What Can Cause Chest Pain That's Not Heart Related? Understanding Non-Cardiac Pain

October 1, 2025 •

4 min read

According to Michigan Medicine, more than half of emergency room visits for chest pain have non-cardiac causes, highlighting that discomfort in this area is not always a sign of a heart attack. Understanding what can cause chest pain that's not heart related is essential for determining the appropriate course of action and alleviating worry.

Quick Summary

Chest pain unrelated to the heart, known as non-cardiac chest pain (NCCP), can stem from various sources, including digestive issues like GERD and esophageal spasms, musculoskeletal inflammation like costochondritis, and anxiety or panic attacks. Symptoms can often mimic cardiac pain, making a professional medical evaluation crucial for an accurate diagnosis.

Key Points

Gastrointestinal Issues are Common: Conditions like GERD, esophageal spasms, and ulcers are frequent causes of non-cardiac chest pain, often mimicking heart attack symptoms due to shared nerve pathways.
Musculoskeletal Pain is Palpable: Pain from chest wall muscles, ribs, or cartilage (e.g., costochondritis) can often be reproduced by pressing on the painful area, a key differentiator from heart pain.
Anxiety Can Mimic Cardiac Symptoms: Adrenaline surges during panic or anxiety attacks can cause a rapid heart rate, chest tightness, and hyperventilation, resulting in sharp or tight chest pain.
Pulmonary Conditions Require Attention: Lung issues like pleurisy, pneumonia, and a pulmonary embolism can cause chest pain, with some, like a PE, being life-threatening emergencies that require immediate medical care.
Seek Medical Evaluation for Any New or Concerning Pain: Since differentiating between cardiac and non-cardiac chest pain can be challenging, it is always safest to have new or persistent chest pain evaluated by a healthcare professional.
Pain Characteristics Offer Clues: Non-cardiac chest pain is often sharp or burning and can occur at rest, whereas cardiac pain is more commonly a heavy pressure exacerbated by physical exertion.

The Diverse Origins of Non-Cardiac Chest Pain

Chest pain can be an alarming symptom, but it is important to remember that the heart is not the only organ in the chest cavity. The esophagus, lungs, and the surrounding muscles, bones, and nerves can all cause pain that feels like a cardiac event. Non-cardiac chest pain (NCCP) is a common condition, with multiple potential causes ranging from relatively minor issues to serious but non-cardiac emergencies. Understanding the different sources of this pain can help in distinguishing it from heart-related conditions, although a medical evaluation is always the safest course.

Gastrointestinal Causes

Issues within the digestive system are a leading cause of non-cardiac chest pain. The esophagus, located near the heart, shares nerve pathways that can refer pain to the chest.

Gastroesophageal Reflux Disease (GERD)

This is perhaps the most common non-cardiac cause of chest pain. It occurs when stomach acid flows back into the esophagus, causing a burning sensation known as heartburn. This discomfort can radiate to the chest and mimic heart attack symptoms.

Esophageal Spasms

These are abnormal and often intense contractions of the muscles in the esophagus. The squeezing pain they cause can be mistaken for angina, the chest pain associated with heart disease.

Peptic Ulcers and Gastritis

Sores in the lining of the stomach or inflammation of the stomach lining (gastritis) can cause a gnawing or burning pain that may be felt in the chest, especially when the stomach is empty.

Gallstones and Pancreatitis

Problems with the gallbladder or inflammation of the pancreas can trigger abdominal pain that radiates to the chest. Pain from gallstones often worsens after a fatty meal.

Musculoskeletal Causes

Pain can originate from the bones, joints, and muscles in the chest wall, ribcage, or spine. This type of pain often intensifies with movement or when a specific area is pressed.

Costochondritis: This is an inflammation of the cartilage that connects your ribs to your breastbone. It can cause sharp pain and is often tender to the touch.
Muscle Strains: Strenuous activity or heavy lifting can strain the muscles between the ribs (intercostal muscles) or the pectoral muscles. Persistent coughing from a respiratory illness can also cause this strain.
Rib Fractures: Trauma to the chest can cause a cracked or broken rib, leading to severe pain that worsens with breathing or coughing.
Fibromyalgia: This chronic condition can cause widespread musculoskeletal pain, including in the chest area.

Pulmonary Causes

Conditions affecting the lungs can also be a source of chest pain. The lungs and their lining, the pleura, are located within the chest cavity, and inflammation or blockages can cause discomfort.

Pulmonary Embolism

This is a medical emergency involving a blood clot that travels to the lungs. It can cause acute, sharp chest pain and shortness of breath and must be ruled out immediately.

