Chest pain is one of the most common reasons Americans, aged 15 years and older, visit the emergency room (ER). In fact, the percentage of chest pain visits that are considered urgent is two to three times higher than the percentage of visits for abdominal pain and other symptoms. Although many of us associate chest pain with having a heart attack, there are indeed, a number of other possibilities for its cause. Let’s take a look at what some of them are.
Besides heart attack, the following conditions involving the heart may also cause chest pain:
- Coronary Artery Disease (CAD) – a blockage in the blood vessels of the heart that diminishes blood flow and oxygen to the heart muscle. The type of pain related to CAD is known as angina. Although angina doesn’t cause permanent damage to the heart, it is often a warning sign of an impending heart attack.
- Myocarditis – inflammation of the heart muscle that may cause fever, fatigue, rapid heartbeat and difficulty breathing. Although not associated with blockage of blood flow and oxygen, symptoms of myocarditis often mimic those of a heart attack.
- Pericarditis – inflammation of the thin, sac-like membrane surrounding the heart. The most common symptom of pericarditis is sharp, stabbing chest pain that radiates (travels) to the neck and left shoulder.
- Hypertrophic cardiomyopathy – a condition in which the heart muscle becomes unusually thick making it difficult for the heart to pump blood. Most people won’t experience symptoms. Some may experience shortness of breath, chest pain and irregular heart rhythm.
- Mitral valve prolapse – occurs when there’s improper closure of the valve between the upper and lower chambers of the heart. Can occur at any age and is hereditary. Symptoms may include shortness of breath, heart palpitations and irregular heart rhythm.
- Coronary artery dissection – a tear in one of the coronary arteries that blocks blood flow and may lead to heart attack.
Problems with the lungs, as noted below, are another common cause of chest pain:2
- Pleuritis – inflammation of the tissues lining the lungs and chest cavity. Causes chest pain that worsens when breathing.
- Pneumonia or Lung abscess – a bacterial infection that occurs in the lung tissue causing it to die and pus to gather in that space.
- Pulmonary embolism – a condition in which one of the arteries in the lungs becomes blocked by a blood clot that usually travels from the leg. Symptoms include shortness of breath, chest pain and cough.
- Pneumothorax – a condition that occurs when air leaks into the space between the lungs and the chest wall. Symptoms include shortness of breath and chest pain.
- Pulmonary hypertension – high blood pressure in the arteries of the lungs causing the right side of the heart to work harder. Chest pain resembles that of angina.
- Asthma – an inflammatory disease of the airways that sometimes causes chest pain. Other symptoms include shortness of breath, wheezing and coughing.
Gastrointestinal problems encompass your entire gastrointestinal tract, from your mouth to your anus. The following conditions are associated with chest pain:2
- Gastroesophageal reflux disorder (GERD) – commonly referred to as “acid reflux”, GERD occurs when the stomach contents back up into the throat causing a sour taste in the mouth and burning sensation in the chest or throat (heartburn). Heartburn and chest pain from acid reflux may feel similar.
- Esophageal contraction disorders – painful spasms within the tube connecting your mouth and stomach (esophagus). May cause sudden severe chest pain that may go away in a few minutes to a few hours.
- Esophageal hypersensitivity – occurs when people feel pain and/or discomfort in the esophageal area.
- Esophageal rupture or perforation – manifested by a sudden, severe chest pain after vomiting or a procedure involving the esophagus.
- Peptic ulcers – painful sores in the lining of the stomach or the first part of the small intestine. More common in smokers and people who drink large amounts of alcohol or who take pain relievers such as aspirin or non-steroidal anti-inflammatories (NSAIDS).
- Hiatal hernia – a common problem that occurs when the top of the stomach pushes up through the diaphragm muscle often causing reflux symptoms such as heartburn or chest pain that may worsen when lying down.
- Pancreatitis – inflammation of the pancreas that causes pain in the lower chest that worsens when you lie flat and improves when you lean forward.
- Gallbladder issues –a sensation of fullness or pain in the right upper chest area or right upper side of your abdomen that follows eating a fatty meal may be a sign you have gallbladder problems.
Bone, Muscle or Nerve Problems
Sometimes, overusing your muscles or sustaining an injury from a fall or accident to the chest area can lead to chest pain, as can having a virus as we see below:
- Rib problems – pain from a fractured rib may cause you to feel chest pain that worsens when you take a deep breath or cough. The rib or ribs may also be sore when you press on them.
- Muscle strain – this occurs when the muscles and tendons between the ribs become sore and inflamed from an injury or even a bad cough. Chest pain from a muscle strain tends to persist and worsens with activity.
- Shingles – a viral infection that’s caused by the chickenpox virus. Symptoms include pain and rash on one side of the body.
Other possible causes of chest pain include anxiety and panic attacks, conditions that may also lead to shortness of breath, dizziness, palpitations, a tingling sensation and trembling.
Chest Pain: When to See a Doctor?
Chest pain can be frightening and if you’re confused as to when you should seek medical attention, you’re not alone. If you’re harboring any doubts about the type of chest pain you’re having, you should contact your doctor, especially if the pain comes on suddenly and is not relieved by anti-inflammatory medications, rest or a change in your diet.
You should also call the doctor if you have any of the following:
- Fever, chills, coughing up yellow or green mucus (this may be a sign of a respiratory infection).
- Difficulty swallowing.
Be sure to call 911 if you have chest pain along with any of the following symptoms:
- A sudden feeling of tightness, pressure, squeezing or crushing under your breast bone.
- Chest pain that radiates to your jaw, left arm, neck or back.
- Sudden sharp chest pain that is accompanied by shortness of breath, especially if you’ve been sedentary for a long period of time.
- Nausea, dizziness, fast heartbeat, fast breathing, confusion, an ashen tone to the skin or extreme sweating.
- Especially low blood pressure or heartbeat.
For more information about chest pain, contact your primary care provider.
 Centers for Disease Control and Prevention. Emergency Department Visits for Chest Pain and Abdominal Pain: United States, 1999-2008. September, 2010.
 WebMD. What’s Causing my Chest Pain? Last reviewed January, 2017.