The sensation of chest pain can immediately send your mind racing to: "Oh no, am I having a heart attack?" And, it's true that severe pressure or tightness in the chest is the most common symptom of a heart attack. But many other chest pain causes can lead to similar types of discomfort, experts say, and it can be really tricky to know what you're actually dealing with.
"The key is to remind our patients — and remind all of us — to tune in with our bodies and recognize and pay attention when something doesn't feel right," Dr. Anuradha Lala, an advanced heart failure and transplant cardiologist at The Mount Sinai Hospital, tells TODAY.com.
Because a new instance of chest pain can signal a serious issue, like a heart attack, it's always important to get medical attention — especially if your pain persists and is particularly severe, Lala says. But that doesn't always mean the actual underlying cause is life-threatening.
Here's what to look out for, as well as some sneaky causes of chest pain that aren't a heart attack.
First, learn the signs of a heart attack
Different people can have different sets of symptoms with a heart attack, Dr. Ron Blankstein, a preventive cardiology specialist at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School, tells TODAY.com.
"But, by far, the most common symptom would be chest discomfort," he says. And experts use the term "discomfort" rather than pain because that sensation may not always feel distinctly painful, Blankstein adds.
For some, it might feel like tightness, heaviness or pressure in the chest. The discomfort tends to be severe, though. It's also typically persistent, and it doesn't change when you switch your position, Blankstein says. The pain might also radiate to the shoulder, neck or jaw areas.
Some people might have other symptoms along with chest discomfort that can signal a heart attack. In particular, women can have excessive sweating, vomiting or nausea, Blankstein says.
"It's (also) worth thinking about who the person is that's having the chest pain," Dr. Seth Martin, cardiologist and associate professor of medicine at Johns Hopkins Hospital, tells TODAY.com.
If someone with chest pain also has known risk factors for a heart attack (such as high blood pressure, high cholesterol, diabetes, or smoking), "the likelier it is that it could be a heart attack or this pain could be due to a blockage in the heart arteries," Martin explains.
Chest pain causes that aren't a heart attack
Pericarditis
If the chest discomfort is positional — meaning that it feels better when you sit up or lie down — then it might be related to pericarditis, Blankstein says.
This condition occurs when the tissue lining the heart, the pericardium, becomes inflamed, which sometimes happens as a complication of a viral infection.
"That can cause a sharp chest pain that can also spread to your left arm or shoulder," Lala says. "It can be worse when you're lying down or when you're taking deep breaths."
Coronary artery dissection
A coronary artery dissection is a rare but serious condition that can cause severe chest pain when one of your arteries develops a tear.
You can even have a tear in the aorta, the largest blood vessel in your body, which carries blood from the heart to the rest of the body, Lala explains.
That causes an intensely painful tearing chest pain that can radiate to the back, Blankstein says.
Lala adds: "That's a very strong pain that feels like something's ripping inside of you. The pain can be in your back and between your shoulder blades and your chest, as well."
Aortic dissection is more likely to occur in people who have high blood pressure and those who have certain connective tissue conditions that make the aorta more likely to tear, Blankstein says.
Respiratory infections
Chest pain that gets worse when you inhale deeply is called "pleuritic pain," Martin explains. Pericarditis can cause pleuritic pain, but this type of discomfort is typically related to lung issues, he says.
Respiratory infections can lead to inflammation and swelling of the tissue that lines the lungs, a condition called pleurisy, according to Mayo Clinic. This typically leads to sharp chest pain on inhalation.
Pulmonary embolism
A pulmonary embolism is a blood clot that's made its way to the arteries that connect the heart and the lungs, which can cause chest discomfort and shortness of breath, Blankstein explains.
"It can lead to chest pain, trouble breathing, low oxygen levels and a fast heart rate," Martin adds.
The condition, which can be life-threatening, often starts elsewhere in the body. Typically, it breaks off of a blood clot that starts in one of the legs, which may be swollen, Blankstein says.
Asthma
In people with asthma, the airways can become narrow and produce extra mucus that causes coughing and wheezing and makes it hard to breathe, the Mayo Clinic explains.
