24 causes of chest pain in adults—and how to treat it

While certain types of chest pain require an ER visit, not all are that severe

By Sara Lindberg | Feb. 2, 2022 Medically reviewed by Laura K. Grubb, MD, MPH

Chest pain, especially a sudden or ongoing episode, may be a red flag that something more serious is going on. And while certain chest pain can be life-threatening and require immediate medical attention, many other types are less severe and often manageable with a visit to your healthcare provider’s office.

Many different conditions can cause chest pain, including cardiac or heart-related problems, respiratory or lung conditions, gastrointestinal issues and indigestion, musculoskeletal problems, panic attacks, and even a simple pinched nerve. Because there is such a wide range of chest pain causes and treatments, identifying the different types of chest pain and recognizing the early warning signs is critical to your overall health and medical care.

What does chest pain feel like?

Chest pain can involve a variety of locations, including the upper and lower chest and right or left side. In general, you can feel chest pain anywhere along the front of your body between your neck and upper abdomen, according to Mount Sinai Hospital. But it can also spread to the chest from the back, neck, or abdomen. Where your chest pain originates has a lot to do with the condition you may be experiencing.

Depending on the cause, you may feel a sharp stab, a dull ache, or a burning or crushing sensation. You may also experience pain in other parts of your body, including the neck, jaw, abdomen, rib cage, or arms. It can last for seconds or several minutes. It can also feel terrifying, especially if you don’t know what is happening.

When thinking about chest pain and describing it it is important to consider the following:

Onset of pain (e.g., abrupt or gradual)
Provocation/palliation (i.e., which activities provoke pain; which alleviate pain)
Quality of pain (e.g., sharp, dull, squeezing)
Radiation (e.g., shoulder, jaw, back)
Site of pain (e.g., substernal, chest wall, back, diffuse, localized)
Timing (e.g., constant or episodic, duration of episodes, when pain began)

If your chest pain is cardiac in nature, you may feel an uncomfortable pressure, squeezing, fullness, or pain in the center of the chest. According to the American Heart Association (AHA), this pain can last for a few minutes of come and go. Chest pain related to your heart is also most often felt on the left side, but that doesn’t mean you should dismiss it if you feel it on the right side. In fact, women tend to experience chest pain on either side of the chest or in one or both arms or no pain at all, according to the Mayo Clinic.

When you experience pain on the right side only, this could be attributed to non-cardiovascular causes like lung conditions, ulcers, acid reflux, gallbladder issues, or a muscle strain. However, these conditions can also trigger pain on both sides of the chest or in the center, so it’s always a good idea to tell your provider about any type of chest pain. Being able to identify the location of your chest pain can help a healthcare provider or emergency department team better diagnose the possible causes and begin treatment right away.

What causes chest pain?

We often think of chest pain in adults being caused by a heart condition like a heart attack—but it can also be a warning sign that something else is going on in your body. More common causes of chest pain that are non-cardiac include respiratory illness, gastrointestinal disorders, reflux esophagitis, costochondritis, lifestyle factors like stress or panic attacks, and musculoskeletal issues, among others.

Respiratory and lung-related issues

Like cardiac chest pain, respiratory and lung-related chest pain can be serious and life-threatening if not caught in time and treated.

Asthma: A chronic lung disease that makes it difficult to move air in and out of your lungs, according to the American Lung Association. During an asthma attack, you may feel a sudden tightness in the chest or chest pain.
Pneumonia: An infection that can affect one or both of your lungs. One of the most common symptoms of pneumonia is a sharp or stabbing chest pain that gets worse when you cough or breathe deeply, according to the American Lung Association.
Bronchitis: A condition that causes the bronchial tubes to become inflamed, which causes severe coughing. In addition to coughing, wheezing, and shortness of breath, chest pain is a common symptom of bronchitis, according to the National Heart, Lung, and Blood Institute.
Chronic obstructive pulmonary disease: COPD is a chronic inflammatory lung disease that blocks airflow, making it difficult to breathe. Chest tightness and shortness of breath are common symptoms of this disease.
Pleurisy: Swelling of the pleura, which covers and separates the lungs from the chest wall, is called pleurisy. Pleuritic chest pain feels like a sharp stabbing in the chest while breathing.
Pulmonary embolism: A blood clot that gets stuck in the lung is called a pulmonary embolism.
Collapsed lung: A collapsed lung, also called pneumothorax, can cause sudden chest pain and shortness of breath.

