• Angina and Other Causes of Chest Pain


    Chest pain is one of the most common symptoms of angina. You can learn more about Angina Causes and Risk Factors, but chest pain can also signal other problems. This is why it is very important to discuss your symptoms with your doctor to determine the underlying problem and the best course of treatment.

    In general, heart-related chest pain feels different from other sources of chest pain, but if you have any doubt, it is safest to call 911 for immediate medical assistance. It could save your life. Click here to learn more about heart attack, its symptoms and what to do if you or someone you love could be having one.

    Other Heart Problems That Can Cause Chest Pain

    Aortic Dissection

    Over time, uncontrolled high blood pressure can weaken the wall of the main artery from the heart (the aorta) until it eventually tears, causing aortic dissection, a medical emergency. Aortic dissection usually causes sudden, severe pain in the chest, neck, throat or jaw, and often a sensation of tearing in the chest that radiates to the back. Aortic dissection is a dangerous condition. You can learn more about aortic dissection here.

    Heart Valve Disease

    The heart has four chambers. The upper and lower chambers are connected by valves with flaps that open and close to ensure that blood flows in only one direction. If you have valve disease, these flaps harden, join together, or leak and do not work properly. The effects of these valve problems can cause chest pain. You can learn more about valvular heart disease by clicking here.

    Myocarditis and Pericarditis

    Chest pain is also caused by irritation and swelling of the heart (myocarditis) or its outer covering (pericarditis). This inflammation can be caused by an infection or happen after a heart attack or heart surgery. Pain from myocarditis or pericarditis is usually is sharp and in the center of the chest. It tends to get worse when you breathe, lie down, cough or swallow. Sitting or leaning forward sometimes reduces the pain.

    Hypertrophic Cardiomyopathy (HCM)

    HCM is a thickening of part of the heart. If you have this condition, your heart has to work harder to pump the blood in and out of your heart, which can cause chest pain. To learn more about hypertrophic cardiomyopathy, click here.

    Non-Heart-Related Causes of Chest Pain

    When you talk with your doctor about your chest pain, try to be as descriptive as possible. Where is the pain? How long does it last? Is it sharp or dull?

    The following symptoms are less likely to signal a heart attack or angina:

    • Sour taste in mouth
    • Trouble swallowing
    • Pain that improves or worsens after changing your body position
    • Pain that gets worse with coughing or breathing deeply
    • Chest pain that is tender to the touch
    • Chest pain that lasts less than 5 seconds
    • Chest pain that lasts continuously (all day, every day) for several days

    If you have one or more of these symptoms, it is important to see your doctor for diagnosis or referral to get the help you need to feel better. You may have one of the following non-heart related causes of chest pain:

    Lung and Breathing Problems

    • Pulmonary Embolism (PE): If you have trouble breathing, call 911. It could be a heart attack or other type of medical emergency, such as a blood clot in the lung, which is called a pulmonary embolism (PE). The chest pain from PE usually comes on suddenly with difficulty breathing, especially when you take a deep breath. You are at greater risk for PE if you have had surgery in the past three months, a blood clotting disorder, or cancer, or if you take oral contraceptives. PE is a life-threatening situation. The clot must be dissolved by medication to allow the heart and lungs to work properly.
    • Pulmonary Hypertension: Increased blood pressure in the blood vessels of the lungs, called pulmonary hypertension, can also cause chest pain and difficulty breathing, especially if you are exerting yourself. Other symptoms include feeling very tired and fainting.
    • Pneumonia is an infection in the lungs that can cause chest pain. Other symptoms of pneumonia include fever, difficulty breathing and a cough that brings up phlegm.
    • Pneumothorax is a lung problem that occurs when air gets trapped in between the lung and the chest wall, causing the lung to compress and making it difficult to breathe. In some cases, the pressure is so great it can cause a lung to collapse and even push the lungs, heart, and major vessels to the opposite side of the chest. This condition usually causes immediate chest pain and difficulty breathing. The pressure must be relieved immediately by a needle or tube through the chest wall.
    • Pleural Effusion: If fluid builds up around the lungs, it’s called pleural effusion. Just like air, fluid can press on the lungs making it difficult to breathe and causing some chest pain.
    • Pleurisy (also called pleuritis) is the inflammation of the lung covering. The pleura is composed of two layers, one surrounding the lungs and one lining the inside of the chest wall. In between these two layers is a small amount of fluid that prevents friction between the two layers when you breathe. If the pleura becomes inflamed, usually from infection, then the friction between the two layers will cause chest pain when you breathe.
    • Lung cancer is a rare but often deadly cause of chest pain. Symptoms can include a cough, difficulty breathing, weight loss, coughing up blood and chest pain. If the chest pain is severe or does not go away, it may mean the cancer has spread to the chest wall.

