9 Causes of Chest Pain That Aren't a Heart Attack

Chest pain can have many causes, some benign and some serious. If you experience new chest pain, it's best to seek medical care immediately. Some clues can help you determine if chest pain is muscular and not a heart attack. For example, if chest pain does not last longer than several minutes, it might be muscular. If the pain feels tender or worsens when you press on the area, a chest injury or pulled muscle may be the cause. 

Chest pain can have many causes, including angina, heartburn, infections, inflammation, and panic attacks. A heart attack occurs when something severely reduces or completely cuts off the blood flow that brings oxygen to the heart muscle. Heart attacks may cause pain that lasts for hours and can be fatal if untreated.

1. Pulled Muscle in Chest

Someone can mistake a strained chest muscle for something more serious, like a heart attack, Christine Jellis, MD, Ph.D., a cardiologist at the Cleveland Clinic, told Health.

"I had a patient who came in with chest pain, and he was worried he was having a heart attack," said Dr. Jellis. "After taking his history, I learned he had moved [to a new house] and hadn't lifted heavy furniture in years. But he did the right thing, coming in."

Healthcare providers do not expect people to be able to tell the difference between a heart attack and a pulled chest muscle, added Dr. Jellis. However, pain is more likely due to a pulled muscle if it hurts when you press on it

2. Angina

Angina, or ischemic chest pain, is a type of chest pain that may feel like pressure or squeezing, typically when you physically exert yourself or are emotionally stressed. It happens if there is a lack of blood supply and oxygen to your heart muscle. Angina pain is the same type of pain you could feel during a heart attack. While not all angina is a heart attack, it is still a potenti emergency, and you should seek medical attention immediately.

If you have angina, you may feel that discomfort in other body parts, such as:

• Abdomen
• Arms
• Back
• Jaw
• Neck
• Shoulders

Angina may feel like heartburn, but it is short-lived and typically does not last longer than several minutes. Angina indicates an increased risk of a heart attack. It is a symptom of coronary artery disease (CAD), a common type of heart disease. A heart attack is the most severe symptom of CAD, so seeing a healthcare provider if you have angina is essential.

Different types of angina exist. Chronic stable angina is when you experience angina almost predictably when you exert yourself to a certain degree. The angina should subside when you stop the activity. You should still have your heart checked out if you experience this type of angina.

Unstable angina is when you experience unexpected chest pain, and it usually occurs while you're resting. Unstable angina is a type of acute coronary syndrome, as are heart attacks, meaning it can happen when your heart stops receiving blood. It should be treated as an emergency.

3. Heartburn

Occasional acid reflux is relatively common and probably nothing to worry about. However, if you have reflux more than once weekly, you may have gastroesophageal reflux disease (GERD). Acid reflux can be hard to distinguish from a heart attack, so you should see a healthcare provider if you're experiencing any new chest pain.

Stomach acid is highly acidic. On the pH scale, which measures how acidic something is, stomach acid falls between battery acid and vinegar. As a result, GERD causes a burning sensation behind your breastbone.

Other GERD symptoms include:

• Chest pain
• Chronic cough
• Hoarseness
• Nausea
• Painful swallowing
• Trouble swallowing

GERD occurs when stomach contents back up into your esophagus, or the tube that connects your throat and stomach.

Risk factors for GERD include:

• Certain medications (e.g., antidepressants, asthma medicines, and non-steroidal anti-inflammatory drugs)
• Hiatal hernia, which causes your upper stomach to push upward into your chest 
• Overweight or obesity
• Pregnancy
• Smoking or secondhand smoke

GERD may cause asthma flares or symptoms, Barrett's esophagus, and chronic cough if untreated. Barrett's esophagus causes tissue that looks like your intestinal lining to replace the tissue in your esophagus. Barrett's esophagus may raise your risk of a rare type of cancer.

4. Pericarditis

Pericarditis is inflammation of the pericardium, or the tissue layers surrounding your heart. Sharp, stabbing pain on the left side or front part of the chest is one of the most common pericarditis symptoms. Pain may occur in the abdomen, back, neck, or shoulders.

Pain may be more intense while breathing deeply, coughing, lying down, or swallowing. In contrast, pain may improve with leaning forward while sitting up.

Other pericarditis symptoms include:

• Anxiety
• Chills
• Dry cough
• Fatigue
• Fever
• Sweating
• Swollen ankles, feet, or legs
• Trouble breathing while lying down

Research has found that viral infections commonly cause pericarditis in 80% to 85% of cases. Other less common causes include bacterial and fungal infections.

Pericarditis risk factors include:

• Certain health conditions (e.g., autoimmune diseases and cancer)
• Certain medicines (e.g., those that suppress the immune system and treat cancer)
• Chest, esophagus, or heart injuries
• Heart attack
• Heart muscle inflammation and swelling 
• Heart surgery 
• Previous radiation therapy to the chest

To treat pericarditis, a healthcare provider will likely prescribe a high-dose pain reliever, such as ibuprofen, and colchicine. Like ibuprofen, colchicine is a medicine that reduces pain, inflammation, and swelling. You may need antibiotics, antivirals, or antifungals if an infection causes your pericarditis. Other treatments may include drainage of fluid from the pericardium and surgery.

5. Pleuritic Chest Pain

Pleuritic chest pain is inflammation of the pleura, or the lining of your lungs. You may feel sudden burning, sharp, or stabbing chest pain while breathing deeply.

An infection, like pneumonia, may cause pleuritic chest pain. Typically, chest pain from pneumonia occurs when you breathe or cough.

