What causes the middle part of your chest to hurt? Navigating Potential Health Issues

October 2, 2025 •

5 min read

Did you know that over 6.5 million people visit emergency departments annually for chest pain, but more than half of these cases are due to non-cardiac causes? Understanding what causes the middle part of your chest to hurt is crucial for knowing when to seek immediate medical attention and when to manage a less severe condition.

Quick Summary

Middle chest pain can arise from a range of issues affecting the heart, esophagus, lungs, or muscles. It is essential to differentiate symptoms to identify potentially serious conditions like a heart attack from less severe causes such as acid reflux or costochondritis.

Key Points

Differentiating pain types is crucial: Central chest pain can be cardiac (e.g., heart attack, angina) or non-cardiac (e.g., GERD, costochondritis, anxiety).
Don't ignore concerning symptoms: If chest pain is severe, radiates to the arm/jaw, or is accompanied by shortness of breath or sweating, seek emergency medical help immediately.
Common non-cardiac causes exist: Conditions like costochondritis (rib cartilage inflammation), acid reflux (heartburn), and muscle strain are common and less severe causes of central chest pain.
Anxiety can trigger physical pain: Stress and panic attacks can cause chest tightness and sharp pain that mimics heart-related issues due to hormonal responses and muscle tension.
Medical evaluation is always recommended: Self-diagnosis is risky. For persistent, unexplained, or new chest pain, a medical professional can provide an accurate diagnosis and treatment plan.

Pain in the middle of the chest, often felt behind the breastbone or sternum, can be a source of significant anxiety. While many people's immediate concern is a heart attack, the discomfort can stem from a variety of systems, including the musculoskeletal, digestive, or respiratory systems. Accurate diagnosis by a healthcare professional is crucial, as is recognizing symptoms that require immediate emergency care.

Cardiac Causes for Middle Chest Pain

Pain originating from the heart is the most serious concern for many experiencing chest pain. Several heart conditions can cause pain felt in the central chest.

Heart Attack

A heart attack occurs when blood flow to a part of the heart muscle is blocked. This is a medical emergency that requires immediate treatment.

Symptoms: Chest pain that may feel like pressure, tightness, squeezing, or aching. It can last for more than a few minutes or may come and go.
Associated signs: Pain or discomfort can radiate to the shoulder, arm, back, neck, or jaw. Other symptoms include shortness of breath, sweating, nausea, fatigue, and lightheadedness.

Angina

Angina is a symptom of coronary artery disease, caused by reduced blood flow to the heart muscle. Unlike a heart attack, it is not a medical emergency, but it is a warning sign of underlying heart disease.

Symptoms: Squeezing, pressure, heaviness, or tightness in the chest.
Triggers: Often triggered by physical exertion or emotional stress and typically subsides with rest.

Other Heart-Related Conditions

Less common but still serious, inflammation of the heart or surrounding sac can cause chest pain.

Pericarditis: Inflammation of the sac surrounding the heart (pericardium). The pain can be sharp and may worsen when lying down or taking a deep breath.
Myocarditis: Inflammation of the heart muscle, often following a viral infection. Symptoms can mimic a heart attack and may include fever, fatigue, and shortness of breath.

Gastrointestinal Issues That Cause Central Chest Pain

The esophagus, stomach, and other digestive organs are located close to the heart, and problems in these areas can cause pain that radiates to the middle of the chest.

Gastroesophageal Reflux Disease (GERD) and Heartburn

GERD, or chronic acid reflux, is one of the most common non-cardiac causes of chest pain.

Symptoms: A burning sensation in the middle of the chest (heartburn).
Triggers: Often occurs after eating, consuming acidic or fatty foods, or lying down.
Associated signs: Can include a sour taste in the mouth, bloating, belching, or difficulty swallowing.

Esophageal Spasms

These are abnormal, sometimes painful, muscle contractions in the esophagus. The pain can be intense and may mimic heart pain.

Symptoms: Intense, squeezing chest pain that can last for minutes to hours.
Triggers: Can be triggered by swallowing very hot or very cold liquids.
Associated signs: Difficulty swallowing and sometimes regurgitation of food.

Musculoskeletal Reasons for Pain Near the Sternum

Pain can also arise from the bones, cartilage, or muscles of the chest wall. These are typically not life-threatening but can cause significant discomfort.

Costochondritis

This is an inflammation of the cartilage connecting the ribs to the breastbone. It is a very common cause of chest pain.

Symptoms: Sharp, aching, or pressure-like pain often felt on the left side of the breastbone.
Triggers: The pain worsens with deep breathing, coughing, sneezing, or movement. The area is often tender to the touch.

Muscle Strain and Injuries

Straining muscles or ligaments in the chest wall from physical activity, lifting, or even severe coughing can cause pain.

