Chest pain is one of the most common reasons adults visit emergency departments and primary care clinics worldwide1 . Surprisingly, about 60% to 90% of patients presenting with chest pain do not have underlying cardiovascular disease2 . While chest pain can be alarming, many causes are not related to the heart but still require proper diagnosis and management3 .
Pulled Chest Muscle
Musculoskeletal problems are the most common causes of chest pain in general practice, accounting for about one-third to one-half of cases4 5. A pulled muscle in the chest can result from strenuous workouts, heavy lifting, or coughing due to respiratory illness6 . This type of pain often feels sharp or stabbing and is localized to the chest wall.
Musculoskeletal chest pain usually improves with conservative treatments such as rest, over-the-counter pain relievers like ibuprofen, and applying warm compresses to the affected area6 . Unlike cardiac chest pain, musculoskeletal pain is often reproducible by pressing on the chest or moving the upper body.
“By far, the most common cause of chest pain is musculoskeletal, referring to the muscles, bones, joints, tendons, ligaments and cartilage that make up the body's structural components. Studies looking at causes of chest pain in the primary care setting have shown that about one-third to one-half of all patients seeing their doctor about chest pain had pain related to musculoskeletal conditions or chest wall pain.”
— Jim Liu, Ohio State Wexner Medical Center5
Angina Symptoms
Angina is a symptom of coronary artery disease (CAD) caused by reduced blood flow to the heart muscle7 8. It typically presents as chest pain described as pressure, heaviness, tightness, or squeezing. Angina is usually triggered by physical exertion and relieved by rest7 5.
Associated symptoms may include shortness of breath, nausea, clamminess, fatigue, and pain radiating to the jaw or left arm5 . Chronic stable angina occurs predictably with exertion, and the risk of myocardial infarction (heart attack) or death within 12 months for these patients ranges from 2% to 9% 7.
“The classic signs and symptoms of anginal chest pain are pain described as pressure, heaviness, tightness or squeezing. Typically, the pain is provoked by physical exertion and relieved with rest. Sometimes, there can also be associated symptoms such as shortness of breath, nausea, clamminess, fatigue and radiation of pain to the jaw or left arm.”
— Jim Liu, Ohio State Wexner Medical Center5
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Heartburn and Chest Pain
Gastroesophageal reflux disease (GERD) is the most common non-cardiac cause of chest pain9 10. GERD causes acid reflux, which leads to heartburn that can mimic the pain of a heart attack6 . This pain is often described as pressure or tightness behind the breastbone and may spread to the neck, back, or arms10 .
Because GERD-related chest pain can be difficult to distinguish from cardiac pain, it is important to seek medical evaluation for any new chest pain11 . Diagnostic tools such as upper gastrointestinal endoscopy can help identify GERD as the cause11 .
Treatment for GERD-related chest pain includes lifestyle modifications like avoiding late-night meals and acidic or fatty foods, as well as medications such as proton pump inhibitors (e.g., omeprazole) or H2 blockers (e.g., famotidine) 65.
- GERD-related chest pain characteristics10 6:
- Pressure or tightness behind the breastbone
- May spread to neck, back, or arms
- Often triggered by large meals or stress
- Usually does not cause sweating or shortness of breath
- Improves with antacids or acid-reducing medications
Pericarditis Causes
Pericarditis is inflammation of the pericardium, the sac surrounding the heart, and can cause chest pain1 . This pain often worsens with deep breaths or when lying down and may improve when sitting up or leaning forward1 . It is usually sharp and stabbing in nature.
Pericarditis can result from infections, autoimmune diseases, or after a heart attack. It is important to differentiate pericarditis from other causes of chest pain because it may require specific treatment such as anti-inflammatory medications.
Pleurisy Chest Pain
Pleurisy is inflammation of the pleura, the lining around the lungs, and is a common cause of chest pain related to respiratory conditions12 1. The pain is typically sharp and worsens with deep breathing, coughing, or sneezing12 .
Common causes of pleuritic chest pain include pneumonia, pulmonary embolism, and other lung infections12 . Pulmonary embolism, a blood clot in the lungs, is a severe cause of pleuritic chest pain and requires urgent medical attention12 .
Shingles and Chest Pain
Shingles, caused by reactivation of the varicella-zoster virus, can cause chest pain before the characteristic rash appears1 . This pain is usually burning or tingling and localized to one side of the chest following a nerve distribution.
Chest pain from shingles can be mistaken for cardiac pain, especially in the early stages. The rash typically develops a few days after the pain starts, helping to confirm the diagnosis.
Costochondritis Symptoms
Costochondritis is inflammation of the cartilage that connects the ribs to the breastbone and is a frequent cause of chest wall pain5 . This pain is sharp or aching and worsens with movement, deep breathing, or pressure on the chest wall.
It is often caused by injury, repetitive strain, or viral infections. Treatment includes rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and applying heat or ice to the affected area5 .
Pancreatitis Pain
Pancreatitis, inflammation of the pancreas, can cause upper abdominal pain that sometimes radiates to the chest1 . The pain is usually severe, constant, and may worsen after eating.
Other symptoms include nausea, vomiting, and fever. Pancreatitis requires prompt medical evaluation and treatment to prevent complications.
Panic Attack Signs
Psychological factors, including panic disorder and anxiety, are implicated in a majority of non-cardiac chest pain cases13 146. Panic attacks can cause chest tightness or discomfort that mimics heart-related pain.
Chest pain from panic attacks is often accompanied by intense stress, a sense of dread, rapid heartbeat, sweating, and shortness of breath6 . These symptoms can be frightening but are not caused by heart disease.
- Common signs of panic attack chest pain13 146:
- Chest tightness or discomfort
- Rapid heartbeat or palpitations
- Sweating and shortness of breath
- Intense fear or sense of doom
- Symptoms often start suddenly and peak within minutes
“Psychological factors, including panic disorder, are implicated in a majority of non-cardiac chest pain cases. These patients often have impaired quality of life and high healthcare utilization. A stepped care approach, including psychological support, may improve outcomes.”
— Campbell et al. 131415
When to See a Doctor
It is essential to consult a healthcare provider as soon as possible if you experience chest pain7 . While most chest pain is not caused by heart disease, the risk of serious events remains, especially in people with cardiovascular risk factors such as high blood pressure, diabetes, kidney disease, or age over 607 6.
Call emergency services immediately if you have chest pain with any of the following signs7 :
- Pain that occurs at rest or is more severe than usual
- Pain spreading to the jaw, left arm, or between the shoulders
- Sudden squeezing or tightening pressure in the chest
- Associated symptoms like nausea, vomiting, sweating, shortness of breath, or light-headedness
Rapid evaluation and risk stratification can improve outcomes and ensure timely treatment for life-threatening conditions7 .
Key Takeaways
- Most chest pain cases are not caused by heart attacks but by musculoskeletal, gastrointestinal, or psychological conditions3 6.
- Pulled chest muscles and costochondritis are common musculoskeletal causes, often treated with rest and anti-inflammatory medications5 6.
- GERD is the leading non-cardiac cause of chest pain and can mimic heart-related pain, requiring medical evaluation for diagnosis9 10.
- Angina is a heart-related chest pain caused by reduced blood flow and requires prompt medical attention due to risk of heart attack7 8.
- Panic attacks can cause chest pain with symptoms similar to heart problems but are related to anxiety and stress13 14.
