Different Causes of Chest Pain
Explore the various causes of chest pain, from minor issues to serious medical conditions, and learn when to seek urgent medical attention.
Written by Dr. Rohinipriyanka Pondugula
Reviewed by Dr. D Bhanu Prakash MBBS, AFIH, Advanced certificate in critical care medicine, Fellowship in critical care medicine
Last updated on 3rd Sep, 2025
Introduction
Chest pain is one of the most common reasons people rush to the emergency room, and for a good reason, it’s our body’s primal alarm bell for heart trouble. However, what many don't realize is that chest pain different causes can feel remarkably similar, originating from a complex web of organs and systems within your chest cavity. That squeezing sensation might be a muscle spasm, not a heart attack. That sharp, stabbing feeling could be from your lungs, not your heart. Understanding the nuances of chest pain is crucial for making informed decisions about your health. This guide will walk you through the different potential causes, from the critical cardiac events to common gastrointestinal issues, helping you decipher what your body might be trying to communicate and when it's essential to seek immediate help.
Cardiac Causes: When Chest Pain is a Heart Alert
When we feel chest pain, our minds often jump to the heart. This is a vital instinct, as cardiac-related pain requires immediate attention. The heart is a muscular organ that demands a constant supply of oxygen-rich blood. When that supply is compromised, it cries out in pain.
1. Heart Attack (Myocardial Infarction)
A heart attack occurs when a coronary artery becomes completely blocked, stopping blood flow to a part of the heart muscle. The classic symptom is a feeling of pressure, squeezing, fullness, or pain in the centre of the chest that may last for several minutes or go away and come back. It can feel like an "elephant sitting on your chest." This pain often radiates to the shoulders, neck, jaw, arms (particularly the left), or back. It's frequently accompanied by shortness of breath, cold sweat, nausea, lightheadedness, and overwhelming anxiety. It's critical to understand that not all heart attacks present this way; some, especially in women, can cause more subtle symptoms like unusual fatigue or indigestion-like pain.
2. Angina Pectoris
Think of angina as the heart's warning shot. It's chest pain or discomfort caused by reduced blood flow to the heart muscle, often due to narrowed arteries (coronary artery disease). The sensation is very similar to a heart attack: pressure, squeezing, or pain in the chest, but it's typically triggered by physical exertion or emotional stress and relieved within a few minutes by rest or medication (nitroglycerin). It’s the body’s way of saying the heart is working harder than its blood supply allows.
3. Pericarditis
This is inflammation of the pericardium, the thin, sac-like tissue surrounding the heart. The pain is usually a sharp, stabbing sensation behind the breastbone or on the left side of the chest. A key identifier for this type of chest pain is that it often gets worse when you lie down, take a deep breath, or cough. Leaning forward or sitting up can relieve the pain. It's often caused by a viral infection.
4. Aortic Dissection
This is a rare but life-threatening condition where the inner layer of the aorta, the major artery leading from the heart, tears. Blood surges through the tear, causing the inner and middle layers to separate (dissect). The pain is classically described as a sudden, severe, tearing or ripping sensation in the chest and back. This is a medical emergency requiring instant surgical intervention.
Unique Insight: While we often picture heart pain as being on the left side, the heart is centrally located behind the breastbone. True cardiac pain is most often felt in the centre of the chest, which is a crucial detail for differentiating it from a localized muscle strain on the left or right side.
Consult a General Physician for the best advice
Pulmonary Causes: Issues in the Lungs
Your lungs and their surrounding tissues occupy most of your chest cavity, so problems here can easily be mistaken for heart pain. A key indicator for pulmonary issues is that the pain is almost always tied to breathing.
1. Pulmonary Embolism
This is a blockage in one of the pulmonary arteries in your lungs, usually caused by blood clots that travel from the legs or other parts of the body (deep vein thrombosis). The chest pain from a PE can mimic a heart attack; it's often sharp and stabbing and felt in the center of the chest. However, it is almost always accompanied by sudden and severe shortness of breath, a rapid heart rate, and a cough that may bring up bloody mucus. It's a medical emergency.
2. Pleurisy
Also known as pleuritis, this is inflammation of the pleura, the two large, thin layers of tissue that separate your lungs from your chest wall. The pain is a sharp, stabbing sensation that occurs when you breathe in and out deeply, cough, or sneeze. You may avoid taking deep breaths to prevent the pain. Pleurisy can be caused by viral infections, pneumonia, or autoimmune conditions.
3. Pneumothorax
This occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung, making it collapse. A collapsed lung typically causes sudden, sharp stabbing pain in the chest on the affected side, along with shortness of breath. It can happen without a clear cause in otherwise healthy people or result from a chest injury.
