What causes pain between breasts in the center of the chest?

September 23, 2025 •

4 min read

According to studies, a significant portion of patients visiting the emergency room for chest pain have a non-cardiac cause. Understanding what causes pain between breasts in the center of the chest is critical, as the source can range from benign musculoskeletal issues to more serious health concerns.

Quick Summary

Pain in the center of the chest, known as substernal pain, often stems from benign conditions like costochondritis, acid reflux, or muscle strain. While less frequently cardiac, it is essential to consider heart-related issues, lung conditions, and anxiety. A proper diagnosis from a healthcare professional is crucial to determine the underlying cause.

Key Points

Costochondritis is a frequent cause: Inflammation of the rib cartilage is a common and often benign source of pain in the center of the chest, aggravated by movement and pressure.
Digestive issues often mimic heart pain: Conditions like GERD can cause a burning sensation behind the breastbone, especially after eating or lying down.
Musculoskeletal pain is usually positional: Pain from muscle strain or rib cartilage inflammation often worsens with specific movements, deep breaths, or direct pressure on the chest wall.
Anxiety can trigger physical symptoms: Panic attacks can cause sharp chest pain, a pounding heart, and other physical signs that mimic more serious conditions.
Seek immediate help for radiating pain and other severe symptoms: If chest pain is accompanied by shortness of breath, nausea, or radiates to the arm, jaw, or back, call 911 immediately to rule out a heart attack.
A professional diagnosis is essential: Due to the wide range of potential causes, a healthcare provider should always evaluate unexplained or persistent chest pain to ensure accurate diagnosis and proper treatment.

Common Musculoskeletal Causes

Musculoskeletal issues are among the most frequent causes of pain felt between the breasts, in the area of the sternum. The pain often intensifies with movement, deep breaths, or pressure on the affected area. Since the breastbone is connected to the ribs by cartilage, inflammation is a prime suspect.

Costochondritis

Costochondritis is an inflammation of the cartilage that connects your ribs to your breastbone. It is a benign, self-limiting condition, meaning it often resolves on its own over time. The pain is typically sharp, aching, or pressure-like, and most commonly affects the upper ribs on the left side, though it can occur anywhere along the sternum.

Pain that worsens with a deep breath, cough, or sneeze.
Localized tenderness when pressing on the rib joints near the breastbone.
Pain that can radiate to the arms or shoulders, mimicking heart-related pain.

Muscle Strain

Straining muscles in the chest wall, such as the intercostal muscles between the ribs or the pectoral muscles, can cause central chest pain. This can happen from strenuous exercise, heavy lifting, or even severe coughing from a respiratory infection. The pain is often localized and feels sore or bruised.

Tietze Syndrome

Less common than costochondritis, Tietze syndrome is a similar condition but involves noticeable swelling over one or more of the rib cartilages, typically the second or third rib. The swelling can help differentiate it from costochondritis, which does not involve visible swelling.

Gastrointestinal Problems

Digestive issues can frequently cause referred pain in the chest, as the nerves connecting to the esophagus and stomach can trigger sensations that feel like they're coming from the heart or chest wall.

Gastroesophageal Reflux Disease (GERD)

GERD, or acid reflux, occurs when stomach acid flows back into the esophagus. This can cause a burning sensation (heartburn) behind the sternum, which is often mistaken for heart-related pain. Pain from GERD may worsen after eating, when lying down, or when bending over. Antacids often provide relief.

Esophageal Spasms

Esophageal spasms are involuntary contractions of the muscles in the esophagus. These spasms can feel like sudden, severe chest pain that can be confused with a heart attack. The pain is typically intense, squeezing, and can occur with or without eating.

Stomach Ulcers and Gastritis

Inflammation of the stomach lining (gastritis) or a stomach ulcer can cause a burning or gnawing pain in the upper abdomen that can radiate to the chest. The pain may be more noticeable when the stomach is empty and can be relieved by eating or taking antacids.

Potential Cardiac and Pulmonary Issues

While less common for the described location, it is critical not to dismiss the possibility of heart or lung-related problems. Pain between the breasts warrants a medical evaluation, especially if certain risk factors or symptoms are present. For accurate and up-to-date information on symptoms, it's advisable to consult authoritative resources, such as the American Heart Association.

