Extreme chest tightness: what to do

Chest tightness may feel like pressure, squeezing, a band around the chest, or difficulty getting a full breath. Angina can cause pressure related to exertion. Asthma and COPD may cause tightness with wheeze, cough, or breathlessness. Acid reflux can produce burning or discomfort after meals. Panic disorder and generalised anxiety disorder can bring chest sensations with rapid breathing, trembling, or fear, but anxiety should not be assumed when symptoms are new, intense, or unexplained.

Stop exertion, sit upright, loosen restrictive clothing, and note when the tightness started and what you were doing. If you have a prescribed reliever inhaler, use it exactly as directed in your action plan. Do not drive yourself if symptoms are severe. Arrange medical assessment for new, recurrent, or unexplained tightness even when it settles, particularly if it follows activity or comes with wheeze.

Call emergency services immediately for severe or persistent chest pressure, trouble breathing, blue or grey lips, fainting, confusion, cold sweating, or pain spreading to the arm, back, neck, or jaw. Urgent assessment is also needed when tightness occurs with marked weakness or a fast, irregular heartbeat. These signs can signal a serious heart or lung problem and cannot be safely sorted out at home.

Ask whether the pattern suggests a heart, airway, reflux, muscle, or panic-related cause; which tests or observations are needed; and how to use inhaler therapy if asthma or COPD is involved. Mention exertion, meals, position, stress, cough, wheeze, and every medicine you take.