Chest Pain After Exercising: Should You Be Concerned?

Exercise is a great way to keep your heart healthy. But what if your workout is leaving you with chest pain? Whether you’re a seasoned athlete, a weekend warrior or you’re just beginning your fitness journey, it’s important to take chest pain after exercise seriously.

Sports cardiologist Tamanna Singh, MD, breaks down the many possible causes, why it’s important to tell a provider about it and when it qualifies as an emergency.

Is it normal to have chest pain after working out?

While it’s common and rarely life-threatening, getting chest pain while exercising — or after your workout’s over — is still cause for concern.

“If you feel a pain in your chest while you’re exercising or playing a sport, don’t try to just push through it,” Dr. Singh stresses. “Stop what you’re doing immediately and let your coach or trainer (if you have one) know what’s going on.”

And if you’re working out solo? Stop and take note of your symptoms. If the pain continues or gets worse, call for emergency medical help right away.

Even if the pain lets up, Dr. Singh urges you to make an appointment with a provider.

“They’ll discuss your symptoms with you and evaluate your heart, lung, gastrointestinal health and more,” she explains. “If the cause of the pain is still not clear, your doctor may refer you to a sports cardiologist for further evaluation.”

Potential causes

There are many possible reasons your chest could be hurting during or after a workout. In fact, people who are physically active are more likely to get chest pain than sedentary people, for the simple reason that they place greater demands on their cardiovascular and musculoskeletal systems.

Of course, having chest pain isn’t always a sign that your ticker’s in trouble.

“Delayed chest pain after exercise isn’t typically a sign of heart trouble,” Dr. Singh says. “But the only way to rule out serious concerns is through a medical evaluation.”

Here’s what might be going on.

Musculoskeletal issues

Sports can cause a lot of wear and tear on your body, and sometimes, you feel it in your chest. Possible causes of musculoskeletal chest pain include:

• Muscle spasms: Have you ever experienced “stitches” during a workout? Most common when you’re starting a new training program, these sudden, sharp pains are usually just a spasm in your diaphragm, abdomen or one of your intercostal muscles (the muscles between your ribs).
• Bruised or fractured ribs: These painful, slow-healing injuries are especially common if you play high-contact sports, like boxing, American football or rugby.
• Musculoskeletal issues that affect your chest wall: From costochondritis and precordial catch to Tietze syndrome and myofascial pain syndrome, there’s a wide range of musculoskeletal conditions that can cause chest pain during or after exercising.

Gastroesophageal reflux disease (GERD)

While it’s great for your digestion, strenuous exercise can also increase your risk of gastrointestinal (GI) issues that cause chest pain. That’s especially true, Dr. Singh adds, if you eat a specialized diet, or put yourself through periods of “fasting and feasting.”

Chronic acid reflux (GERD) is common among fitness enthusiasts — and often mistaken for heart issues. That’s why it’s called “heartburn.”

During exercise, food moves more slowly from your stomach into your intestines, and the muscle at the bottom of your esophagus relaxes. This allows stomach acid to rise and causes a burning sensation in your chest. Tensing your abdominal muscles, like when you exercise, can increase pressure and worsen this effect.

Other GI concerns

Other common digestive issues that can lead to chest pain during and after exercise include:

• Gas and bloating
• Hiatal hernias
• Peptic ulcers

Do you ever take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen after a tough workout? That could be contributing to your chest pain, too.

“Those medicines can irritate the lining of your stomach, contributing to GI upset and chest pains,” Dr. Singh explains.

Lung conditions

When chest pain strikes during (or immediately after) exercise, the most common cause is a spasm of the small airways in your lungs. It’s called an exercise-induced bronchospasm (EIB). These spasms are often worse at certain times of the year, like during winter or allergy season, or when you’re exercising in certain environments.

But EIB isn’t the only lung issue that could be behind exercise-induced chest pain.

If you exercise outside, exposure to the elements can increase your risk of viral and bacterial lung infections. Those infections can sometimes lead to pneumonia or pleurisy, an inflammation of the tissues that line your lungs and chest cavity.

“The inflammation you get with pleurisy feels like a very sharp pain that’s most severe when you breathe in,” Dr. Singh notes.

Rare, but more serious lung issues that can cause chest pain with exercise include:

• Pneumothorax, commonly called a collapsed lung
• Pulmonary embolism, blood clots in one or more of your lungs’ arteries

Mental health causes

You’ve probably heard the phrase, “Get your head in the game.” But sometimes, mental health factors are the driving force behind exercise-induced chest pain.

“Fitness buffs and athletes tend to be high achievers,” Dr. Singh observes. “Being competitive and motivated is great, but it can also contribute to high stress levels, anxiety, panic disorders and depression.”

These conditions can cause your heart rate or blood pressure to spike — or even trigger hyperventilation (rapid, shallow breathing). That’s a recipe for chest pain.

Stimulants like caffeine, which are found in many energy drinks and protein supplements, can further compound the problem.

Cardiac concerns

The most common cause of heart-related chest pain with exercise varies by age.

In athletes 35 and older, Dr. Singh says the most likely source of your chest pain is angina. Reduced blood flow to your heart muscle as a result of coronary artery disease causes it. In these cases, the pain typically comes during exercise and eases with rest.

If you’re under 35, cardiac chest pains during or after a workout are most often related to congenital heart defects, meaning you were born with the problem. These conditions include:

• Hypertrophic cardiomyopathy, an excessive thickening of the heart muscle
• Abnormal locations of your coronary arteries
• Congenital valvular issues

Of course, not all heart conditions that cause chest pains are congenital or age-related. Myocarditis, an inflammation in the heart’s muscle, and pericarditis, inflammation of the membrane that surrounds the heart, are often caused by a virus and can be made worse by exercise.

When to go to the hospital

Sometimes, chest pain while running or working out is a sign of a major medical emergency. Call local emergency services if you’re having chest pain during or after exercising and:

• The pain or pressure is severe, like you’re being squeezed or someone is sitting on your chest.
• There’s no clear reason for the pain.
• It’s more severe than makes sense for the type of activity you’re doing.
• It doesn’t resolve quickly, or gets worse over time.
• The pain is radiating to your arms, shoulders, neck, jaw or back.
• You’re dizzy, lightheaded or you’ve fainted.
• It’s accompanied by nausea or vomiting.
• You’re short of breath, wheezing or your lips and skin are turning blue.
• Breathing causes sharp, stabbing pains.
• You have a family history of sudden cardiac death.

“You know your body better than anyone,” Dr. Singh reminds us. “If something feels seriously wrong to you, trust your instincts. It’s better to be safe than sorry.”