Other respiratory infections, including the flu and COVID-19 can cause chest pain. Viral infections typically do not require treatment apart from rest and fluids; however, your provider may prescribe antibiotics for bacterial infections. If you are at a high-risk for complications, it may be necessary to seek immediate medical care.

Gastrointestinal and digestive problems

These types of chest pain are usually not life-threatening, but can be a warning sign of a more serious digestive condition.

Gastroesophageal reflux disease (GERD): Non-cardiac chest pain that feels like a burning sensation below your breastbone or rib cage is common with GERD, also known as heartburn.
Hiatal hernia: This occurs when part of your stomach protrudes up into your chest. The pressure and heartburn that this triggers can feel like chest pain, according to University of Michigan Health.
Gallbladder disease: Gallstones, which are pebble-like pieces of material that develop in your gallbladder, can cause pain in the upper abdomen (mostly the right side) close enough to the chest area to feel like chest pain, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Inflammation of the gallbladder can also trigger chest pain.
Ulcers: Peptic ulcers form in the stomach and can occasionally cause chest pains that come and go.
Gastritis: Inflammation of the stomach lining can lead to a burning ache or pain in the upper abdomen, according to the Mayo Clinic. Due to its location, the discomfort can be mistaken for chest pain.
Pancreatitis: An inflammation of the pancreas causes pain in the upper abdomen, which can be mistaken for chest pain.

In addition to these causes, gas and constipation can cause minor chest pains.

Musculoskeletal or other causes

An injury may feel like a heart attack, as can certain mental health issues and infections.

Costochondritis: An inflammation of the cartilage that connects a rib to the sternum is another cause of chest pain. In fact, many people who have a bout of costochondritis believe they are having a heart attack. Severe coughing can lead to this condition.
Injured rib: An injured or broken rib can cause chest pain, especially while breathing. Also, back pain, bad posture, shoulder pain, and a pinched nerve can all trigger chest pains of varying intensity.
Shingles: This viral infection (varicella zoster) can cause sharp chest pain. According to the Mayo Clinic, some people even think they are having a heart attack at the onset of shingles.
Panic attacks: Anxiety, stress, and panic attacks can also cause chest pain of a non-cardiac nature. Some panic attacks are so severe, they can mimic the symptoms of a heart attack.
Medications: Certain medications may cause chest pain as a side effect, such as the migraine medication sumatriptan.

Certain clothing, like too tight sports bras or underwires, can also cause musculoskeletal chest pain.

Heart-related problems

A heart problem is often the first thing you think of when considering chest pain—and for a good reason. Cardiac chest pain is the most serious and life-threatening condition.

Angina: Poor blood flow to the heart that causes chest pain is called angina. This occurs when thick plaques build up on the inner walls of the arteries causing them to narrow and restrict the heart’s blood supply. According to the AHA, this may feel like pressure or squeezing in your chest.
Heart attack: Symptoms of a heart attack (myocardial infarction) include shortness of breath, sharp chest pain or discomfort, pain or discomfort in the right or left arm, and lightheadedness, according to the AHA. Women are also more likely to experience other heart attack symptoms, such as shortness of breath, nausea, vomiting, and back or jaw pain.
Pericarditis: Chest pain is one of the most common symptoms when the pericardium becomes inflamed. The pericardium is a sac-like structure that surrounds the heart to hold it in place and help it work.
Aortic dissection: A tear in the inner layer of your aorta (the main blood vessel to your heart) is called an aortic dissection. This is a life-threatening condition that requires immediate emergency attention.
Coronary artery disease (CAD): CAD is the most common type of heart disease. It occurs when the arteries become hardened and narrowed, which limits the blood supply to the heart or creates a blockage. This can cause angina (chest pain) or a heart attack.
Myocarditis: Myocarditis is an inflammation of the heart muscle that makes it harder for the heart to pump and maintain a regular rhythm. Its symptoms can include chest pain.

How do I know if my chest pain is serious?

It can be difficult to know when to head to the emergency room for chest pain. However, Rigved Tadwalkar, MD, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, California, says signs that your chest pain may be serious and coming from your heart include continuous chest discomfort of a dull, tight, or heavy quality. “On many occasions, this discomfort may travel to the neck or arms and be associated with symptoms like malaise, weakness, nausea, sweating, or shortness of breath,” he adds.