Symptoms of concern

Heart Attack: Pressure, squeezing, or fullness in the chest that lasts more than a few minutes. Pain can radiate to the jaw, neck, back, or arms, and may be accompanied by shortness of breath, cold sweats, or nausea.
Pericarditis: Inflammation of the sac around the heart. This can cause sharp, stabbing chest pain that may improve when sitting up and leaning forward.
Pleurisy: Inflammation of the lung lining can cause sharp chest pain that gets worse with deep breathing or coughing.
Pulmonary Embolism: A life-threatening blood clot in the lung that can cause sudden, sharp chest pain, shortness of breath, and an elevated heart rate.

Anxiety and Stress

Emotional stress and anxiety, particularly panic attacks, can trigger physical symptoms that are often mistaken for heart problems. During a panic attack, the body releases stress hormones that can increase heart rate and cause muscle tension, leading to chest pain or tightness.

Anxiety Chest Pain Characteristics: Often described as sharp or stabbing, can come on suddenly, and may be accompanied by a pounding heart, dizziness, or a feeling of losing control. The pain is often fleeting but can leave a lingering ache.

Comparison of Pain Sources


Feature	Musculoskeletal Pain	Gastrointestinal Pain	Heart-Related Pain
Sensation	Sharp, aching, or bruised. Tender to the touch.	Burning, gnawing, or squeezing.	Pressure, tightness, fullness, or crushing.
Location	Localized on the chest wall or sternum.	Typically behind the sternum, may radiate.	Center or left side of chest, often radiates to arm, jaw, or back.
Trigger	Movement, deep breathing, coughing, pressure.	Eating, lying down, bending over.	Physical exertion, emotional stress.
Duration	Can be intermittent or persistent over days/weeks.	Can last minutes or hours, may be relieved by antacids.	Lasts more than a few minutes; does not improve with rest.
Accompanying Symptoms	Muscle soreness, swelling (Tietze).	Heartburn, frequent burping, trouble swallowing.	Shortness of breath, cold sweats, nausea, lightheadedness.

When to Seek Medical Attention

While many causes of central chest pain are not life-threatening, certain symptoms require immediate medical evaluation. You should go to the emergency room or call 911 if you experience:

Severe, crushing chest pain that is sudden or unremitting.
Pain that radiates to your jaw, left arm, or back.
Shortness of breath or difficulty breathing.
Cold sweats, dizziness, or nausea along with chest pain.
A racing or uneven heart rate.

For non-emergency situations where the pain is persistent, you should consult with your doctor. They can conduct a thorough examination to rule out serious conditions and determine the correct course of treatment.

Conclusion

Pain in the center of the chest can have many causes, ranging from the relatively harmless to the potentially life-threatening. Common triggers include inflammation of the rib cartilage (costochondritis), digestive issues like acid reflux, and muscle strains. Though less frequent, it is crucial to remain aware of cardiac symptoms, especially if accompanied by other serious signs. A careful evaluation by a healthcare professional is always the most prudent step to ensure an accurate diagnosis and appropriate management. By understanding the different potential sources of pain, you can make informed decisions about your health and know when to seek help immediately.

Frequently Asked Questions

Costochondritis pain is often sharp or aching, worsens when you press on the chest, and is triggered by deep breaths or movement. Heart attack pain is typically a dull pressure or tightness that may radiate to the arm, jaw, or back, and is often accompanied by shortness of breath, sweating, or nausea.

Yes, excess gas in your intestines can cause pressure and sharp pain in the chest, which can sometimes be confused with heart pain. This pain may be accompanied by bloating and is often relieved by passing gas.

Anxiety-induced chest pain can feel like a sharp, stabbing sensation, or a persistent, dull ache. It often comes on during a panic attack, even when resting, and can be accompanied by a fast heart rate, dizziness, and shortness of breath.

While not 'normal,' mild and transient soreness can occur from activities like heavy lifting or a forceful cough. However, persistent, severe, or concerning chest pain should always be evaluated by a medical professional to ensure a serious underlying condition is not the cause.

Both conditions involve inflammation of the chest cartilage. The key difference is that Tietze syndrome includes swelling of the affected cartilage, whereas costochondritis does not.

Treatment for costochondritis typically involves rest, avoiding strenuous activity, applying warm compresses to the area, and considering options for pain management after consulting with a healthcare professional. Physical therapy and stretching exercises can also be beneficial.

Go to the emergency room immediately if you have severe or sudden crushing chest pain, or if the pain is accompanied by symptoms such as shortness of breath, radiating pain to the arm or jaw, sweating, or nausea. It is always safest to be cautious with chest pain.