Pleurisy

An inflammation of the lining around the lungs, pleurisy causes a sharp pain that worsens with deep breathing or coughing.

Pneumonia and Pneumothorax

Pneumonia is a lung infection that can cause chest pain along with fever and coughing. A pneumothorax, or collapsed lung, causes sudden, sharp chest pain and difficulty breathing.

Psychological Causes

Anxiety and stress can manifest with intense physical symptoms, including chest pain that feels very real and alarming. This is often the result of the body's 'fight or flight' response.

Panic Attacks

During a panic attack, the body releases a surge of adrenaline, causing a rapid heart rate, chest tightness, and hyperventilation, which can all lead to chest pain.

Chronic Stress

Prolonged stress can cause muscle tension and increased blood pressure, contributing to persistent chest discomfort.

Comparison of Cardiac and Non-Cardiac Chest Pain

Since distinguishing between cardiac and non-cardiac chest pain can be difficult, a medical professional must perform an evaluation. The following table highlights some general distinctions, but should not replace a doctor's assessment.


Feature	Typical Non-Cardiac Chest Pain	Typical Cardiac Chest Pain (Angina/Heart Attack)
Sensation	Sharp, stabbing, burning, or specific localized pain	Heavy, squeezing, crushing pressure
Location	Often localized to one area, can be tender to touch	Spreads from chest to arm, jaw, neck, or back
Duration	Can be brief (seconds), come and go, or last for hours	Lasts more than a few minutes and may worsen
Trigger	Can happen at rest, after eating, or during stress	Often triggered or worsened by physical exertion
Associated Symptoms	Hyperventilation, tingling, dizziness	Sweating, shortness of breath, nausea, lightheadedness
Relief	Sometimes responds to antacids or changing position	Resolves with rest or nitroglycerin (unreliable)

Seeking Medical Evaluation

Because the consequences of misdiagnosing a cardiac event are so severe, all new or persistent chest pain should be evaluated by a healthcare provider. A doctor can use a range of diagnostic tools, including an EKG, blood tests, and imaging, to rule out heart-related issues. Once a cardiac cause is excluded, a treatment plan can be developed based on the specific non-cardiac diagnosis.

For more information on the evaluation process for non-cardiac chest pain, the American College of Gastroenterology provides resources for patients with NCCP.

Conclusion

Chest pain, while frightening, has a multitude of potential causes beyond the heart. Common culprits include gastrointestinal conditions like GERD and esophageal spasms, musculoskeletal problems such as costochondritis, and respiratory issues like pleurisy and pneumonia. Psychological factors, especially anxiety and panic attacks, are also frequent contributors. The key takeaway is that any unexplained or persistent chest pain warrants professional medical attention to ensure a proper diagnosis and rule out any life-threatening conditions. With a correct diagnosis, effective treatments can alleviate discomfort and address the root cause, providing peace of mind and improving overall health.

Frequently Asked Questions

Anxiety-related chest pain often presents as a sharp, stabbing, or tight feeling that may come and go quickly. It is often accompanied by other anxiety symptoms like dizziness, shortness of breath, and rapid heart rate, but typically does not radiate to the arms or jaw like cardiac pain.

Yes, acid reflux is a very common cause of non-cardiac chest pain. The esophagus, irritated by stomach acid, shares nerve pathways with the heart, which can cause referred pain that is perceived as a burning or squeezing sensation in the chest, much like a heart attack.

Costochondritis is an inflammation of the cartilage that connects your ribs to your breastbone. It causes localized, sharp, or aching pain and is characterized by tenderness when you press on the affected area. It can feel similar to heart pain but is usually harmless.

You should seek immediate emergency medical care if you experience chest pain that is sudden, severe, or accompanied by symptoms such as shortness of breath, sweating, nausea, dizziness, or pain radiating to your jaw, neck, or arms. Always err on the side of caution.

Yes, muscle strains in the chest wall, often from activities like heavy lifting, exercise, or even persistent coughing, are a common cause of musculoskeletal chest pain. This pain may feel sore or sharp and can worsen with movement.

Several lung conditions can cause chest pain, including pleurisy (inflammation of the lung lining), pneumonia, and a collapsed lung (pneumothorax). A pulmonary embolism (blood clot in the lung) is a serious cause that requires immediate attention.

If your chest pain occurs during or after a meal, it may be a sign of a digestive issue, such as GERD or gallstones. Pain from gallstones is particularly known to occur after consuming a fatty meal.