If you treat chest pain like a medical whodunit, the heart is always a prime suspect. But your doctor can tell you that the lungs, gastrointestinal problems and the bones, muscles and nerves in the chest area can also cause discomfort or more serious pain that resembles a heart attack.
Non-cardiac chest pain, the type not related to the heart, affects up to 25 percent of American adults, according to the National Institutes of Health. But never assume that unusual chest pain is unrelated to the heart. It’s important to know the source of your chest pain – there’s a big difference between heartburn and the onset of a heart attack.
If you think you’re having a heart attack or other serious issue affecting the heart, don’t take any chances. Dial 911.
If you have -- or are susceptible to -- any of the conditions below, talk to your doctor about the types of chest pain you can expect, the risks and the appropriate response.
Heart
Angina: Angina usually announces itself with pain or discomfort behind the breastbone. The tightness, aching, pressure and burning sensation can span the entire chest and beyond. If you’re experiencing angina, sometimes even your teeth hurt. But you’re not having a heart attack.
Aortic dissection: The aorta carries oxygen-filled blood from the heart to the rest of your body. When diseased, the aorta can dilate (aneurysm) or split (dissection). A rupture is potentially fatal.
Pericarditis: Pericarditis, an inflammation of the two-layered membrane around the heart, often announces itself with intense pain either in the chest’s central region or left side. Pain also might radiate to the shoulders, back, neck and abdomen. Unlike angina, a short-lived chest pain that usually responds to rest, pain caused by pericarditis can last for hours, even days, and is unaffected by rest.
Hypertrophic cardiomyopathy: Thickened heart muscle, affecting how the heart fills with blood or how it distributes blood to the body. This condition can cause sudden death in adolescents and young adult athletes. It’s frequently inherited.
Mitral valve prolapse:The mitral valve, which controls blood flow between two chambers of the heart, has two valves that can bulge back or prolapse, into the left atrium. It’s usually a harmless malfunction that affects 2 percent to 3 percent of the general population.
Coronary artery dissection: A heart attack caused by a spontaneous tear in the coronary artery wall.
Digestive
Heartburn: It might feel like the heart, but heartburn has nothing to do with the heart. It’s usually caused by stomach acid backing up in the esophagus, better known as GERD (gastroesophageal reflux disease.
GERD (Gastroesophageal reflux disease): A weakening or relaxation of the lower esophageal sphincter, causing acid reflux.
Gallbladder: Gallstones, created by cholesterol and other material in the bile, can cause chest pain that feels like a heart attack.
Pancreatitis: Inflammation of the pancreas, the long, flat gland behind the stomach, with pain that extends to the chest.
Esophageal spasm: These sudden contractions can cause intense chest pain that lasts for only a few minutes or for hours.
Esophageal hypersensitivity: With symptoms similar to GERD, people with esophageal hypersensitivity can experience heartburn and chest pain.
Esophageal rupture or perforation: A large tear of the esophagus can feel like a heart attack. A rupture, whether caused by vomiting, trauma or cancer, is a medical emergency that requires immediate attention.
Hiatal hernia: Part of the stomach extends through the diaphragm and into the chest cavity, where it can cause pain and, in extreme cases, feel like a heart attack.
Muscle/Bone
Costochondritis: Inflammation of the cartilage in the rib cage that can cause mild to severe chest pain.
Muscle strain: Lifting heavy weights or even coughing can cause a muscle strain the produces sharp pain similar to a heart attack. In this case, however, applying ice immediately after the pain starts for up to 20 minutes at least three times daily should help relieve the pain.
Rib Injury: Bruised or broken ribs can cause extreme pain in the chest area, notably when you inhale.
Shingles: This condition, rooted in the same virus that causes chickenpox, causes chest discomfort. It also increases your risk of heart attack and stroke.
Lung
Pulmonary hypertension: High blood pressure in the lung’s arteries. Chest pain can be accompanied by swelling in the ankles, legs and abdomen and bluish skin and lips.
Pulmonary embolism: A sudden blockage of an artery in the lung caused by a blood clot. With each breath, you will feel pain in the chest.
Pleuritis: An inflamed pleura, the membrane that lines part of the chest cavity and the tissue surrounding the lungs, can cause stabbing chest pain.
Collapsed lung: When air accumulates between the lung and the chest wall, preventing your lungs from expanding normally as you inhale, you’ll experience chest pain and shortness of breath.
Pneumothorax: A collapsed lung, when air leaves the lung and collects outside the lung between the lung and chest wall.
Asthma: A respiratory condition that can produce chest pain before, during and after an attack.