What's Causing My Chest Pain?

Medically Reviewed by Poonam Sachdev on June 06, 2024
10 min read

Chest pain is not something to ignore. But you should know that it has many possible causes. In many cases, it's related to the heart. But problems in your lungs, esophagus, muscles, ribs, or nerves may also cause chest pain. Some of these conditions are serious and life-threatening; others are not. If you have unexplained chest pain, the only way to confirm its cause is to have a doctor check you.

You may feel chest pain anywhere from your neck to your upper abdomen. It can also spread to other areas of your upper body, like your jaw, back, or down your arm. The pain can persist for a few minutes to hours, and sometimes even for months or more. It might get worse when you're doing something active but ease up when you're taking it easy. Or it could hit you even when you're just relaxing. The pain might feel like it's in one spot or spread out more.

This condition might be unilateral, affecting only one side of your chest, or be bilateral, affecting both sides or in the middle. Depending on its cause, chest pain may be:

  • Sharp
  • Dull
  • Burning
  • Aching
  • Stabbing
  • A tight, squeezing, or crushing sensation

Here are some of the more common causes of chest pain.

These heart problems are common causes:

Coronary artery disease (CAD). This blockage in the heart's blood vessels lowers blood flow and oxygen to the heart muscle. It can cause pain, known as angina. It's a symptom of heart disease but typically does not cause permanent damage to the heart. It is, though, a sign that you are at risk for a heart attack in the future. The chest pain may spread to your arm, shoulder, jaw, or back. It may feel like a pressure or squeezing sensation. Exercise, excitement, or emotional distress can trigger angina, and rest makes it better.

Myocardial infarction (heart attack). This lowered blood flow through heart blood vessels causes the death of heart muscle cells. Though similar to angina chest pain, a heart attack is usually a more serious and crushing pain, usually in the center or left side of the chest, and rest doesn't make it better. Sweating, nausea, shortness of breath, or severe weakness may happen with the pain.

Myocarditis. Along with chest pain, this heart muscle inflammation may cause fever, fatigue, fast heartbeat, and trouble breathing. Although you don't have a blockage, myocarditis symptoms can feel like those of a heart attack.

Pericarditis. This is an inflammation or infection of the sac around the heart. It can cause pain similar to that caused by angina, but it often causes a sharp, steady pain along the upper neck and shoulder muscles. Sometimes, it gets worse when you breathe, swallow food, or lie on your back.

Hypertrophic cardiomyopathy. This genetic disease causes the heart muscle to grow abnormally thick. Sometimes, this leads to problems with blood flow out of the heart. Chest pain and shortness of breath often happen with exercise. Over time, you may have heart failure when your heart muscle becomes very thickened. This makes the heart work harder to pump blood. Along with chest pain, this type of cardiomyopathy may cause dizziness, lightheadedness, fainting, and other symptoms.

Mitral valve prolapse . It happens when a valve in the heart fails to close properly. A variety of symptoms have been associated with mitral valve prolapse, including chest pain, palpitations, and dizziness, but it can also have no symptoms, especially if the prolapse is mild.

Coronary artery dissection. Many things can cause this rare but deadly condition, which results when a tear develops in the coronary artery. It may cause a sudden, severe pain with a tearing or ripping sensation that goes up into the neck, back, or abdomen.

Aortic dissection. It happens when there's a tear in the inner layer of a weak spot in your aorta, the big artery carrying blood from your heart to the rest of your body. You may suddenly feel a sharp pain in your chest or back, like tearing or ripping. Other symptoms include shortness of breath, fainting, and dizziness.

Aortic aneurysm. Aortic aneurysms are like bulging balloons that form in the aorta. Normally, the aorta has strong walls that can handle the pressure of blood flow. But health issues, genetics, or injury sometimes damage or weaken these walls. When blood presses against these weakened areas, an aneurysm can form.

Aortic stenosis. Your aortic valve is like a gatekeeper, allowing blood to move from the heart's left lower chamber (left ventricle) into the aorta, carrying blood throughout your body. Aortic stenosis happens when this valve becomes narrow, disrupting the normal flow of blood.