That constriction of the airways is also "a very common cause" of chest tightness and discomfort, Martin says. "If you're noticing that there's wheezing and you feel like there's an asthma flare, then that that could be a very good explanation for chest pain."
Muscle strain
Pain that gets worse when you make certain movements or when you press on parts of your chest can indicate musculoskeletal issues, Blankstein says, which can be as simple as a pulled muscle.
For example, "If you're going to the gym and the next day your chest is sore, it's likely that you overdid it," he says. One telltale sign is that "you may be able to reproduce some of that discomfort by doing some of the activities you did at the gym."
Costochondritis
Another possible cause of chest pain that you can reproduce easily is costochondritis, which happens when the cartilage around your ribs becomes inflamed, the Mayo Clinic says. And it most often shows up in the sternum — at the exact right position to mimic a heart attack. It has no clear cause but could be due to physical strain.
"Typically, this type of this pain has a different characteristic than heart-related pain," Martin says. It's often "a sharper or even a shooting kind of pain" that gets worse when you press on the area, he adds.
And it's usually easy for a doctor to pinpoint and reproduce that pain by gently putting pressure on the ribs during a physical examination. If that elicits the same type of discomfort, "that's a really strong indicator that that's where the pain is coming from," Martin says.
Heartburn
Heartburn is actually one of the most common causes of chest pain out there, Martin says. It causes a type of pain that's "more of a burning sensation towards like the bottom part of your chest where it's connecting with the abdomen," he explains.
This occurs when the digestive acid in your stomach makes its way back up your esophagus, the Mayo Clinic explains, and it tends to happen after eating certain foods, large meals or too close to bedtime.
If you start to get heartburn frequently, it qualifies as gastroesophageal reflux disease and you may require prescription medication or other treatments to manage your symptoms.
Esophageal spasms or inflammation
Issues with the esophagus can also cause sensations of chest pain and discomfort. That can be due to food getting stuck on its way down, inflammation of the lining of the esophagus or muscle spasms, the experts say.
"The esophagus has muscle in it, and if that muscle starts spasming, that can cause chest pain," Martin explains.
In fact, "the symptoms are very difficult to differentiate from heart disease," Blankstein adds.
Gallstones
Inflammation and swelling in the gallbladder is typically a result of gallstones interfering with the flow of bile, the Cleveland Clinic explains. Some people don't have any symptoms with gallstones, but others might experience intense pain in the area.
"Swelling in your gallbladder can make it hurt under the ribs on your right side," Lala explains, "and you can have right-sided chest pain with that."
Panic attack
Anyone who's had a panic attack knows that the symptoms — fast heart rate, sweating, trouble breathing, a sense of impending doom — can make you feel like you're dying.
And it's not unusual for people in the midst of a panic attack to seek emergency care, which is the correct course of action if you think there's any chance you might be having a heart attack.
It's important to understand this condition because, "at times, individuals can truly have a racing heart," Blankstein says, but they find that doctors brush their symptoms off as being anxiety-related.
So, the context of what triggers your symptoms is crucial, he says, "but it's not always easy to separate one from the other, and when in doubt, it certainly requires a medical evaluation."
When to get medical attention:
There are many issues that cause chest pain, and the true cause often isn't obvious even to experts without further testing. (And this list isn't exhaustive.) So any new chest pain, pressure, tightness or discomfort is worth getting checked out, the experts say.
"What you really care about is calling 911 and seeking immediate medical attention when you need to rule out something catastrophic, like a heart attack or an aortic dissection," Lala says.
In particular, if your pain is severe, persistent, radiating or causing other symptoms, you should call 911, the experts agree.
To determine the cause of your pain, Blankstein says doctors at the hospital might give you an EKG, a blood test, a treadmill test or imaging, like an MRI or CT scan.
Even if your chest pain turns out to not be related to your heart, it's a good time to talk to your doctor and ask questions to make sure you're doing what you can to prevent heart disease, Martin says. No matter what the cause of your chest pain turns out to be, it's worth taking the opportunity to ease your mind and get your doctor's guidance.