Gastrointestinal Causes: It Might Be Your Gut
The oesophagus runs right through the chest to the stomach, and problems here are among the most common mimics of heart pain. If your chest pain after eating is a common theme, your gut is likely the culprit.
1. Heartburn (GORD) and Acid Reflux
Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (oesophagus). This backwash (acid reflux) can irritate the lining of your oesophagus, causing a burning sensation (heartburn) in the central chest that can rise up toward the throat. It often occurs after meals, when lying down, or bending over. The pain can be severe enough to be mistaken for a heart attack.
2. Oesophageal Spasm
The oesophagus is a muscular tube. Sometimes these muscles contract abnormally, causing a sudden, intense chest pain that can feel like a squeezing pressure, similar to angina. It can be triggered by swallowing hot or cold liquids and may be accompanied by a feeling that something is stuck in your throat.
3. Gallbladder Issues
While the gallbladder is located in the upper right abdomen, pain from gallstones or inflammation (cholecystitis) can radiate to the right shoulder, back, and even the centre of the chest. This pain is often triggered by fatty meals and can be severe and steady.
Unique Insight: A simple at-home test to differentiate between heartburn and cardiac pain is to drink a glass of water or take an over-the-counter antacid. If the pain subsides significantly within minutes, it's likely related to acid reflux. Cardiac pain will not be affected. However, this should never delay seeking emergency care for suspected heart issues.
Musculoskeletal Causes: Pain from the Chest Wall
Sometimes, the pain isn't coming from deep inside but from the structures that make up the chest wall itself, the bones, cartilage, and muscles.
1. Costochondritis
This is inflammation of the cartilage that connects a rib to the breastbone (sternum). The pain mimics that of a heart attack or other heart conditions. It causes sharp, aching pain and tenderness at the front of the chest, usually on the left side. The key differentiator is that pressing on the affected rib joint will reproduce the pain, which is not typical for cardiac pain.
2. Muscle Strain or Injury
Have you been painting a ceiling, doing a new workout, or had a coughing fit? You can easily strain the pectoral muscles between your ribs (intercostal muscles). This causes a localized, aching or sharp chest pain that worsens with specific movements, twisting, or deep breathing. The pain is usually easy to pinpoint.
Conclusion
Understanding the different origins of chest pain empowers you to be an active participant in your health. While this guide provides a framework for differentiating between cardiac, pulmonary, gastrointestinal, and musculoskeletal causes, it is not a substitute for professional medical evaluation. The human body is complex, and symptoms can overlap. The most important takeaway is to trust your instincts. If you experience severe, unexplained, or concerning chest pain, especially with symptoms like shortness of breath, radiating pain, or dizziness, your safest course of action is to seek immediate emergency care. For persistent, recurring, or less severe pain, a timely consultation with a doctor is essential for an accurate diagnosis and peace of mind. If your symptoms are persistent but not an emergency, consult a doctor online with Apollo24|7 for a convenient initial evaluation and guidance on the next steps.
Frequently Asked Questions (FAQs)
Below are the FAQs:
1. How can I tell if my chest pain is anxiety or a heart problem?
A. Anxiety or panic attacks can cause chest pain that feels sharp, stabbing, and is accompanied by a racing heart, hyperventilation, and a feeling of dread. The key difference is that cardiac pain is usually triggered by physical exertion, while anxiety pain can occur at rest. However, only a doctor can definitively rule out a cardiac cause.
2. What does it mean if I have a sharp stabbing pain in my chest that comes and goes?
A. This is a common description for several issues. If it's worse when breathing, it could be pleurisy or a muscle strain. If it's brief and triggered by swallowing, it might be an oesophageal spasm. If it's reproducible by pressing on your chest, it's likely costochondritis. A doctor can help pinpoint the cause.
3. Can gas cause severe chest pain?
A. Yes. Trapped gas in the colon (especially under the left side of the diaphragm) can cause sharp, intense pain that radiates to the chest, mimicking heart pain. It often resolves with passing gas or having a bowel movement.
4. When should I absolutely not ignore left side chest pain?
A. You should never ignore left side chest pain if it is accompanied by pressure, squeezing, shortness of breath, pain radiating to the left arm or jaw, nausea, or cold sweats. These are hallmark signs of a heart attack and require immediate emergency care.
5. Are there any home remedies for non-emergency chest pain?
A. For diagnosed heartburn, antacids can help. For musculoskeletal pain, rest, ice, and over-the-counter anti-inflammatories (like ibuprofen) may provide relief. However, you should only attempt home remedies if you are certain of the cause. If your condition does not improve after trying these methods, consult a doctor for a proper diagnosis.
Consult a General Physician for the best advice
Consult a General Physician for the best advice
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