Heart rhythm problems. Also known as heart rhythm disorders, this can happen to anyone, even if you don’t have any other heart diseases. But people with other heart problems are more vulnerable. Heart rhythm problems are divided into three categories: 

  • Electrical. Irregular heartbeats, known as arrhythmias, happen when there are issues with your heart's electrical system, which normally keeps a steady rhythm. The heartbeat can become too slow, too fast, or irregular and disorganized.
  • Circulatory. High blood pressure and coronary artery disease, which cause blockages in the arteries supplying blood to the heart, are the main reasons for your circulatory issues. These conditions can lead to strokes or heart attacks.
  • Structural. Heart muscle disease, also known as cardiomyopathy, and congenital abnormalities — issues with the development of the heart and blood vessels at birth — can harm your heart muscle or its valves.

These are common causes of chest pain:

Pleuritis. Also known as pleurisy, this is an inflammation or irritation of the lungs and chest lining. You likely feel a sharp pain when you breathe, cough, or sneeze. The most common causes of pleuritic chest pain are bacterial or viral infections, pulmonary embolism, and pneumothorax. Other less common causes include rheumatoid arthritis, lupus, and cancer.

Pneumonia or lung abscess. These lung infections can cause pleuritic and other types of chest pain, such as a deep chest ache. Pneumonia often comes on suddenly, causing fever, chills, cough, and pus from the respiratory tract.

Pulmonary embolism. When a blood clot travels through the bloodstream and lodges in the lungs, it can cause acute pleuritis, trouble breathing, and a rapid heartbeat. It may also cause fever and shock. Pulmonary embolism is more likely following deep vein thrombosis, after being immobile for several days following surgery, or as a complication of cancer.

Pneumothorax. Often caused by a chest injury, pneumothorax happens when a part of the lung collapses, releasing air into the chest cavity. This can also cause pain that gets worse when you breathe and other symptoms, such as low blood pressure.

Pulmonary hypertension. With chest pain resembling that of angina, this abnormally high blood pressure in the lung arteries makes the right side of the heart work too hard.

Asthma. An inflammatory disorder of the airways, asthma causes shortness of breath, wheezing, coughing, and sometimes chest pain.

Chronic obstructive pulmonary disease (COPD). This includes one or more of three diseases — emphysema, chronic bronchitis, and chronic obstructive asthma. The disease blocks airflow by shrinking and damaging both the airways that bring gases and air to and from your lungs and the tiny air sacs (alveoli) that transfer oxygen to your bloodstream and remove carbon dioxide. Smoking is the most common cause.

Lung cancer. You get lung cancer when unusual cells grow out of control in your lungs. It's a major health problem and can be fatal. The symptoms include a cough that doesn’t go away, chest pain, and trouble breathing.

Tuberculosis (TB). It is a contagious illness caused by bacteria that usually affects the lungs. TB spreads through the air when infected individuals cough, sneeze, or spit.

Viral infection. Respiratory viruses such as SARS-CoV-2 (which causes COVID-19) and influenza can cause myocarditis, a rare condition often triggered by an infection reaching the heart. The heart muscle becomes thick, swollen, and weak. One symptom is chest pain similar to a heart attack.

Gastrointestinal problems can also cause chest pain and include:

Gastroesophageal reflux disease (GERD). Also known as acid reflux, GERD happens when stomach contents return to the throat. This may cause a sour taste in the mouth and a burning sensation in the chest or throat, known as heartburn. Things that may trigger acid reflux include obesity, smoking, pregnancy, and spicy or fatty foods. Heart pain and heartburn from acid reflux feel similar partly because the heart and esophagus are close to each other and share a nerve network.

Esophageal contraction disorders. Uncoordinated muscle contractions (spasms) and high-pressure contractions (nutcracker esophagus) are problems in the esophagus that can cause chest pain.

Esophageal hypersensitivity. This occurs when the esophagus becomes very painful at the smallest change in pressure or exposure to acid. The cause of this sensitivity is unknown.

