What would cause chest pain in the middle of your chest? A comprehensive guide

October 2, 2025 •

5 min read

Approximately 1–3% of annual visits to a primary care provider in the United States are related to chest pain. While often associated with the heart, there are many reasons for what would cause chest pain in the middle of your chest, ranging from musculoskeletal issues to gastrointestinal problems.

Quick Summary

This article explores the diverse causes of central chest pain, differentiating between serious cardiac events, common musculoskeletal issues, digestive problems, and psychological factors. Learn to identify key symptoms and understand when it is crucial to seek emergency medical attention.

Key Points

Always take chest pain seriously: Due to the potential for a heart attack, any unexplained chest pain should be evaluated by a healthcare professional.
Cardiac pain can be crushing: Heart attack symptoms often include a sensation of squeezing or pressure, radiating to the arms or jaw, accompanied by shortness of breath or sweating.
GERD pain feels like burning: Heartburn from acid reflux is a very common non-cardiac cause of mid-chest pain, characterized by a burning sensation that worsens after eating or lying down.
Anxiety pain can be sharp: Anxiety or panic attacks can cause sharp, fleeting chest pain alongside a racing heart, hyperventilation, and dizziness.
Musculoskeletal pain is often localized: Conditions like costochondritis cause pain that is tender to the touch, and which worsens with movement or deep breaths.
Know when to call emergency services: Call 911 immediately for severe, sudden, or radiating chest pain, especially if accompanied by other serious symptoms like shortness of breath or nausea.

Experiencing pain in the middle of your chest can be alarming due to its proximity to the heart, but it is important to remember that not all central chest pain is a sign of a heart attack. The discomfort can originate from various systems within the chest and upper abdomen, including the esophagus, lungs, and the surrounding muscles and bones. Understanding the different possible sources of pain is the first step toward appropriate care.

Potential Cardiac Causes

Pain in the center of the chest is a classic symptom of several heart-related conditions. While these are often the most urgent causes, an evaluation is necessary to rule them out.

Heart Attack (Myocardial Infarction)

A heart attack occurs when blood flow to a section of the heart muscle is blocked.

Symptoms: This often feels like a crushing pressure, tightness, or squeezing in the center of the chest. The pain can spread to the arms (especially the left), jaw, neck, back, or stomach. Other symptoms include shortness of breath, nausea, sweating, and lightheadedness. Pain does not typically go away with rest.

Angina

Angina is chest pain caused by reduced blood flow to the heart muscle, often during physical exertion or stress.

Symptoms: Described as squeezing, pressure, or heaviness, angina pain usually subsides with rest and is a symptom of coronary artery disease.

Pericarditis

This is inflammation of the sac surrounding the heart, often caused by a viral infection.

Symptoms: The pain is often sharp and stabbing and typically worsens when lying down or taking a deep breath. Sitting up and leaning forward may provide some relief.

Aortic Dissection

This life-threatening condition involves a tear in the inner layer of the aorta.

Symptoms: It causes sudden, severe, ripping, or tearing pain in the chest that often radiates to the back. It is a medical emergency requiring immediate attention.

Gastrointestinal Causes

Digestive issues can frequently cause pain that is referred to the chest, leading to misidentification as a heart problem.

Gastroesophageal Reflux Disease (GERD) and Heartburn

GERD is a very common cause of non-cardiac chest pain, occurring when stomach acid flows back into the esophagus.

Symptoms: A burning sensation, often called heartburn, is felt behind the breastbone and can worsen after eating or when lying down. It can also cause a sour taste, bloating, and coughing.

Esophageal Spasms

These are involuntary, painful contractions of the muscles in the esophagus.

Symptoms: Esophageal spasms can cause sudden, intense, squeezing chest pain that may last for minutes or hours and is often triggered by eating or drinking very hot or cold food. It can be very difficult to distinguish from cardiac pain without testing.

Other Digestive Issues

Gallstones and Pancreatitis: Pain from gallstones or an inflamed pancreas can sometimes be referred to the chest area.
Hiatal Hernia: This occurs when a portion of the stomach bulges through the diaphragm, causing heartburn and chest discomfort.

Musculoskeletal Causes

Problems with the chest wall, muscles, and bones can cause localized pain that may feel like it originates deeper in the chest.

Costochondritis

This is inflammation of the cartilage that connects the ribs to the breastbone (sternum).

Symptoms: A sharp, aching, or pressure-like pain often on the left side of the breastbone. It can be triggered by deep breathing, coughing, or physical activity and is often tender to the touch.

Muscle Strain or Bruise

Overexertion, intense coughing, or an injury can strain or bruise the muscles in the chest wall.

Symptoms: The pain is usually localized and worsens with movement, coughing, or deep breathing.

Rib Fracture

Trauma to the chest can cause a rib fracture, resulting in severe pain, swelling, and difficulty breathing.

Lung-Related Causes

Several lung conditions can cause chest pain, which is often pleuritic (worsens with breathing).

