10 Common Causes of Chest Pain (It’s Not Always a Heart Attack)

Chest pain is any pain between the neck and upper abdomen, and it can be frightening. Chest pain can be sharp, dull, throbbing, or aching. And sometimes chest pain can spread to other parts of the body, like the jaw, back, or arms. Or it can happen along with other symptoms, like nausea, vomiting, or sweating.

If you experience chest pain, the first question that may come to mind is if you’re having a heart attack. While a heart attack is a major concern, there are many causes of chest pain. And they vary in levels of danger. Either way, you’ll want to get medical attention to figure out the exact cause. 

Your healthcare team will want to know how the pain feels, how often it happens, and which other symptoms you have. These can all be clues to the cause. And knowing the possible causes may help ease the anxiety a bit.  

Here are 10 of the most common causes of chest pain.

1. Heartburn

People often describe heartburn as a burning sensation that starts at the bottom of the chest and moves up toward the throat. And it’s a common cause of chest pain. 

Acid reflux, or gastroesophageal reflux disease (GERD), frequently causes heartburn. It occurs when acid or stomach contents come back into the throat. Nausea, vomiting, and a metallic taste in the mouth are some symptoms that can occur with GERD.

Sometimes people mistake a heart attack for GERD. Your pain is more likely to be from GERD than a heart issue if:

• It usually occurs after eating, especially a spicy or fatty meal.

• It occurs after lying down or at night.

• You notice a metallic taste.

• It usually goes away after you take an antacid (like Tums). 

• You have no trouble breathing, sweating, or numbness of any part of your body.

2. Shingles

Shingles is a painful condition caused by the varicella zoster virus. Varicella attacks groups of nerves in one area of the body. And sometimes it happens in the chest area. This can cause burning chest pain. After a few days, there is commonly an outbreak of a rash with fluid-filled bumps.

When you get chickenpox, you’re infected with this virus. It can then live in the body in an inactive state for a long time before becoming active again. When it becomes active again, you can develop shingles. It’s not alway clear why the virus becomes active. Sometimes it can be caused by stress, infection, aging, or anything that weakens the immune system.

Shingles pain can be so intense you may feel like you’re having a heart attack. Your pain is more likely from shingles than from your heart if:

• You have a rash in the same location as the pain (the rash often shows up later),

• You don’t have any trouble breathing, nausea, vomiting, or sweating.

You have a risk for shingles if you’re at least 50 years old or you’re an adult with a weakened immune system. Talk to your provider to see if the shingles vaccine is an option for you. 

3. Pneumonia

Pneumonia is an infection in the lung and is a common cause of chest pain. It can be caused by different germs — including bacteria or viruses, like COVID. Common symptoms of pneumonia are:

• Sharp, stabbing pain that gets worse with breathing

• Fever

• Cough

• Fatigue

• Chills

• Nausea or vomiting

• Shortness of breath

Pneumonia can be serious. In some cases, it requires hospitalization. So be sure to let your provider know if you have any symptoms. 

4. Muscle injury

Muscle injury or muscle strain can cause chest pain after activities like heavy lifting or exercise. Sometimes, the pain can be intense enough to mimic a heart attack. But there are some features of muscle strain that may make it easier to tell the difference. 

Pain from muscle strain is usually reproducible — when you push on the area of the pain, you feel the pain. And it will get worse when you move a certain way or into certain positions.

There is no nausea, vomiting, sweating, or trouble breathing with pain from muscle strain. And it doesn’t get worse when you exert yourself.

5. Gallstones

Gallstones can form when bile hardens in the gallbladder. The purpose of bile is to help digest fatty foods. But it can solidify and form stones. 

The pain typically occurs after a meal. Usually the pain is in the right or middle part of the upper abdomen, but it can travel to the chest. 

Certain factors increase the risk of developing gallstones, like:

• Being born with female anatomy

• Being older 

• Being pregnant

• Having a heavier body weight 

It can be hard to tell gallstone pain apart from a heart attack. But there are some features of gallstone pain that may help:

• Eating usually triggers it, especially fatty or greasy food.