Esophageal rupture or perforation. A sudden, severe chest pain following vomiting or a procedure involving the esophagus may be a sign of a rupture in the esophagus.

Peptic ulcers. These painful sores in the lining of the stomach or the first part of the small intestine may result in vague, repeated discomfort. They're more common in people who smoke, drink a lot of alcohol, or take painkillers such as aspirin or NSAIDs. The pain often gets better when you eat or take antacids.

Hiatal hernia. This common problem occurs when the top of the stomach pushes into the lower chest after eating. This often causes reflux symptoms, including heartburn or chest pain. The pain tends to get worse when you lie down.

Pancreatitis. You may have pancreatitis if you have pain in the lower chest that is often worse when you lie flat and better when you lean forward.

Gallbladder problems. After eating a fatty meal, do you feel full or have pain in your right lower chest area or the right upper side of your abdomen? If so, your chest pain may be due to a gallbladder problem.

Esophagitis. This happens when your esophagus, the tube that carries food from your mouth to your stomach, becomes inflamed. Symptoms include painful swallowing and chest pain.

Sometimes, chest pain may result from overuse or an injury to the chest area from a fall or accident. Viruses can also cause pain in the chest area. Other causes of chest pain include:

Rib problems. Pain from a broken rib may worsen with deep breathing or coughing. It is often confined to one area and may feel sore when you press on it. The area where the ribs join the breastbone may also become inflamed.

Muscle strain. Sometimes, even hard coughing can injure or inflame the muscles and tendons between the ribs and cause chest pain. The pain tends to persist, and it worsens with activity.

Shingles. Caused by the varicella-zoster virus, shingles may prompt a sharp, band-like pain before a telltale rash appears several days later.

Costochondritis. Also called chest wall pain syndrome or costosternal chondrodynia, this is an inflammation of the cartilage connecting a rib to the breastbone. Pain from the condition can be similar to that of a heart attack or other heart issues.

Another potential cause of chest pain is anxiety and panic attacks. As everyone experiences anxiety at some point, it's hard to pinpoint when it becomes an anxiety disorder. However, if your worries start affecting your daily life for an extended period, it's wise to seek advice from a mental health expert. Anxiety disorders and stress come in various forms, but they typically share these common symptoms:

  • Faster heart rate and breathing
  • Muscle tension
  • Chest tightness
  • Persistent worries and restlessness
  • Fixating on trivial matters that leads to compulsive actions

If you notice these signs in a friend or family member, it's essential to talk to them about seeking help from a mental health professional. Some associated symptoms can include dizziness, sensation of shortness of breath, palpitations, tingling sensations, and trembling.

When in doubt, call your doctor about any chest pain you have, especially if it comes on suddenly or is not relieved by anti-inflammatory medications or other self-care steps, such as changing your diet.

Call 911 if you have any of these symptoms along with chest pain:

  • A sudden feeling of pressure, squeezing, tightness, or crushing under your breastbone
  • Chest pain that spreads to your jaw, left arm, or back
  • Sudden, sharp chest pain with shortness of breath, especially after a long period of inactivity
  • Nausea, dizziness, rapid heart rate or rapid breathing, confusion, ashen color, or excessive sweating
  • Very low blood pressure or very low heart rate

Call your doctor if you have any of these symptoms:

  • Fever, chills, or coughing up yellow-green mucus
  • Problems swallowing
  • Severe chest pain that does not go away

Chest pain can signal various issues, from heart problems such as aortic dissection to lung conditions such as pneumonia. Gastrointestinal troubles (such as GERD) or bone and muscle issues (such as costochondritis) can also cause discomfort. Anxiety and panic attacks are also potential causes of the condition. Also, note that the pain can be short or long, depending on the cause. You should get medical help if you have symptoms such as trouble breathing or pain spreading to the jaw or arm.

How do you know if chest pain is serious?

The best way to know how serious your chest pain is is to visit your doctor or call 911 or the local emergency number for medical help.

What can cause chest pain in women?

One of the most common causes is angina, but there are others including reflux, esophageal spasms, lung issues such as asthma or COPD, musculoskeletal pain, and stress.