What Causes Chest Pain When Walking? A Cardiologist Explains

Why Does My Chest Hurt When I Walk?

Chest pain that occurs during walking or physical activity is called exertional chest pain. While it can have many causes -- including muscle strain, acid reflux, or anxiety -- it can also be a sign that your heart is not receiving enough blood during exertion.

When the coronary arteries that supply blood to the heart muscle are narrowed by plaque (a condition called coronary artery disease), the heart may receive enough blood at rest but not during exercise. This is called angina, and it is one of the most common reasons patients are referred to a cardiologist.

Cardiac Causes of Chest Pain During Exercise

Stable angina is the most common cardiac cause. It typically feels like tightness, pressure, or heaviness in the chest and may radiate to the left arm, neck, or jaw. It usually occurs predictably with exertion and resolves within a few minutes of rest.

Other cardiac causes include coronary artery spasm (Prinzmetal angina), aortic stenosis (a narrowing of the heart valve that can cause chest pain and dizziness during activity), and hypertrophic cardiomyopathy (thickened heart muscle that can obstruct blood flow during exercise).

Less commonly, chest pain during walking may be related to pericarditis (inflammation of the lining around the heart) or pulmonary hypertension (high blood pressure in the lung arteries).

When Should I See a Cardiologist?

You should see your GP and ask for a referral to a cardiologist if your chest pain occurs repeatedly with exertion, if it is getting worse over time, if it is accompanied by breathlessness, dizziness, or sweating, or if you have risk factors for heart disease such as high blood pressure, high cholesterol, diabetes, smoking, or a family history of heart disease.

If you experience sudden, severe, or crushing chest pain that does not resolve within a few minutes, call 000 immediately. This may be a heart attack.

How a Cardiologist Investigates Exertional Chest Pain

A cardiologist will start with a thorough history and physical examination. Based on your symptoms and risk profile, they may recommend one or more of the following tests:

A stress echocardiogram involves exercising on a treadmill while your heart is monitored with ultrasound. This is particularly effective at detecting reduced blood flow to parts of the heart during exertion -- exactly the scenario that causes your symptoms.

A CT coronary angiogram produces detailed 3D images of the coronary arteries, allowing the cardiologist to directly visualise any narrowing or plaque build-up. It also includes a coronary artery calcium score, which quantifies calcified plaque and predicts future heart events.

An echocardiogram (heart ultrasound) assesses the overall structure and function of the heart, including the valves and pumping ability.

At Complete Heart Centre, all consultations and in-clinic diagnostic tests are fully bulk billed through Medicare. You pay nothing out of pocket.

Can Chest Pain During Walking Be Prevented?

Many cardiac causes of exertional chest pain can be managed effectively once diagnosed. Treatment may include medication to improve blood flow to the heart, lifestyle changes such as regular exercise, a heart-healthy diet, and quitting smoking, and in some cases, procedures to open or bypass blocked arteries.

The key is early detection. If you are experiencing chest pain during walking or exercise, do not ignore it. See your GP, get a referral, and have it properly investigated.