Chest Pain While Marathon Running

I am an elite distance runner and competed for England in the Toronto marathon on Sunday. During the last 3-4 miles I developed a pain in the centre of my chest, this disappeared as soon as I stopped running at the end of the race.

I also felt a bit light headed and had black spots in my vision. Could you please give me some advice on this matter.

– Julie

Answer by Dom: Hi Julie, thanks for your question. I am not a doctor, and I am not going to guess at what caused your chest pain – but the combination you describe is exactly the kind that needs a proper check before you train hard again, not a shrug.

Here's what I want to cover:

1. Why chest pain is treated differently from ordinary exhaustion
2. Why the combination of symptoms matters
3. What to track and tell the doctor
4. What to do with your training in the meantime

Why Chest Pain Is Treated Differently from Ordinary Exhaustion

The end of a marathon is a brutal stage. Your body is completely exhausted, running on empty. Plenty of finishers need to walk, some faint, most feel dreadful in some way – as a top athlete you just keep going through it. So on its own, general fatigue at mile 23 doesn't worry me much.

Chest pain is a different category entirely. Tired legs, heavy breathing, a fading pace – that's your muscles and your energy system running low. Pain in the centre of your chest involves your heart and the vessels around it, organs that don't get a "just exhaustion" pass the way your quads do. That's the one big rule I try to follow with any pain while running: better safe than sorry, and chest pain sits right at the top of that list.

After all, Emil Zatopek, the legendary long distance runner, once said: "We are different, in essence, from other men. If you want to win something, run 100 meters. If you want to experience something, run a marathon." Marathon running does ask a lot of your body – but that's exactly why it's worth being precise about which discomforts are "part of the deal" and which ones aren't.

Why the Combination of Symptoms Matters

It isn't just the chest pain on its own that moves this from "keep an eye on it" to "get it checked." You've also described light-headedness and black spots in your vision, alongside the chest pain, in the closing miles.

Any one of those on its own during a hard effort might be put down to exhaustion or dehydration. All three together, though – chest pain, light-headedness, visual disturbance – is not a set of symptoms to self-diagnose. That's a pattern I'd want a doctor to look at directly, with proper tests, not something to explain away with a race-day story.

What to Track and Tell the Doctor

When you go in, give the doctor as much detail as you can – it makes their job easier and speeds up getting you sorted. I'd note down:

• Exactly where the pain was (centre of chest, as you describe) and whether it spread to your arm, jaw or back
• What it felt like – sharp, dull, tight, burning
• When it started (roughly mile 22-23) and when it stopped (immediately on finishing)
• The light-headedness and black spots – did they arrive with the chest pain or separately
• Your heart rate and pace in that closing stretch, if your watch logged it
• Any family history of heart issues, and whether this has ever happened in training before

That level of detail turns a vague "I felt off at the end" into something a doctor can actually work with – and it's worth writing it down now, while it's fresh, rather than trying to recall it at the appointment.

What to Do with Your Training Until You're Cleared

My advice here is simple: don't return to hard training – races, threshold effort, intervals – until you've been checked and cleared. Easy running, if you feel fine and the doctor hasn't told you otherwise, is generally fine while you wait for an appointment. But anything that pushes your heart rate back up towards where it was in those final miles should wait.

I know that's frustrating for a competitive athlete. But this is exactly the situation where being sensible now protects your career later. Get the tests done, get the answer, and then you can either get back to it with confidence or start on treatment early – both are better outcomes than pushing on without knowing.

Good luck with the appointment, and with your season ahead.

Kind regards,
Dom

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