Chest pain can be scary, but it doesn’t always mean you’re having a heart attack. Here’s what to know about heart pain versus chest pain.

Story by: Sara Thompson on December 6, 2023

Most people are familiar with the typical way someone shows they are having a heart attack: gasping, clutching their chest, and so on. Despite what may be depicted as a heart attack in movies or on TV, sometimes chest pain is just chest pain — with a harmless cause. However, sometimes pain in the chest can mean something serious.

Here are some tips on when to worry about chest pain.

Millions of Americans go to the emergency room every year, complaining of chest pain. Only about 20% of them are having a heart attack. Pain, pressure, aches and other feelings in the body can mean different things.

“Chest pain and the potential for heart issues should be taken seriously,” said Abdullahi O. Oseni, M.D., interventional cardiologist with Norton Heart & Vascular Institute. “While there are many conditions that can cause chest pain, you should err on the side of caution and see a health care professional. We want to rule out anything more dangerous.”

Heart attack or chest pain?

While the scenes in TV and movies might make you think sudden, severe chest pain is the prime sign of a heart attack, that’s not exactly true or even true in every case.

“Very few people actually describe the symptom as pain,” Dr. Oseni said. “People say it feels more like pressure, tightness, squeezing or even indigestion. Some just describe a general feeling of discomfort.”

The feeling may travel into the left arm, shoulder, neck, jaw or back. There are often early signs of a heart attack that people ignore.

Everyone experiences heart attacks in different ways, Dr. Oseni said. Heart attack symptoms also can be different in men than in women.  Some people don’t have any discomfort in the chest but may experience other symptoms, including:

• A feeling in the chest often described as pressure, tightness, squeezing or constriction — but not always
• Nausea
• Pain or tightness in the arm, shoulder, neck, jaw or back
• Shortness of breath
• Sweating
• Weakness or dizziness

“Sharp pain that is very focal and you can point directly to with one finger is often not a heart attack but could be another condition that is an emergency,” Dr. Oseni said. “People more commonly describe the chest pain associated with a heart attack as feeling like someone is sitting on their chest.” 

What causes chest pain?

Besides a heart attack, there are other conditions that cause pain in the chest.

Gastroesophageal reflux (GAS’-troh-ee-soff-uh-jee-ul REE’-flux) disease (GERD)

Is it heartburn or a heart attack? Heartburn is a condition where stomach acids push up into your esophagus, the tube that connects your mouth with your stomach. This can happen once in a while, maybe after you eat spicy food. It causes a burning feeling in your chest. If heartburn happens often, the lining of the esophagus can become irritated, and GERD can develop.

Pain from GERD can be managed at home by avoiding certain foods and beverages such as alcohol, caffeine, fatty foods and peppermint, not lying down after a meal or stopping smoking. If GERD is not manageable for you and is interfering with daily life, you may want to speak to your doctor about a prescription antiacid or other ways to treat GERD.

Chest pain from muscle strain

If you have ever “overdone it” with a physical activity and been sore, you may have had musculoskeletal (muss-kyuh-loh-SKELL’-eh-tul) chest pain. This kind of pain affects the bones, muscles and nerves of the chest wall, which are close to the heart. Injury or overuse are the most common causes of musculoskeletal pain.

Most of the time, musculoskeletal pain goes away on its own, especially if you use some treatments such as:

• Taking over-the-counter pain medicine, such as ibuprofen
• Cold or hot compresses
• Gentle stretching
• Reducing the activity that causes the pain, until the pain goes away

See a doctor if the pain does not get better over time, with or without home remedies, or if the pain gets worse.

Emotional stress and anxiety

The link between mind and body is powerful. When we believe we are in danger, our body responds, moving into fight, flight or freeze mode. Muscles clench, breathing become shallow and rapid, and the mind races. While everyone reacts to anxiety differently, anxiety-induced chest pain can feel like a sudden sharp pain or pressure.

People often say a panic attack feels like a heart attack, so it’s best to have a health care provider check you if you have this type of pain.

Angina

Angina (an-JY’-nuh) is another cause of chest pain. It happens when the heart doesn’t get enough oxygen-rich blood. It can feel like pressure or squeezing in your chest. The pain may be felt in your shoulders, arms, neck, jaw, abdomen or back. Angina pain may even feel like indigestion. Some people don’t feel any pain but have other symptoms like shortness of breath or fatigue.

Angina is a symptom of a heart issue, such as coronary heart disease (CHD), also known as coronary artery disease (CAD) or coronary microvascular disease (MVD).

Angina usually happens because one or more of the coronary arteries is narrowed which leads to what is known as ischemia (uh-SKEE’-me-uh ).

You should see a health care provider if you have a personal or family history of heart conditions and develop pain in the chest, shortness of breath or any of the above symptoms.

“It is always better to come have chest pain checked out by your doctor,” Dr. Oseni said. “We would prefer your chest pain to be from a little gas or too many bench presses, and not from something very serious.”