Symptoms: Localized pain or tenderness that is exacerbated by specific movements or pressure.
Cause: Often results from exercise, heavy lifting, or a forceful, persistent cough.

Respiratory Problems Affecting the Middle Chest

Conditions affecting the lungs or the surrounding structures can also manifest as central chest pain.

Pleurisy: Inflammation of the tissue that lines the lungs and chest cavity (pleura). Causes sharp chest pain that worsens with deep breathing or coughing.
Pulmonary Embolism: A blood clot that has traveled to the lungs. This is a medical emergency. Symptoms include sudden, sharp chest pain, shortness of breath, and rapid heart rate.

Psychological Factors: The Link Between Anxiety and Chest Pain

Anxiety and panic attacks can trigger a physical stress response that causes chest pain, which can be frightening and exacerbate the anxiety.

Symptoms: Tightness, sharp or stabbing pain, or pressure.
Associated signs: Rapid heart rate, sweating, and dizziness.
Duration: Typically comes on suddenly and may fade relatively quickly, often within minutes to an hour.

When to Seek Medical Attention

While many causes of middle chest pain are not life-threatening, it is vital to be cautious and not attempt self-diagnosis. You should seek immediate emergency medical help if you experience sudden, severe, or unexplained chest pain, especially with associated symptoms like shortness of breath, radiating pain, nausea, or sweating.

If the pain is persistent, recurrent, or you are concerned, see a healthcare provider for a proper evaluation.

Comparison Table: Non-Cardiac vs. Cardiac Chest Pain


Feature	Non-Cardiac Chest Pain	Cardiac Chest Pain
Sensation	Sharp, stabbing, burning (GERD), or tender to touch (costochondritis)	Crushing, squeezing, tightness, or pressure.
Location	Often localized to the center (sternum) or can move around.	Typically central or left-sided, potentially radiating to the arms, jaw, or back.
Triggers	Eating certain foods (GERD), deep breathing/coughing (costochondritis/pleurisy), anxiety/stress, specific movements.	Physical exertion, emotional stress.
Duration	Can be brief (seconds), minutes, or longer, sometimes episodic. Anxiety pain often fades relatively quickly.	Lasts more than a few minutes; does not resolve with rest (heart attack).
Associated Symptoms	Sour taste, bloating, difficulty swallowing (GERD); tenderness to touch (costochondritis); dizziness, rapid breathing (anxiety).	Shortness of breath, sweating, nausea, lightheadedness.
Relief	May improve with antacids (GERD) or rest (muscle strain/anxiety).	Relieved by rest (angina) or emergency treatment (heart attack).

Conclusion

Middle chest pain can be a symptom of conditions ranging from mild to life-threatening. While many non-cardiac causes like acid reflux, musculoskeletal issues, and anxiety are common, it is impossible to self-diagnose accurately. Symptoms that mimic heart problems, such as squeezing or radiating pain, especially with other signs like shortness of breath, necessitate immediate emergency medical evaluation. For less severe but persistent discomfort, a doctor's visit can provide clarity and an appropriate treatment plan, such as those recommended by Healthline on sternum pain. The most prudent course of action is always to take chest pain seriously and seek professional medical guidance when in doubt.

Frequently Asked Questions

Yes, stress and anxiety can cause significant pain in the middle of your chest. During a panic or anxiety attack, the body releases hormones like adrenaline, which can cause muscles in the chest to tense and the heart rate to increase, leading to a feeling of tightness, pressure, or sharp pain.

While it can be difficult to tell the difference, pain from acid reflux (heartburn) is typically a burning sensation, may leave a sour taste in your mouth, and often occurs after eating. Cardiac pain is more likely to feel like a crushing pressure and is often accompanied by shortness of breath, sweating, or pain radiating to the jaw or arm.

Costochondritis is an inflammation of the cartilage that connects your ribs to your breastbone. It typically causes sharp, localized pain or tenderness where the ribs meet the sternum. The pain can worsen with deep breathing, coughing, or when pressure is applied to the area.

You should go to the emergency room immediately if you have sudden, severe chest pain, especially if it's accompanied by shortness of breath, sweating, nausea, or pain radiating to the arms, neck, or jaw. This could indicate a heart attack or pulmonary embolism.

Yes, a muscle strain is a common cause of middle chest pain. The intercostal muscles between your ribs can become strained from strenuous exercise, lifting heavy objects, or even a persistent, forceful cough. This pain is often localized and may be tender to the touch.

Yes, conditions affecting the lungs or the surrounding lining can cause central chest pain. For example, pleurisy, which is inflammation of the lining around the lungs, can cause sharp chest pain that increases with deep breaths or coughing.

Not necessarily. While some benign conditions like anxiety or GERD can cause pain that comes and goes, so can more serious issues like unstable angina. Any recurring or persistent chest pain should be evaluated by a medical professional to determine the underlying cause.