Chest pain is a common but complex symptom that can arise from many organs in and around the chest. It’s important to remember that not all chest pain is related to the heart — other causes include lungs, muscles, nerves, stomach, and even psychological factors.
1. Cardiac Causes (Heart-Related Chest Pain):
The heart is often the first organ to be checked when someone complains of chest pain.
Angina Pectoris is chest pain due to reduced blood flow to heart muscles (usually from coronary artery disease). It’s typically described as a squeezing or pressure-like sensation behind the breastbone, triggered by exertion or stress, and relieved by rest or nitroglycerin.
Myocardial Infarction (Heart Attack) causes severe, crushing chest pain lasting more than a few minutes, often radiating to the arm, neck, or jaw, and may be associated with sweating, nausea, and breathlessness.
Pericarditis (inflammation of the heart lining) causes sharp, stabbing pain that worsens when lying down and improves sitting forward.
Aortic Dissection is a life-threatening condition where the inner layer of the aorta tears, causing sudden, severe chest or back pain described as tearing or ripping.
Heart Failure may cause chest discomfort due to strain but usually presents with breathlessness and swelling more than pain.
2. Respiratory Causes (Lungs and Pleura):
Many lung-related problems cause chest pain, often sharp and worsened by breathing or coughing.
Pneumonia can cause pleuritic chest pain (sharp, stabbing pain on deep breath).
Pulmonary Embolism (PE) causes sudden chest pain, often sharp and associated with breathlessness and sometimes coughing up blood.
Pneumothorax (collapsed lung) causes sudden, severe unilateral chest pain and breathlessness.
Pleural Effusion or pleuritis causes sharp chest pain worsened by breathing or movement.
Lung cancer may cause dull, persistent chest pain if tumors invade chest wall or nerves.
3. Gastrointestinal Causes:
Several stomach and esophageal problems mimic heart pain.
Gastroesophageal Reflux Disease (GERD) causes burning chest pain (heartburn) that may worsen after meals or lying down.
Esophageal spasms or achalasia can cause squeezing chest pain similar to angina.
Peptic ulcers and gastritis sometimes present with upper abdominal or chest discomfort.
Hiatal hernia may cause chest or upper abdominal pain.
Gallbladder disease (biliary colic) can refer pain to the chest area.
4. Musculoskeletal Causes:
Chest wall structures are a frequent cause of non-cardiac chest pain.
Costochondritis (inflammation of rib cartilage) causes localized sharp pain, reproducible on pressing the chest wall.
Muscle strain or injury from heavy lifting, coughing, or trauma can cause chest pain.
Rib fractures cause sharp pain that worsens with movement or deep breath.
Herpes zoster (shingles) can cause severe burning chest pain before rash appears.
5. Neurological Causes:
Nerve compression or irritation (e.g., cervical radiculopathy) may cause chest pain radiating from the neck or spine.
Thoracic outlet syndrome can cause chest and arm pain with numbness or weakness.
Postherpetic neuralgia after shingles can cause persistent chest pain.
6. Psychological Causes:
Anxiety and panic attacks often cause chest tightness or sharp pain along with palpitations, sweating, and breathlessness.
These pains are real but often mistaken for heart attacks.
Duration & Pattern Clues
Sudden, severe ripping pain: Think aortic dissection or pneumothorax.
Exertional chest pain: Classic angina or coronary artery disease.
Sharp pain worsening with breathing: Pleuritis or pulmonary embolism.
Burning pain after meals: GERD or esophageal causes.
