Common Non-Cardiac Causes of Chest Pain
Pain in the middle of the chest is often mistaken for a heart issue, but many less-urgent conditions can be the cause. Your sternum, or breastbone, sits at the center of your chest and connects your ribs. Various muscles, joints, and organs in this area can cause discomfort. Understanding the common non-cardiac causes can help determine the next steps, though any severe or persistent chest pain warrants a doctor's evaluation.
Musculoskeletal Issues
Musculoskeletal conditions are a frequent source of chest pain. They involve the muscles, bones, and cartilage in the chest wall and are typically less severe than cardiac problems.
Costochondritis
This is the most common cause of sternum pain and involves inflammation of the cartilage that connects your ribs to your breastbone.
- Symptoms: Sharp, aching, or pressure-like pain often on the left side of the breastbone. It can radiate to the arms and shoulders and worsens with deep breathing, coughing, or movement of the chest wall.
- Causes: Often unknown, but can result from chest injuries, muscle strain, viral infections, or conditions like arthritis.
- Relief: Rest, warm compresses, and over-the-counter pain relievers can often help.
Muscle Strains and Injuries
Straining chest muscles from strenuous exercise, heavy lifting, or even persistent, severe coughing can lead to aches in the middle of the chest.
- Symptoms: A dull, localized ache that worsens with specific movements or pressure on the affected area. The pain is not typically accompanied by other concerning symptoms like shortness of breath.
- Causes: Overexertion, heavy lifting, and chronic coughing.
Tietze Syndrome
Similar to costochondritis, but involves swelling of the rib cartilage. It often presents as a distinct, localized, painful lump or swelling near the breastbone.
Gastrointestinal Conditions
Digestive issues can trigger pain behind or below the breastbone, a sensation that can be difficult to distinguish from heart-related pain.
Gastroesophageal Reflux Disease (GERD)
When stomach acid flows back into the esophagus, it can cause a burning chest sensation known as heartburn.
- Symptoms: A burning, gnawing, or squeezing sensation, often worse after eating, when lying down, or bending over. It may be accompanied by a sour taste in the mouth, frequent burping, or difficulty swallowing.
- Causes: Certain foods, large meals, obesity, and hiatal hernia can contribute.
Esophageal Spasms
These are abnormal muscle contractions in the esophagus that can feel like sudden, intense, squeezing chest pain.
- Symptoms: Intense, squeezing chest pain that can radiate to the neck, jaw, or arms, potentially mimicking a heart attack. It can be triggered by eating or drinking, especially very hot or very cold liquids.
Hiatal Hernia
This occurs when the stomach pushes through the diaphragm into the chest cavity, potentially causing heartburn and other pain.
- Symptoms: Heartburn, burping, and trouble swallowing, which may manifest as chest discomfort.
Anxiety and Panic Attacks
Emotional stress and anxiety can manifest as physical symptoms, including chest tightness and pain.
- Symptoms: Sharp, crushing, or tight chest pain, often accompanied by a racing heart, shortness of breath, sweating, and feelings of dread or fear. The pain usually lasts for minutes and often subsides as the panic attack resolves.
How to Distinguish Between Causes
Since multiple conditions can cause chest pain, it helps to understand the key differences. This is not a substitute for a medical diagnosis, but can help in observation.
- Cardiac Pain (Heart Attack): Often feels like pressure, squeezing, or fullness. It can radiate to the left arm, shoulder, back, neck, or jaw. It may be accompanied by shortness of breath, lightheadedness, nausea, or a cold sweat. It is often triggered by physical exertion and subsides with rest.
- Musculoskeletal Pain: Usually sharp or aching and localized to a specific spot. It worsens with movement, deep breathing, or direct pressure on the breastbone or ribs. This pain may improve with rest and pain relievers.
- Gastrointestinal Pain: Often described as burning or gnawing. It frequently occurs after eating, when lying down, or bending over. It may be relieved by antacids. A bitter taste, belching, or difficulty swallowing can also indicate a GI issue.
Comparison of Common Chest Pain Causes
| Feature | Costochondritis | Acid Reflux (GERD) | Anxiety Attack | Heart Attack | Musculoskeletal Strain |
|---|---|---|---|---|---|
| Sensation | Sharp, aching, pressure | Burning, gnawing, squeezing | Tightness, crushing, shortness of breath | Squeezing, heaviness, pressure | Localized ache or sharp pain |
| Location | Left side of sternum, affects ribs | Behind the breastbone | Center of chest | Center or left side, may radiate | Localized to muscle or joint |
| Triggers | Movement, deep breathing, cough | Large meals, lying down, spicy food | Stress, emotional triggers | Exertion, stress | Lifting, strenuous activity, cough |
| Relieving Factors | Rest, warm compress, pain reliever | Antacids, sitting up, avoiding triggers | Relaxation techniques | Rest (may or may not relieve) | Rest, gentle stretching |
| Associated Symptoms | Tenderness to touch | Burping, sour taste, swallowing issues | Racing heart, sweating, dread | Nausea, sweating, shortness of breath | Tenderness, localized swelling |
When to Seek Medical Attention
While many causes are non-emergent, it is crucial to recognize when pain could be serious. If you have any doubt, seek immediate medical care. You should call 911 or your local emergency number if your chest pain is accompanied by:
- Radiating pain: Spreading to your jaw, neck, back, or arms.
- Associated symptoms: Shortness of breath, dizziness, cold sweats, or nausea.
- Abrupt onset: Pain that appears suddenly and is very severe, especially with tearing or ripping sensations.
- Worsening pain: Pain that does not improve or continues to get worse over time.
At-Home Management for Non-Urgent Chest Pain
If a healthcare professional has ruled out life-threatening conditions, here are some strategies for managing less severe chest pain:
- Modify Your Diet: For acid reflux, avoid trigger foods like spicy, fatty, and acidic meals. Eat smaller, more frequent meals and avoid lying down immediately after eating.
- Rest and Apply Heat: For musculoskeletal pain, rest and apply a warm compress to the area to soothe sore muscles and inflammation.
- Manage Stress: Incorporate relaxation techniques, deep breathing exercises, and meditation to help manage anxiety-related chest pain.
- Consider Over-the-Counter Medication: For costochondritis or muscle strain, pain relievers like acetaminophen or ibuprofen can help reduce inflammation and discomfort, but always follow a doctor's advice.
For more detailed, professionally vetted information on distinguishing cardiac from non-cardiac chest pain, you can refer to authoritative sources like the American Heart Association.
Conclusion
While chest pain between the breasts can be alarming, a variety of conditions, from musculoskeletal problems to digestive issues and anxiety, can be the underlying cause. While it's always wise to err on the side of caution and consult a healthcare professional for a proper diagnosis, understanding the different types of pain and accompanying symptoms can provide some insight. Distinguishing between cardiac and non-cardiac causes is crucial for determining the appropriate course of action, and any severe or persistent chest pain, especially with heart-related symptoms, should be evaluated immediately by a doctor.