Pulmonary Embolism

This life-threatening condition involves a blood clot in the lung artery.

Symptoms: Causes sharp, sudden chest pain that worsens with inhalation, shortness of breath, a rapid heart rate, and sometimes a cough.

Pleurisy

Inflammation of the lining of the lungs can cause sharp, stabbing chest pain that worsens with deep breathing or coughing.

Pneumonia

A lung infection like pneumonia can lead to chest pain, often accompanied by coughing, fever, and shortness of breath.

Psychological and Other Causes

Anxiety and Panic Attacks

Anxiety can trigger physical responses like increased heart rate, hyperventilation, and muscle tension, which can be perceived as chest pain.

Symptoms: This can feel like a sharp, stabbing pain or a tight, squeezing sensation. It often occurs with other panic symptoms, such as a racing heart, sweating, and dizziness. Unlike cardiac pain, it can happen at rest.

Differentiating Causes: Comparison Table


Symptom	Heart Attack	Anxiety/Panic Attack	Acid Reflux (GERD)	Costochondritis
Sensation	Crushing pressure, tightness, squeezing, or heaviness	Sharp, stabbing, or tight squeezing	Burning sensation or indigestion	Sharp, aching, or pressure-like
Location	Mid-chest, often radiating to arms, jaw, back	Usually localized to the chest	Behind the breastbone (sternum)	Left side of the breastbone, tender to touch
Trigger	Often during physical exertion; can happen at rest	Emotional stress, anxiety, or can occur at rest	Eating, especially large or acidic meals; lying down	Deep breathing, coughing, or physical activity
Relief	Not relieved by rest; requires medical treatment	Can resolve with relaxation techniques or breathing exercises	May be relieved by antacids or sitting up	Rest, anti-inflammatory medication, or applying heat
Associated Symptoms	Shortness of breath, nausea, sweating, fatigue	Rapid heart rate, sweating, dizziness, tingling	Sour taste, bloating, difficulty swallowing	Worsens with movement of the chest wall

When to Seek Medical Attention

While many causes of chest pain are not life-threatening, it is crucial to take all chest pain seriously until a definitive diagnosis is made. Never attempt to self-diagnose based on symptoms alone. In any case of doubt, especially if it is your first time experiencing chest pain, seek immediate medical care.

Call 911 or your local emergency number immediately if you experience:

Sudden, severe, or crushing pain or pressure in the chest.
Pain that spreads to your arms, back, neck, or jaw.
Shortness of breath, sweating, nausea, or dizziness accompanying the pain.
Chest pain that lasts longer than a few minutes and does not get better with rest.

See a doctor if:

You have new or unexplained chest pain that comes and goes.
You suspect your pain is related to acid reflux or musculoskeletal issues.

Conclusion

Chest pain in the middle of your chest can be a distressing and potentially serious symptom with a wide range of underlying causes. While urgent cardiac conditions are a primary concern and should be immediately evaluated, many instances of central chest pain stem from more benign issues like acid reflux, musculoskeletal inflammation, or anxiety. A detailed assessment of your pain—including its characteristics, location, and associated symptoms—is vital for a correct diagnosis. Given the risk of misinterpreting a serious cardiac event, it is always safest to seek prompt medical attention for any new or worrisome chest pain. By understanding the potential culprits and knowing when to act swiftly, you can protect your health and ensure the right course of treatment is followed. Further information on heart attack symptoms can be found on the British Heart Foundation website.

Frequently Asked Questions

Heart attack pain often feels like a crushing pressure that may radiate to the arm or jaw and usually doesn't subside with rest. Anxiety-related chest pain is frequently described as a sharp or stabbing pain that stays localized to the chest and may be accompanied by a rapid heart rate, sweating, and dizziness.

Yes. The burning sensation of heartburn from acid reflux (GERD) occurs in the same area as cardiac pain—behind the breastbone. It is a very common cause of non-cardiac chest pain and can be difficult to distinguish from a heart attack without medical evaluation.

Costochondritis causes a sharp, aching, or pressure-like pain, often on the left side of the breastbone. The pain is usually localized and tender to the touch, and it can worsen with deep breathing, coughing, or certain movements.

A pulmonary embolism is a life-threatening blood clot that travels to the lungs. It causes sudden, sharp chest pain that worsens with breathing, shortness of breath, rapid heart rate, and sometimes a cough.

If pressing on the chest wall, specifically around the breastbone or ribs, reproduces the pain, it is more likely to be a musculoskeletal issue like costochondritis than a heart attack. However, this is not a reliable method for self-diagnosis, and any chest pain should be medically evaluated.

Yes, stress can cause chest pain through muscle tension and the body's 'fight or flight' response, which increases heart rate and blood pressure. A panic attack can lead to chest pain that feels sharp or tight.

You should go to the emergency room or call 911 immediately if you experience sudden, severe, or crushing chest pain that radiates, is accompanied by shortness of breath, sweating, or nausea, or does not go away with rest.