It’s always better to be safe than sorry. There should be a low threshold to go to the emergency department for ongoing chest pain, including if you:

Are older than 40 years of age.
Have a family history of heart disease in a first-degree relative male age younger than 55 years or female younger than 65 years.
If you have a personal history of risk factors such as tobacco use, established heart disease, high blood pressure, high cholesterol, diabetes, kidney disease, obesity, and/or sedentary with minimal to no physical activity.

There are also other forms of chest pain that are not overtly cardiac in nature but are worthy of seeking emergency medical attention, including chest pain of a ripping or tearing quality, chest pain that appears to worsen with deep breathing or chest pain related to some form of trauma. “Ultimately, if you are unsure as to whether to go to the emergency department or an urgent care for chest pain, we typically tell individuals to do so as we would not want to miss something life-threatening,” Dr. Tadwalkar says.

If your chest pain is not of the above-stated quality or not associated with many of the prior risk factors, it is still worthy of evaluation, but perhaps not urgently. This includes chest pain that is brief, sharp, infrequent, and non-bothersome. “Often, chest pain that changes with position is less likely to be related to the heart and may instead be due to a muscular or skeletal cause,” Dr. Tadwalkar says. If this type of positional pain is not severe, it can typically wait for the office setting where a physician can evaluate you and provide professional medical advice.

“If you have chest pain that is similar to a recent prior episode of chest pain that was worked up comprehensively by a cardiologist and deemed NOT to be related to the heart, it might be better to skip the emergency department and speak more casually with your heart doctor, particularly if the pain is not persistent,” Dr. Tadwalkar adds. Additionally, chest pain in the context of a true panic attack, which then resolves completely when the panic attack subsides, usually does not need to be evaluated urgently.

When the cause of chest pain is not evident, your healthcare provider may run a series of tests, including an electrocardiogram (ECG), blood tests, chest X-ray, or a computerized tomography (CT) scan, according to the National Heart, Lung, and Blood Institute.

Chest pain treatment

How your provider proceeds with treating your chest pain depends on the cause. “Fortunately, the vast majority of patients presenting to medical attention for chest pain have a benign underlying cause, such as a musculoskeletal source or symptoms from gastroesophageal reflux or anxiety,” says Dr. Tadwalkar. In many instances, these sources of discomfort may be treated with conservative measures, such as rest, physical therapy, and appropriate lifestyle changes.

At times, he says, your physician may recommend anti-inflammatory medications for musculoskeletal pain, OTC antacids to reduce acid in the stomach, or an anxiolytic (anti-anxiety drug), depending on what they deem is most likely to be helpful. But if you have chest pain from a true cardiac source, including forms of myocardial infarction (heart attack), specific targeted medical therapies like antiplatelet therapies such as aspirin, a statin medication, beta blocker medications, nitrate therapies, and certain anticoagulants are beneficial.

How to prevent chest pain naturally

There are many factors that affect your health, some of which can be modified with lifestyle changes.

Stop smoking. People who smoke have a higher risk of heart problems. Up to 30% of coronary heart disease deaths are caused by cigarette smoking. Vaping has similar effects, as the chance of heart attack increases 42% among e-cigarette users versus non-smokers.
Stay hydrated.
Avoid asthma triggers. Chest tightness is a symptom of asthma. Allergies, irritants in the air (like smoke), exercise, weather conditions, stress, infections, and certain medications can trigger asthma. Avoiding triggers and using preventative medications before exposure can help prevent asthma attacks.
Clean up your diet. More than 66% of heart disease-related deaths worldwide are linked to diet. Avoiding foods that are bad for your heart, like saturated and trans fat, as well as triggers for heartburn can prevent chest pain and heart problems.
Limit alcohol. Heavy drinking (more than four drinks per day or 14 drinks per week for men; more than three drinks per day or seven drinks per week for women) is associated with an increase in high blood pressure, heart failure, stroke, and cardiomyopathy.
Improve your sleep. Almost everyone could use more sleep, but improving your sleep hygiene is critical if you’re experiencing chest pain, especially if it’s related to a heart condition. According to the Centers for Disease Control and Prevention, adults who sleep less than 7 hours each night are more likely to have health problems like a heart attack. The good news is there are a few things you can do to improve your sleep. The first step is to stick to a regular sleep schedule, which includes going to bed and waking at about the same time each day. Also, avoid screens a few hours before bedtime. Participating in regular physical activity during the day and avoiding heavy foods and alcohol within a few hours of bedtime can also improve your sleep.