    Musculoskeletal Problems That Can Cause Chest Pain

    The vast majority of chest pain seen by doctors is actually related to muscles, bones, or joints rather than the heart or lungs. It is often sharp pain, specific to one area (although not always), and may improve or worsen with deep breathing, turning or arm movements. It may last several hours or weeks and is often easily reproducible. Sometimes, after giving it some thought, patients with this type of chest pain recall recent heavy lifting or other unusual physical activities that may have caused the pain. But for middle-aged or older people with risk factors, it is important to have your doctor make this determination.

    • The muscles between the ribs can be pulled or even torn by excessive exercise (especially if you don’t exercise regularly) or by direct injury to the muscle. Injury to these muscles can also cause sharp chest pain.
    • Costochondritis, a condition where the cartilage between the ribs becomes inflamed, is another common cause of chest pain.
    • Other sources of musculoskeletal chest pain may be due to broken ribs, cancer in the chest wall, sickle cell anemia, or infections, such as osteomyelitis or septic arthritis.
    • Rheumatic diseases, such as rheumatoid arthritis, ankylosing spondylitis or fibromyalgia can affect joints in the chest area and cause chest pain.

    Digestive Problems That Can Cause Chest Pain

    The heart and the esophagus (the tube between the mouth and stomach) share some of the same nerves. The esophagus runs directly behind the heart. Therefore, problems with the esophagus can feel similar to heart-related chest pain. Even if your chest pain improves with antacids or on its own, see your doctor to make sure your chest pain is not heart related.

    • Gastro-esophageal reflux disease (GERD), often simply referred to as heartburn, can give you chest pain. The esophagus and the stomach are connected by the lower esophageal sphincter (LES) that closes to prevent stomach contents from backing up into the esophagus. In GERD, the sphincter leaks and allows acids from the stomach to escape up into the esophagus and damage it. Symptoms of GERD are very similar to heart attack symptoms, so if you are not sure, call 911. GERD can cause squeezing, burning pain, often located in the center of the chest that sometimes radiates to the back, neck, jaw or arms. It can last minutes to hours. Many times younger people having their first episode of angina or heart attack do not think that their chest discomfort is coming from their heart. They do not see themselves as being at risk yet. Do not assume that these symptoms are due to your stomach. Unlike a heart attack, GERD may resolve on its own or with antacids. Symptoms from GERD tend to occur after meals, worsen with stress, and wake you up from sleep. GERD can also cause stomach pain, regurgitation, and an acid taste in mouth.
    • Other problems affecting the esophagus can also cause chest pain. These problems include spasms, ruptures (caused by vomiting, ulcers, chemicals, or medical instruments), and foods or small objects getting stuck in the esophagus.
    • Medications: Certain medications may also cause chest pain by damaging the esophagus or stomach. In some cases, swallowing becomes difficult because of the pain. This kind of irritation and pain most often happens after pills are swallowed without water, especially at bedtime.
    • Pain radiating from the abdomen can also feel like chest pain. This type of pain can be caused by peptic ulcer disease, inflammation of the gallbladder, gallstones, inflammation of the pancreas (pancreatitis), kidney stones or inflammation of the appendix (appendicitis).

    Perforated Viscus

    A perforated viscus is a hole in one of the organs in the body, such as the stomach, appendix, spleen, gallbladder or bladder—usually from injuries, such as from a car accident, gunshot, or stab wound or infection. The hole allows toxic materials and waste from the perforated organ to escape into the body cavity, which can cause chest pain.

    Skin and Sensory Nerves

    The skin and nerves of the chest may be the source of chest pain. For example, chest pain may occur before the shingles rash appears. Nerve-related chest pain can occur after certain therapies and radiation, but it is fairly uncommon.

    Psychological Disorders That Can Cause Chest Pain

    Panic disorders, anxiety, depression, emotional stress or other psychological disorders may also cause chest pain. In these psychological disorders, the chest pain is not related to angina or digestive causes but instead seems to be triggered by the emotional stress. Emotional stress is a relatively common cause of chest pain, but it is extremely important that you see your doctor to rule out coronary artery disease (CAD) before attributing your chest pain to psychological disorders, even if you do not have a history of coronary artery disease.

    Learn More

    While not all chest pain is a heart attack, it is important for everyone to know the symptoms of a heart attack and what to do if these symptoms occur. It is safer to assume you may be having a heart attack and seek medical attention, even if a heart attack is NOT the cause, than to ignore the symptoms of a heart attack. This is because a heart attack indicates that the heart is not getting enough blood. Without the blood it needs, the heart muscle begins to die. This is why doctors say "time is muscle" -- because the more time that passes without the heart getting the oxygenated blood it needs, the more likely it is that heart muscle will die, leading to long-term heart problems such as heart failure, or even death. 

    You can learn more about other causes of chest pain that mimic heart attack, such as angina and takotsubo syndrome (also known as Broken Heart Syndrome), among others, here.