some cases, hospitalization may be necessary to treat and manage a serious problem. In other cases, factors such as your age, medical history, and other health conditions may require hospitalization to prevent a minor problem from becoming worse.
If hospitalization is required, your healthcare provider will individualize your treatment plan to address the underlying cause of your chest pain and coughing and the severity of your condition. Generally, the following treatments may be used for emergency heart conditions:
Heart Failure Treatments
Your healthcare provider may advise one or more of the following heart failure treatments during hospitalization:
Heart Attack Treatment
Hospitalization for a heart attack may involve the following treatments:
Heart attack medications that include the following: Nitroglycerin, thrombolytics (clot busters), and aspirin
Oxygen therapy to deliver oxygen gas for you to breathe
Hospitalization may also be required to deliver the following treatments for conditions that cause chest pain and coughing in your treatment plan:
Acute aortic dissection: Surgery to repair the rupture, if possible.
Cardiac tamponade: Drainage of fluid in the tissue surrounding the heart, followed by treatment of the cause of tamponade
Pulmonary embolism: Treatment with medications to thin your blood or medications to dissolve life-threatening clots (thrombolytic therapy)
Pneumothorax: Needle aspiration or chest tube inserted into the chest cavity to remove the excess air, while pleurodesis (non-surgical repair of pleural effusion) or surgery may be needed for more severe cases
Hemothorax: Insertion of a chest tube through the chest wall between your ribs to drain the blood and air or a thoracotomy (surgery to control the bleeding) if drainage doesn't work
Esophageal perforation: Placement of a stent in the esophagus for minor cases or surgery to repair a tear in more severe cases
Outcomes of Hospitalization for Chest Pain with Coughing
Prompt action and immediate medical treatment can improve your outcomes when dealing with most emergency causes of chest pain and coughing.
However, other factors can impact your results. For example, outcomes in cases involving cardiovascular diseases can be impacted by factors including your age, other medical conditions, and the type of healthcare provider delivering your care.
In other cases, simply having certain conditions can increase your risk of potential complications. Being hospitalized for new-onset heart failure has a high mortality rate for both short-term and long-survival.
Know your risk factors and reasons to call 911. Failure to seek emergency care when needed can result in treatment delays and potentially death, which may have been avoided with immediate care.
Chest pain while coughing can be caused by many types of problems that range from mild to severe. It often can be hard to know when to seek urgent care until your symptoms progress.
Contact your healthcare provider if you are unsure about the best way to deal with your symptoms. While mild cases can often be treated at home, severe cases may need prompt skilled care to save your life
Learn the symptoms that point to a need for urgent treatment. Do not delay in calling 911 if you think there is a need.
Read the original article on Verywell Health.