Chest pain can be frightening because many people immediately think of a heart attack. While chest pain should always be taken seriously, the good news is that many episodes of chest discomfort are caused by conditions that do not originate from the heart.

The chest contains the heart, lungs, esophagus, muscles, ribs, cartilage, nerves, and other structures. A problem involving any of these can produce chest pain, pressure, tightness, burning, soreness, or discomfort. Current American Heart Association (AHA) and American College of Cardiology (ACC) guidance emphasizes that potentially cardiac symptoms are not limited to the word “pain”; pressure, tightness, heaviness, or discomfort may also be important.¹

Some patterns provide useful clues. Pain that occurs after lifting something heavy and worsens when you twist may be musculoskeletal. Burning discomfort after a large meal may suggest acid reflux. Sharp pain that worsens when taking a deep breath can occur with several chest or lung conditions. Pressure associated with exertion, sweating, nausea, or shortness of breath raises more concern for a cardiovascular cause.¹˒²

However, symptoms alone cannot safely rule out serious causes of chest pain.

This guide explains common reasons your chest may hurt, how different patterns of chest pain are evaluated, which symptoms warrant urgent care, and when you should call 911 or go to the emergency department.

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What Does Chest Pain Feel Like?

Chest pain does not always feel like severe pain.

People may describe it as:

• Pressure
• Tightness
• Squeezing
• Heaviness
• Burning
• Aching
• Sharp or stabbing pain
• Tenderness
• Fullness
• A pulling sensation
• Mild discomfort
• Pain that travels into the arm, shoulder, jaw, neck, back, or upper abdomen

The 2021 AHA/ACC chest pain guideline emphasizes that symptoms potentially associated with heart disease can involve not only the chest but also the shoulders, arms, neck, back, upper abdomen, or jaw. Shortness of breath and fatigue can also occur as anginal equivalents.¹

This is one reason the severity or description of chest pain alone cannot determine whether it is dangerous.

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Why Does My Chest Hurt?

There are many potential causes of chest pain.

Some are relatively minor and self-limited. Others require immediate treatment.

A healthcare professional evaluating chest pain generally considers several broad categories:

• Cardiovascular causes
• Pulmonary or lung-related causes
• Musculoskeletal causes
• Gastrointestinal causes
• Psychological causes
• Other less common conditions

The first priority is not necessarily finding the most common diagnosis. It is determining whether a life-threatening diagnosis needs to be excluded first.²˒³

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1. Musculoskeletal Chest Pain

Musculoskeletal conditions are among the most common explanations for chest pain seen in outpatient settings.³

Your chest wall contains numerous muscles, ribs, joints, tendons, and cartilage structures that can become irritated.

Possible triggers include:

• Heavy lifting
• Exercise
• Repetitive upper-body movement
• Severe coughing
• Sports
• Trauma
• Unusual sleeping positions
• Muscle strain

Musculoskeletal pain becomes more likely when the discomfort:

• Occurs after a physical activity
• Changes with movement
• Hurts when twisting the torso
• Is localized to a specific area
• Is reproducible when the area is pressed

However, tenderness does not automatically prove that chest pain is harmless. A clinician considers the entire presentation and the person’s cardiovascular risk, rather than relying on one finding.

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2. Costochondritis

Costochondritis is inflammation involving the cartilage where the ribs attach to the breastbone.

It can cause surprisingly intense chest pain and sometimes closely resemble cardiac pain.

Symptoms commonly include:

• Sharp or aching chest pain
• Tenderness near the breastbone
• Pain worsened by movement
• Pain worsened by deep breathing
• Pain with coughing or sneezing

Costochondritis may occur without an obvious cause, although physical strain, illness, trauma, and severe coughing can sometimes be associated with it.⁴

The presence of reproducible tenderness can support a musculoskeletal explanation, but new chest pain—especially in someone with cardiovascular risk factors—should not automatically be labeled costochondritis without an appropriate assessment.

