When you’ve just started a running habit—or perhaps you’re a seasoned runner—feeling your heart hurt can be a scary experience. Fortunately, most causes of chest pain while running are benign, but it’s possible that it could be something more serious or at least something that needs to be further evaluated by a physician.
Non-Heart-Related Causes of Chest Pain While Running
While chest pain and chest pressure are symptoms of sudden cardiac arrest and heart attacks, not all chest pain is related to cardiovascular disease. In most cases, feeling your heart hurt when running is attributable to musculoskeletal strain or indigestion.
New to Running
New runners asking “why does my heart hurt when I run” will often find that the chest pains they feel are simply a consequence of using muscles they haven’t used much before. Heavy respiration works the heart, lungs, and chest muscles harder than they’re used to and results in a feeling of heart pain. If you feel a sharp pain and it’s more positional, you may have strained the intercostal muscles (the muscles surrounding your rib cage).
To prevent sore chest muscles, make sure you warm up with a brisk walk and run at a steady pace rather than in short bursts. On cold days, keep your muscles warm with long jogging clothes, and always remember to stretch afterward (including your chest/upper torso). In both cold and hot weather, drink plenty of fluid electrolytes to prevent chest cramps secondary to dehydration. However, avoid a large meal, as this could lead to pressure from heartburn. During digestion, extra blood flow is diverted to the stomach and gut, so it’s not the best time to run.
Vocal Cord Dysfunction
Healthy vocal cords open when you breathe and close when you lift something heavy, speak, and swallow. However, when you’re running, it’s possible for the vocal cords to remain closed when you most need them to open and let air through, and this constriction of the airway can cause you to feel chest pain. If you are struggling with closed vocal cords while running, the best solution is usually respiratory retraining therapy.
Lung Problems
The ribs, lungs, and heart are all close together in the chest, which is why a problem with the rib muscles or lungs could feel like your heart hurting. Some exercise-induced lung problems can become dangerous, so you should see your doctor if you suspect a lung-related cause.
Exercise-Induced Asthma
Coughing, wheezing, and shortness of breath while running could be signs of exercise-induced asthma. If you don’t normally have asthma but experience these symptoms while running, your doctor might prescribe a pre-exercise medication and give you an inhaler to use only if you become short of breath during a run. If these symptoms progress and you’re struggling to breathe, call 9-1-1 immediately.
Other Lung Problems
There are a few other lung-related causes of chest pain while running.
- Exercise-induced bronchospasms (EIB) are spasms in the lungs’ small airways that might happen in certain environments or seasons.
- Pleurisy is an inflammation of the tissues that line the lungs and chest. Symptoms include chest pain, trouble breathing, and a persistent cough.
- Recent COVID-19 or pneumonia puts runners at an increased risk of lung problems, including pleurisy. Before restarting your exercise routine after illness, see a doctor to get medical clearance and ease into running slowly.
- Pneumothorax happens when air leaks into the space between the chest wall and the lungs.
- A pulmonary embolism occurs when there is a blood clot in one of the arteries in the lungs. Both conditions cause severe pain and shortness of breath, even after resting, and are serious. Seek medical attention right away if you experience these symptoms.
In Rare Cases, Chest Pain When Running Is a Sign of Heart Disease or a Cardiac Event
Experiencing sudden cardiac arrest while running is uncommon—only 0.54 out of 100,000 runners experienced SCA in 40 marathons and half-marathons[mfn]ahajournals.org[/mfn]. However, as you don’t know whether you’re one of the 0.54 or one of the 99,999.46, it’s important to be aware of the possible heart-related causes and symptoms so you can be evaluated and treated, if necessary. If you are at a higher risk for cardiac events, it’s a good idea to run with a friend and take an easy-to-use automated external defibrillator with you in a backpack, such as the LIFEPAK CR2 or Philips HeartStart FRx.
Angina
Angina occurs when a person’s coronary arteries, which transport blood to the heart, contract or become smaller. This results in insufficient blood supply and can cause chest pain when running. If you experience any chest pain (angina), stop and rest for a few minutes to see if the pain goes away. Less demand for oxygen should help the pain go away. Report this to your physician and they can do follow-up tests and diagnostics. If the pain persists even after resting, seek medical attention right away.
Heart Attack
If you have heart disease or a risk factor like smoking, experiencing chest pain while running could indicate a heart attack. Common symptoms of a heart attack include:
- Worsening chest pain
- Pain in the upper body, left arm, jaw, or back
- Chest pressure
- Heavy sweating
- Distention or heartburn
- Nausea or vomiting
- Shortness of breath
- Extreme fatigue
- Palpitations
- Dizziness
If these symptoms come on with intense physical activity but go away when you rest, the pain could be a sign of a heart attack. Call 9-1-1 immediately if you experience any of these symptoms when running.
Supraventricular Tachycardia
Supraventricular tachycardia (SVT) is an arrhythmia that occurs from electrical signals from the heart’s top chambers, and it makes you feel like your heart is racing. It’s a fast-rate arrhythmia and it’s a disruption of your heart’s normal electrical signal pathway. It can manifest by inducing chest pain, palpitations, and shortness of breath.
SVT is typically not life-threatening. However, if your heart rate is above 100 bpm at rest or greater than 150 bpm with exertion, then you should seek medical attention. Asymptomatic SVT can sometimes be remedied by applying a Valsalva Maneuver (coughing or bearing down like you are evacuating your bowels) and it resets the spontaneous rhythm. More serious (sustained or symptomatic) SVT causes should be worked up medically, and an ablation or pacemaker might be indicated to remedy it.
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is a thickening of the heart muscle—usually the left ventricle. This thickening blocks a certain amount of blood flow from the heart, which can lead to chest pain, palpitations, and shortness of breath when you exercise. People with HCM don’t necessarily suffer a heart attack, but HCM is a risk factor for sudden cardiac arrest. Treatments for HCM often involve medications that relax the heart muscle.
What You Should Do If Your Heart Hurts While Running
If you’re new to running and experience slight chest discomfort that goes away when you rest, drink some water or electrolyte solution and wait for the feeling to pass. It’s also a good idea to keep any pre-run snacks light, warm up before heading off, and stretch your chest muscles after you’re done to help reduce the likelihood of chest pain.
However, if you experience sharp chest pain while running and also have nausea, dizziness, pain in the back, jaw, or left arm, palpitations, or profuse sweating (it might be hard to tell it apart from regular sweat), call 9-1-1 immediately as it might be a medical emergency.
When in doubt, it’s better to check it out! Better to find out nothing is wrong than to ignore a pain and find out it’s very serious. And if you can, run with a buddy who is trained in CPR and knows the location of the nearest AEDs on your route (or take one with you). Make sure you have a cell phone with you too. You never know when either you or your running buddy might experience a cardiac event and need a helping hand.
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