Chest pain is one of those symptoms that immediately makes you think the worst: that maybe you’re having a heart attack. But there are a lot of reasons you may feel discomfort, pressure, or tightness in your chest that have nothing to do with your ticker. In fact, half of the people that cardiologists see for chest pain have no heart problems at all.
“Lots of people experience non-cardiac chest pain,” Jeffrey Huffman, MD, an associate professor of psychiatry at Harvard Medical School and the director of the cardiac psychiatry research program at the Massachusetts General Hospital (MGH), tells SELF. “Being told you’re not having a heart attack is great [but] it doesn’t make your chest pain go away.” In other words, you might have to do some detective work with your doctor, Dr. Huffman says, which will provide some clues that can guide you to treatment options for relief.
So next time your chest feels a little weird, try not to automatically assume the worst. Here are five causes of chest pain that are totally unrelated to your heart.
1. You hurt the cartilage or muscles in your chest.
Injuries to the chest (think car accidents and falls) can cause serious pain. But even regular ol’ muscle strains, which can happen after lifting heavy objects, exercising without a proper warm-up, or sitting with poor posture all day, can be a problem too. Another chest-related injury you may not have heard about: costochondritis. It occurs when the cartilage that connects your rib bones to your breastbone becomes inflamed, Timothy Mott, MD, a family medicine physician at the South Baldwin Regional Medical Center in Alabama, tells SELF. Up to one third of people who see a doctor for chest pain actually have this condition, which is slightly more common in women, and can happen after intense exercise, respiratory infections, certain types of arthritis, coughing or vomiting too hard, or complications from surgery.
But one super-important thing to note: These types of chest injuries don’t usually cause shortness of breath, fever, or rash. So if you’re experiencing any of these symptoms along with your chest discomfort, see a doc, stat, because a more serious condition may be to blame.
2. You have acid reflux.
If you’ve ever laid down shortly after eating a hefty dinner and immediately felt a fiery sensation, then you know acid reflux can also cause chest pain. This happens when a muscular valve at the bottom of your esophagus doesn’t function properly and allows your very acidic stomach contents to migrate upward, hence that awful burning pain in your chest, a.k.a. heartburn, Allon Kahn, MD, a gastroenterologist with the Mayo Clinic in Arizona, tells SELF. If your symptoms are long-lasting and severe, you likely have gastroesophageal reflux disease (GERD).
Although it can make you miserable, acid reflux isn’t life-threatening, Dr. Khan says—but the intense pain it often causes can be nerve-wracking. “It may actually not feel any different from a heart attack,” Dr. Kahn adds. “So it can be very scary for people.” GERD can also lead to some complications like damage and inflammation in the esophagus and changes that increase your risk of esophageal cancer. For that reason alone, it’s worth avoiding triggers like alcohol or late-night meals—or even some medications that can make it worse, like aspirin or ibuprofen—but chat with your doc for the best approach.
3. Your anxiety or depression may be to blame.
Anxiety doesn’t usually warrant a trip to the hospital. But if it unexpectedly morphs into a panic attack, it can definitely feel like an emergency, in part because of how it can affect your chest. “They’re unbelievably intense. It’s your fight or flight nervous system going haywire,” Dr. Huffman says. “You feel short of breath. You can experience chest pressure, nausea, fever, chills…. And, gosh darn it, it feels like you’re going to die or you’re having a heart attack.” A panic attack might make you hyperventilate, or breathe faster or deeper than normal, which can strain the muscles in the area, Dr. Huffman says. Or it can lead to chest pain through a more cardiovascular route, by causing your arteries to narrow and thus restrict blood flow to your heart.
At the same time, you don’t have to have a full blown panic attack to experience chest pain; chronic anxiety can, for a lot of folks, cause a more gradual discomfort that ranges from a persistent achey feeling to a dull pressure or tightness. In a similar vein, depression can also make your chest hurt in a “much less episodic and dramatic” way compared to panic attacks, Dr. Huffman says. These physical manifestations of mental health problems are what doctors call somatic symptoms, he notes, and it can cause anything from stomach upset and headaches to chest pain and even difficulty breathing. Luckily, a lot of treatments exist to address these issues, but work with your doctor to ensure nothing more serious is going on. “If you can identify the right diagnosis and get the right treatment, your whole life can be better,” Dr. Huffman says. “Not just from the chest pain, but in general.”
4. Something is going on with your lungs.
Your lungs can sometimes be the source of your chest pain, Panagis Galiatsatos, MD, MHS, a pulmonologist and national spokesperson for the American Lung Association, tells SELF. Air pollution from wildfire smoke and vehicle exhaust, for example, can irritate your airways and lead to tightness and coughing (which can strain your chest muscles and cause pain). Inhaling cold, dry air is another common cause of chest pain, Dr. Galiatsatos says, particularly if you’re a mouth breather (your nose helps to warm the air you breathe) and have respiratory conditions like asthma. This chronic lung disease makes breathing difficult and can cause chest pain on its own, as well as exacerbate other scenarios.
5. You have an infection, clot, or other medical condition.
Some other lung-related conditions known to cause chest discomfort include:
Pneumonia: This infection inflames the air sacs in your lungs and can make your chest hurt when you breathe or cough. Pleurisy: This is a fancy word for swelling that occurs in the lining of your lungs and chest, and it can be the result of certain autoimmune conditions like lupus, viral infections, and blood clots. Pulmonary embolism: A blood clot in one of your lungs restricts blood flow to the organ and increases your blood pressure. Shortness of breath and chest pain are often the first symptoms; it’s considered a medical emergency that warrants a 911 call.
Depending on what lung problem you have, it’s very likely that you’ll also have a cough, Dr. Galiatsatos says, so look out for that extra symptom to help rule out your heart as the source of the problem.
How to tell when your heart might actually be the culprit.
For obvious reasons, your heart is one organ you don’t want to mess with, so it’s important to know the signs that something is off. Heart-related pain is called angina, and it happens when at least one of your coronary arteries becomes blocked (usually by a fatty plaque), temporarily restricting blood flow to the heart. You may feel a pressure or tightness in the chest, and depending on the type of angina you have, it can worsen during physical activity.
A heart attack occurs when that plaque we mentioned ruptures, causing a blood clot to form and further block blood flow to the muscle, Glenn Levine, MD, a cardiologist and volunteer expert with the American Heart Association, tells SELF. In that case, you may feel on-and-off chest pain that lasts longer than a few minutes and can spread to your arms, back, neck, and jaw. It may also cause shortness of breath, nausea, cold sweats, lightheadedness, and vomiting—all of which are common among women specifically.
If you think you’re having a heart attack, don’t hesitate to call 911 and go to the hospital, ASAP, Dr. Levine says. Otherwise, stay tuned to everything you’re feeling, taking note of what you did (or ate) just before your chest pain emerged, and then avoid any triggers you pick up on along the way. “If you’re having chest pain and it’s unexplained, don’t give up,” Dr. Huffman advises. “Go see your primary doctor, really get a good workup, because often there is some non-cardiac cause for it.”
Related:
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