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3. Gastroesophageal Reflux Disease and Heartburn

The esophagus runs through the chest, which is why acid reflux can sometimes produce discomfort that feels surprisingly similar to heart-related chest pain.

Gastroesophageal reflux disease (GERD) may cause:

• Burning behind the breastbone
• Sour or acidic taste
• Regurgitation
• Symptoms after eating
• Symptoms when lying down
• Upper abdominal discomfort

This is often called heartburn, despite originating from the digestive tract rather than the heart.

Gastrointestinal causes account for a meaningful portion of chest-pain presentations.²

But there is an important safety issue:

Do not assume new chest pain is heartburn simply because you have experienced reflux before.

Cardiac and gastrointestinal symptoms can overlap. If the presentation is unusual, severe, exertional, associated with shortness of breath, or accompanied by other warning signs, seek medical evaluation.

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4. Anxiety and Panic Attacks

Anxiety can produce very real physical symptoms.

A panic attack may cause:

• Chest tightness
• Chest discomfort
• Rapid heartbeat
• Palpitations
• Shortness of breath
• Trembling
• Sweating
• Dizziness
• Tingling
• A sense that something terrible is happening

Anxiety and panic disorders are recognized causes of noncardiac chest pain.²˒³

However, anxiety should not automatically be assumed to be the cause of new chest pain.

Serious medical conditions can also produce anxiety, sweating, rapid heartbeat, and shortness of breath. The appropriate diagnosis depends on the complete clinical picture.

Also see Heart Palpitations — When to Worry, Common Causes, and When to Seek Care.

If palpitations accompany the chest discomfort, the article above can provide additional information about common and concerning patterns.

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5. Respiratory Infections and Pneumonia

Problems involving the lungs can also cause chest discomfort.

For example, pneumonia may produce:

• Cough
• Fever
• Chills
• Shortness of breath
• Fatigue
• Chest discomfort

Inflammation involving the tissues surrounding the lungs can cause pleuritic chest pain, meaning pain that becomes worse when taking a deep breath or coughing.

Respiratory infections may be relatively mild, but chest pain associated with significant difficulty breathing, low oxygen levels, confusion, or severe illness requires prompt evaluation. Also see Shortness of Breath — Common Causes, Warning Signs, and When to Seek Care.

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6. Heart-Related Chest Pain

One of the most important causes of chest pain to recognize is myocardial ischemia, which occurs when part of the heart muscle does not receive enough oxygenated blood.

Coronary artery disease can reduce blood flow through the coronary arteries.

Symptoms potentially associated with myocardial ischemia may include:

• Pressure
• Squeezing
• Tightness
• Heaviness
• Chest discomfort
• Symptoms triggered by exertion
• Pain or discomfort extending into the arms, shoulders, neck, jaw, back, or upper abdomen
• Shortness of breath
• Nausea
• Sweating
• Lightheadedness
• Unusual fatigue¹˒⁵

The American Heart Association notes that some heart attacks begin suddenly and intensely, while others begin more gradually with relatively mild discomfort.⁵

That means mild pain does not automatically mean a harmless problem.

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What Is a Heart Attack?

A heart attack, or myocardial infarction, occurs when blood flow to part of the heart muscle becomes sufficiently disrupted to cause injury.

The classic symptom is central chest discomfort, often described as:

• Pressure
• Squeezing
• Fullness
• Pain

The discomfort may persist for several minutes or disappear and return. Symptoms can also involve the arms, back, neck, jaw, or stomach. Shortness of breath, nausea, sweating, fatigue, or lightheadedness may occur.⁵

Not everyone experiences the same presentation.

Women can experience chest discomfort during myocardial infarction just as men do, but may also experience associated symptoms such as nausea, shortness of breath, unusual fatigue, or weakness.¹˒⁵

If you believe you may be experiencing symptoms of a heart attack, call 911 rather than driving yourself to the hospital. Emergency medical personnel can begin evaluation and treatment before arrival.⁵

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What Does Sharp Pain in the Chest Mean?

