In younger patients chest pain is less often caused by the heart than it is in adults, and it is more often related to heart burn, asthma, or muscle and joint inflammation. But a rapid heart rate associated with chest pain is somewhat more concerning.  Though anxiety related to chest pain can lead to increases in heart rate, rates higher than 160—and especially those higher than 180—should be evaluated to exclude an abnormal heart rhythm. Someone who has had chest pain and a rapid heart rate should have a thorough physical exam by a physician, and possibly a chest x-ray and/or EKG, to assess whether there is an underlying problem with heart rhythm that would lead to these symptoms. Anyone having severe chest pain with a rapid heart rate should be evaluated in the emergency room at the time of symptoms.