What are the causes of chest pain in the middle?

September 27, 2025 •

4 min read

An estimated 8 million emergency room visits each year in the US are for chest pain, and while a heart attack is the most feared cause, many non-cardiac conditions can also be the source. Understanding the various possibilities is key to knowing when to seek urgent medical care for what are the causes of chest pain in the middle.

Quick Summary

Pain in the center of the chest can result from a wide array of conditions affecting the heart, lungs, digestive system, or musculoskeletal structures, ranging from benign issues like acid reflux or muscle strain to life-threatening events such as a heart attack or pulmonary embolism. Proper diagnosis relies on a thorough medical evaluation, including a review of symptoms, medical history, and diagnostic tests.

Key Points

Consider Urgency: While many causes of central chest pain are not life-threatening, it is always safest to consider it a medical emergency until proven otherwise by a professional.
Heart Attack vs. Heartburn: Heart attacks are often described as pressure or squeezing, while heartburn is a burning sensation, but symptoms can overlap, making medical evaluation essential.
Musculoskeletal Clues: If the pain can be reproduced by pressing on the area or is worse with movement, it may indicate a musculoskeletal issue like costochondritis.
GI and Lung Mimics: Gastrointestinal issues like GERD and respiratory problems like pulmonary embolism are common culprits and can produce symptoms that mimic heart-related pain.
Anxiety as a Cause: Anxiety and panic attacks can cause chest pain and other physical symptoms, making it important to consider mental health factors.
Diagnostic Necessity: A physician is needed to accurately diagnose the source of chest pain using a variety of tests, as self-diagnosis is unreliable.

Causes of Chest Pain in the Middle: A Comprehensive Guide

Many different systems of the body can produce pain in the chest's central region, making diagnosis complex without a professional medical evaluation. While it's crucial to consider serious heart-related issues, other systems like the lungs, esophagus, and muscles are often the source of the discomfort.

Cardiac-Related Causes

When we consider what are the causes of chest pain in the middle, heart-related problems are often the first to come to mind. These conditions require immediate medical attention to prevent serious complications.

Heart Attack (Myocardial Infarction): Occurs when blood flow to the heart muscle is blocked. The pain is often described as a squeezing or crushing pressure, potentially radiating to the jaw, neck, back, or arm. It is a medical emergency.
Angina: This is chest pain caused by reduced blood flow to the heart muscle, often triggered by physical exertion or stress. Angina can feel like a pressure or squeezing sensation and typically resolves with rest.
Pericarditis: An inflammation of the sac surrounding the heart. The pain is often sharp and steady, worsening when you breathe deeply, swallow, or lie on your back.
Aortic Dissection: A rare but life-threatening condition involving a tear in the inner layer of the aorta. It causes sudden, severe pain in the chest that can feel like tearing or ripping and may extend to the back.

Gastrointestinal (GI) System Causes

Many GI issues can mimic heart-related chest pain because the esophagus and heart are close and share nerve pathways. These are among the most common non-cardiac causes.

Gastroesophageal Reflux Disease (GERD): This is the most common cause of non-cardiac chest pain. Stomach acid splashes up into the esophagus, causing a burning sensation known as heartburn in the middle of the chest.
Esophageal Spasms: Uncoordinated muscle contractions in the esophagus can cause sharp, intense chest pain that may feel like a heart attack.
Esophagitis: Inflammation of the esophagus, often caused by GERD, can lead to chest pain and difficulty swallowing.
Hiatal Hernia: Occurs when part of the stomach pushes up through the diaphragm. It can cause reflux symptoms, including heartburn and chest pain, especially after eating.

Musculoskeletal-Related Causes

Conditions affecting the muscles, bones, and cartilage of the chest wall are a frequent source of central chest pain. Unlike pain from internal organs, this pain can often be reproduced by pressing on the affected area.

Costochondritis: An inflammation of the cartilage that connects a rib to the breastbone (sternum). The pain is often sharp or aching and can be worse with deep breaths, coughing, or physical activity.
Muscle Strain: Strain or injury to the chest wall muscles from overuse or forceful coughing can result in persistent, localized pain.
Rib Injury: A bruised or fractured rib from trauma can cause significant, localized pain that worsens with breathing or movement.

