Chest Pain: When Should You Worry?

Chest pain is one of the most alarming symptoms a person can experience. Your mind may immediately jump to a heart attack, and that instinct is not unreasonable. Chest pain is the number one reason people visit emergency departments in the United States. However, the majority of chest pain cases, roughly 80 to 90%, turn out to be non-cardiac in origin.

That said, distinguishing between dangerous and benign chest pain is not something you should attempt on your own. If you are currently experiencing chest pain and are unsure of the cause, call 911 or your local emergency number immediately. It is always better to be evaluated and reassured than to ignore a potentially life-threatening event.

This guide will help you understand the various causes of chest pain and recognize the warning signs that require urgent medical attention. For a quick symptom assessment, try our symptom checker.

Cardiac Causes of Chest Pain

Heart Attack (Myocardial Infarction)

A heart attack occurs when blood flow to part of the heart muscle is blocked, usually by a blood clot in a coronary artery. The classic symptoms include:

• Pressure, squeezing, or tightness in the center or left side of the chest
• Pain that radiates to the left arm, jaw, neck, back, or shoulder
• Shortness of breath, with or without chest discomfort
• Cold sweats, nausea, or lightheadedness
• A sense of impending doom

It is important to note that women often present differently than men. Women are more likely to experience atypical symptoms such as extreme fatigue, nausea, upper back or jaw pain, and shortness of breath without the classic chest pressure. This can lead to delayed recognition and treatment.

Angina

Angina is chest pain caused by reduced blood flow to the heart, typically due to coronary artery disease. Stable angina is predictable, occurring during physical exertion or emotional stress and resolving with rest or nitroglycerin. Unstable angina occurs unpredictably, even at rest, and is a medical emergency because it may precede a heart attack.

Other Cardiac Causes

• Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, causes sharp chest pain that worsens with deep breathing or lying down and improves when leaning forward
• Myocarditis: Inflammation of the heart muscle itself, often following a viral infection, can cause chest pain, fatigue, and rapid heartbeat
• Aortic dissection: A rare but life-threatening condition where the inner layer of the aorta tears, causing sudden, severe, tearing chest pain that radiates to the back

Non-Cardiac Causes of Chest Pain

Gastroesophageal Reflux Disease (GERD)

GERD is one of the most common non-cardiac causes of chest pain. Stomach acid flowing back into the esophagus causes a burning sensation behind the breastbone that can closely mimic heart pain. GERD-related chest pain typically:

• Occurs after eating, especially large or spicy meals
• Worsens when lying down or bending over
• Has an acidic or burning quality
• Responds to antacids
• May be accompanied by regurgitation or a sour taste

Musculoskeletal Causes

Costochondritis, inflammation of the cartilage connecting the ribs to the breastbone, is a very common cause of chest pain, particularly in young adults. The pain is typically sharp and localized, worsens with movement, deep breathing, or pressing on the affected area, and can last days to weeks.

Muscle strain from exercise, heavy lifting, or even vigorous coughing can cause chest wall pain that may be mistaken for something more serious. This pain is usually reproducible with specific movements and tender to touch.

Anxiety and Panic Attacks

Panic attacks are a frequently underrecognized cause of chest pain. During a panic attack, the sympathetic nervous system activates intensely, causing real physical symptoms including:

• Chest tightness or sharp pain
• Rapid heartbeat (palpitations)
• Shortness of breath or hyperventilation
• Tingling or numbness in the hands and around the mouth
• Dizziness and sweating
• Intense fear of dying

These symptoms overlap considerably with cardiac events. Read our detailed comparison in Anxiety vs Heart Attack: How to Tell the Difference.

Pulmonary Causes

• Pulmonary embolism: A blood clot in the lung artery causes sudden sharp chest pain, shortness of breath, and rapid heart rate. This is a medical emergency.
• Pneumonia: Lung infection can cause chest pain that worsens with breathing or coughing, along with fever, cough, and fatigue
• Pleurisy: Inflammation of the lining around the lungs causes sharp pain that worsens with each breath

When to Call 911

Call emergency services immediately if you experience:

• Chest pain or pressure lasting more than a few minutes
• Pain that radiates to your arm, jaw, neck, or back
• Chest pain with shortness of breath, sweating, nausea, or dizziness
• Sudden, severe, tearing chest pain
• Chest pain with loss of consciousness
• Chest pain with a known history of heart disease

Do not drive yourself to the hospital. Emergency medical services can begin treatment en route and alert the hospital to prepare for your arrival.

Diagnostic Tests for Chest Pain

When you present to a medical facility with chest pain, doctors use several tests to determine the cause:

• Electrocardiogram (ECG/EKG): Records the electrical activity of your heart and can reveal signs of a heart attack or abnormal rhythm within minutes
• Blood tests: Cardiac biomarkers like troponin are released when heart muscle is damaged. Elevated troponin levels strongly suggest a heart attack
• Chest X-ray: Identifies lung-related causes such as pneumonia, pneumothorax, or an enlarged heart
• CT angiography: Provides detailed images of the coronary arteries and can detect pulmonary embolism
• Echocardiogram: Uses ultrasound to visualize heart structure and function
• Stress test: Evaluates heart function during exertion, typically used for stable patients where coronary artery disease is suspected

Upload your recent blood work to our lab results analyzer to understand your cardiac biomarkers and other results.

Reducing Your Risk

While not all causes of chest pain are preventable, you can significantly reduce your risk of cardiac-related chest pain by:

• Not smoking or quitting if you currently smoke
• Maintaining a healthy blood pressure below 120/80 mmHg
• Keeping cholesterol levels in a healthy range
• Exercising regularly, aiming for at least 150 minutes of moderate activity per week
• Eating a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins
• Managing stress through relaxation techniques, adequate sleep, and social support
• Maintaining a healthy weight
• Managing diabetes effectively if diagnosed

The Bottom Line

Chest pain has many possible causes, ranging from completely benign to immediately life-threatening. The key takeaway is this: when in doubt, get checked out. No emergency physician will fault you for seeking evaluation for chest pain that turns out to be non-cardiac. The cost of missing a heart attack or pulmonary embolism is far too high.

If you experience chest pain and want a preliminary assessment of your symptoms, use our symptom checker. But remember, a symptom checker is never a substitute for emergency medical care when you are experiencing acute chest pain.

This article is for informational purposes only and does not constitute medical advice. Chest pain can indicate a life-threatening emergency. If you are experiencing chest pain, call 911 or your local emergency number immediately.