• It can start as sharp pain that comes in waves.

• It may begin in the right, upper belly, move to the middle of the belly, and then up to the chest.

• The painful area is tender to touch.

6. Panic attack

A panic attack is a common cause of intense chest pain. It can cause tightness of the chest, trouble breathing, and a sense of doom. Stress can be a trigger, but it can also occur without an obvious cause.

The first time you have a panic attack, it can be scary. And you might think you’re having a heart attack. Some common features of a panic attack include:

• Short episodes(a few minutes long)

• Rapid breathing 

• Numbness or tingling around the mouth and fingertips

• A history of a recent stressful event

7. Pleurisy

Sometimes, the lining of the lungs gets irritated. This is what happens in pleurisy. And it’s another common reason for chest pain. It’s not clear why this happens, but it’s more likely to happen after a viral infection. 

Pleurisy can be painful, but it’s not life-threatening. Here are some features that may help it stand out from a heart attack:

• A sharp pain that’s worse when you breathe in

• No nausea, vomiting, or sweating

• History of a recent respiratory infection

8. Pericarditis

Pericarditis is when the sac lining the heart gets inflamed. A viral infection can trigger this inflammation. But sometimes there is no identified cause. 

Common symptoms of pericarditis are:

• Sharp chest pain 

• Pain that gets better when leaning forward 

• Pain that’s worse when breathing in

This is a heart-related cause of chest pain. But it’s a totally separate condition from a heart attack. Even so, sometimes the electrocardiogram (EKG) of someone with pericarditis can look like that of a true heart attack.

Fluid can build up in the lining of the heart with pericarditis. And this can be life-threatening in some cases. 

9. Pulmonary embolism

Another common cause of chest pain is a pulmonary embolism (PE). This is a blood clot in the lungs. The pain from a PE is usually sharp, constant, andgets worse with breathing in. You’ll often have trouble breathing with the pain. And you may notice a decreased ability to tolerate activity. Sometimes, this is the only sign of a PE. Occasionally, it can occur without pain.  

Risk factors for a blood clot include:

• A lack of movement (like sitting at a desk, being on a plane, or sitting on a long trip)

• Recent surgery (with limited mobility)

• Hormone therapy (like birth control)

• A personal or family history of clotting disorders (like Factor V Leiden)

• Cancer

• COVID 

A PE is an emergency and needs medical attention right away.

10. Pneumothorax

A pneumothorax happens when the lung collapses and air gets trapped between the lung and chest wall. A pneumothorax can be quite painful. The pain is usually sharp and worsens when you inhale. 

In most cases, the cause of a pneumothorax is a traumatic injury. But it can occur spontaneously in some people. It can be life-threatening and needs immediate attention. 

Some risk factors that make a pneumothorax more likely include:

• Tall individuals with a lower body weight

• Smoking

• Lung disease (as seen in asthma, sarcoidosis, tuberculosis)

• Forceful coughing

• Traumatic injury

• Pregnancy

What to do if you’re feeling pain in your chest

You should let your healthcare provider know if you’re having chest pain. They can help find the source of your pain. And they can develop a treatment plan that is best for your symptoms.

There are some instances where you should go to the emergency room for chest pain. You should seek emergency care if you have any of these symptoms:

• Severe chest pain

• Pain that doesn’t get better after treatment (like heartburn that doesn’t improve with an antacid)  

• Trouble breathing

• Fever or chills

• Vomiting

• Sweating

• Pain that moves to the jaw, arm, or back

• Bloody cough

• Weakness

• Fast heart rate (above 100 beats per minute)

It’s especially important to seek care sooner than later if you have a family history of heart problems. 

You should always get medical attention if you’re concerned about your chest pain — even if you don’t have any of these risk factors.

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Written by:

Mobola Kukoyi, MD, MPH

Dr. Mobola Kukoyi is a board-certified emergency and trauma physician with expertise in medical education, consulting, and public health. She earned her medical degree from Duke University School of Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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