Lung-Related Causes

Respiratory issues can also manifest as central chest pain, often accompanied by other symptoms like shortness of breath or cough.

Pulmonary Embolism (PE): A life-threatening condition where a blood clot travels to the lungs. It causes sudden, sharp chest pain that worsens with breathing, along with shortness of breath and a rapid heart rate. Immediate medical care is necessary.
Pleurisy: An inflammation of the lining of the lungs and chest. It causes sharp chest pain that increases with breathing, coughing, or sneezing.
Pneumonia: A lung infection that can cause chest pain, fever, chills, and a cough that produces phlegm.
Pneumothorax: A collapsed lung that can cause sudden, sharp chest pain and shortness of breath.

Psychological and Other Causes

Not all causes of chest pain are physical in origin. Mental and emotional states can also trigger very real symptoms.

Anxiety and Panic Attacks: A sudden surge of intense fear can cause symptoms that closely mimic a heart attack, including chest tightness, rapid heartbeat, sweating, and shortness of breath.
Shingles (Herpes Zoster): An infection that can cause a sharp, band-like pain on one side of the chest before a rash appears.

Comparison Table: Heart-Related vs. GI-Related Chest Pain


Feature	Heart-Related Pain (e.g., Angina)	Gastrointestinal Pain (e.g., GERD)
Sensation	Squeezing, pressure, heaviness	Burning, acidic taste in mouth
Radiation	Often spreads to arms, jaw, back	Rarely radiates, usually localized
Trigger	Exertion, stress	Eating large meals, lying down, bending over
Relief	With rest or medication (e.g., nitroglycerin)	With antacids or sitting up
Associated Symptoms	Shortness of breath, sweating, nausea	Bloating, burping, difficulty swallowing

When to Seek Emergency Medical Attention

Because it can be impossible to differentiate a harmless cause from a life-threatening one, it is imperative to seek emergency medical attention if you experience new, severe, or persistent chest pain, especially if it is accompanied by other symptoms like shortness of breath, dizziness, sweating, or pain radiating to other parts of the body.

Conclusion

Understanding what are the causes of chest pain in the middle is vital for recognizing potential health risks. While many instances of central chest pain are due to non-cardiac issues like GERD or musculoskeletal strain, the possibility of a serious heart or lung problem means you should never ignore unexplained chest pain. Always consult a healthcare professional for an accurate diagnosis and appropriate treatment plan. For more information on heart health, consider consulting resources like the American Heart Association.

Frequently Asked Questions

Besides heart-related issues, common non-cardiac causes include gastroesophageal reflux disease (GERD), musculoskeletal problems like costochondritis or muscle strain, lung conditions such as pleurisy, and anxiety or panic attacks.

Yes, stress and anxiety can cause chest pain. During a panic attack, the body releases adrenaline, which can cause symptoms like a rapid heart rate, chest tightness, and a sensation of pressure that can easily be mistaken for a heart attack.

Distinguishing between a heart attack and heartburn can be challenging, as symptoms can overlap. Heart attack pain is often a crushing or squeezing pressure that may spread to other body parts, while heartburn is a burning sensation. However, it is crucial to seek emergency medical attention if you are uncertain, especially if you have other risk factors.

Costochondritis is the inflammation of the cartilage connecting your ribs to your breastbone. This condition causes sharp or aching pain in the middle of the chest that can be worse with deep breaths, coughing, or pressing on the area. It is a benign condition but can be mistaken for a heart problem.

You should go to the emergency room immediately if you experience new, severe, or persistent chest pain, particularly if it is accompanied by shortness of breath, dizziness, sweating, nausea, or pain that spreads to your arm, back, neck, or jaw. This is especially true if you have risk factors for heart disease.

Yes, many stomach and esophageal conditions, such as GERD, esophageal spasms, or a hiatal hernia, can cause pain in the center of the chest. This is because the heart and esophagus share a complex network of nerves, leading to referred pain.

To diagnose the cause of chest pain, a doctor may perform several tests, including an electrocardiogram (ECG) to check heart function, blood tests for heart enzymes, a chest X-ray to examine the lungs, or an upper endoscopy to check the esophagus and stomach.