Pulmonary embolism is one of the most severe causes of pleuritic chest pain. A pulmonary embolism occurs when something blocks a lung artery. That blockage can damage the lungs and cause low oxygen levels in your blood, damaging other organs. A pulmonary embolism can be life-threatening if untreated. Common treatments include blood thinners and anticoagulants.

Other causes of pleuritic chest pain include:

• Certain cancers
• Chest injury
• Lupus, in which your immune system mistakenly attacks its healthy cells
• Rheumatoid arthritis, or an inflammatory disease that affects your joints

Pleuritic chest pain does not signal a heart attack. Still, pleuritic chest pain can be severe and have life-threatening causes, so seeing a healthcare provider is essential.

Treatment may include antibiotics if a bacterial infection causes pleuritic chest pain. In contrast, viral infections typically do not require medicine. You may need surgery to drain fluid from your lungs. Pain relievers can help quell any discomfort.

6. Shingles

The virus that causes chickenpox lays dormant in your nerve cells long after the spots have faded. Shingles happens when the varicella-zoster virus (VZV) that causes chickenpox reactivates, usually in people older than 50.

Some of the first symptoms of shingles include pain, itching, or tingling. Typically, a rash appears days later, followed by blisters.

If shingles affect your chest area before a rash appears, you might mistake early pain for a heart attack, Salman Arain, MD, an interventional cardiologist at Houston and the Memorial Hermann Heart & Vascular Institute-Texas Medical Center, told Health.

See a healthcare provider right away if you develop shingles. Antiviral medicine helps shorten the length of your symptoms if you take it within 72 hours of the rash appearing. A healthcare provider might prescribe pain relievers if it's too late to take antiviral medicine.

7. Costochondritis

Costochondritis is inflammation of the tissue connecting your ribs to your breastbone. Typically, costochondritis causes you to feel pressure on your chest wall. You may feel tenderness when pressing on the area like a strained muscle.

Costochondritis is a common harmless cause of chest wall pain. Still, seeing a healthcare provider is a good idea if you suddenly develop costochondritis.

To diagnose costochondritis, a healthcare provider will likely start by taking your medical history and doing a physical exam.

"A physician is going to want to rule out cardiac and other serious issues first," said Dr. Jellis. "It'll most likely be a diagnosis by exclusion."

Some of the most common causes of costochondritis include:

• Arthritis
• Chest injury
• Heavy lifting
• Infections that develop after IV drug use or surgery
• Straining while coughing
• Vigorous exercise
• Viral infections

Over-the-counter (OTC) pain relievers and cold or hot compresses help treat costochondritis. The pain usually goes away within a few days or weeks.

8. Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas, which is located just behind the stomach. Most commonly, pancreatitis causes intense abdominal pain that can radiate up to the chest.

In addition to chest pain, pancreatitis may cause symptoms like:

• Fever
• Nausea
• Rapid heartbeat
• Tender or swollen abdomen
• Vomiting

Pancreatitis often occurs when gallstones—or hard, pebble-like pieces of hardened cholesterol—trigger inflammation in the pancreas. Women are more likely to have pancreatitis than men.

Other risk factors for pancreatitis include:

• Alcohol use disorder
• Autoimmune diseases
• Certain medicines
• Cystic fibrosis, in which sticky, thick mucus clogs the lungs and causes trouble breathing
• High calcium or fat levels in the blood

If you have pancreatitis symptoms, seek immediate medical attention. To diagnose pancreatitis, a healthcare provider may order blood work and other tests, such as an abdominal ultrasound or CT scan.

You will likely have to stay in the hospital for antibiotics, IV fluids, and pain medicine for a few days.

9. Panic Attack

A panic attack is intense anxiety due to your body's fight-or-flight response kicking in. A panic attack can feel like a heart attack.

In addition to chest pain, a panic attack may cause symptoms like:

• Dizziness
• A feeling of "going crazy" or like you are dying
• Nausea
• Pounding heart
• Shaking
• Sweating

Some people have a family history of panic attacks. Generally, people experience panic attacks suddenly without a known cause.

Visiting a healthcare provider can be helpful if you have had a panic attack. They can rule out any physical issues with your heart, which can put you at ease. This can be particularly important if you don't yet have a panic attack diagnosis and are experiencing symptoms for the first time. A healthcare provider may refer you to a mental health specialist who can help you manage your symptoms.

When To Contact a Healthcare Provider

A heart attack is not always the cause of chest pain. Some chest pain causes can be mild, like heartburn, while others can be severe, like pancreatitis.

Still, it's essential to consult a healthcare provider as soon as possible if you have chest pain. They can figure out if your chest pain is angina, heart attack pain, or something else.

Do not hesitate to call 911 if you have chest pain, especially if you experience any of the following:

• Angina that occurs at rest or is more painful than normal
• Dizziness
• Nausea
• Pain that spreads to your jaw, left arm, or between your shoulders
• Rapid heartbeat
• Sudden squeezing or tightening pressure in your chest
• Sweating
• Trouble breathing

Other symptoms to watch out for include sudden, intense chest pain after periods of rest and leg swelling in one leg, especially after a long car trip, flight, or bedrest after surgery. Those symptoms may signal a pulmonary embolism.

If you suspect you're having a heart attack, it's best to call an ambulance rather than driving yourself or asking someone to drive you. It's safest to be transported by emergency personnel who are properly equipped to help you.

A Quick Review

Chest pain does not always signal a heart attack. Other causes of chest pain include heartburn, infections, inflammation, and panic attacks. 

Consult a healthcare provider if you have heart attack risk factors, such as existing heart disease, high blood pressure or cholesterol, and overweight or obesity.