A sharp pain in the chest can have many explanations.

Possibilities include:

• Musculoskeletal pain
• Costochondritis
• Pleuritic inflammation
• Pneumonia
• Pulmonary embolism
• Pneumothorax
• Pericarditis
• Gastrointestinal causes
• Other chest-wall conditions

Sharp pain is generally less characteristic of myocardial ischemia than pressure, heaviness, squeezing, or exertional discomfort.²

However, sharp does not mean safe.

For example, a pulmonary embolism can produce chest pain and shortness of breath, while pneumothorax can cause sudden chest pain with difficulty breathing.²

The surrounding symptoms and risk factors matter much more than whether someone uses the word “sharp.”

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What Causes Left-Sided Chest Pain?

Left chest pain understandably causes concern because the heart is located primarily toward the left side of the chest.

But location alone cannot determine the cause.

Left-sided chest pain can result from:

• Chest-wall muscle strain
• Costochondritis
• Rib injury
• Acid reflux
• Anxiety
• Lung conditions
• Pericardial inflammation
• Coronary artery disease
• Acute coronary syndrome

Conversely, heart-related symptoms do not necessarily remain confined to the left chest.

Cardiac discomfort can be central or may radiate to other parts of the upper body.¹

Therefore:

Left-sided does not automatically mean heart attack, and right-sided does not automatically mean noncardiac.

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What Causes Pain on the Right Side of the Chest?

Right-sided chest pain is frequently caused by noncardiac conditions, but it still has a broad differential diagnosis.

Potential causes include:

• Muscle strain
• Rib injury
• Costochondritis
• Pneumonia
• Pleurisy
• Pulmonary embolism
• Pneumothorax
• Gastrointestinal disease
• Gallbladder-related referred pain
• Anxiety

A clinician will usually consider what triggered the pain and whether symptoms such as fever, cough, shortness of breath, trauma, abdominal pain, or movement-related tenderness are present.

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What Causes Pain in the Middle of the Chest?

Central chest discomfort deserves particular attention because cardiac ischemia frequently produces symptoms behind the breastbone.

However, other conditions can also cause central chest pain.

Possibilities include:

• Acid reflux
• Esophageal problems
• Costochondritis
• Musculoskeletal strain
• Anxiety
• Heart disease

If central chest discomfort feels like pressure, squeezing, heaviness, or tightness, particularly when associated with exertion, shortness of breath, sweating, nausea, or radiation into the arm or jaw, seek immediate medical evaluation.¹˒⁵

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What About Chest Tightness?

Some people do not describe their symptom as pain at all.

Instead, they say:

“My chest feels tight.”

Chest tightness can occur with:

• Asthma
• Anxiety
• Respiratory infections
• Musculoskeletal problems
• Acid reflux
• Cardiovascular disease
• Other lung conditions

Chest tightness is particularly important when it occurs with exertion, difficulty breathing, dizziness, sweating, nausea, or other potentially cardiac symptoms. Also see Chest Tightness at Night — What It Means and When to Worry.

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Chest Pain With Shortness of Breath

Chest pain occurring together with shortness of breath deserves more attention than either symptom should receive in isolation.

Possible explanations range from relatively minor conditions to emergencies.

Potential causes include:

• Respiratory infection
• Asthma
• Anxiety or panic attack
• Pneumonia
• Heart disease
• Heart failure
• Pulmonary embolism
• Pneumothorax

A healthcare professional considers the onset, severity, oxygen level, vital signs, medical history, risk factors, physical examination, and often an ECG when determining the appropriate next step. Also see Shortness of Breath — Common Causes, Warning Signs, and When to Seek Care.

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Pulmonary Embolism: A Dangerous Cause of Chest Pain

A pulmonary embolism (PE) occurs when material—most commonly a blood clot—travels into the pulmonary circulation and blocks blood flow through part of the lungs.

This can be life-threatening.

Symptoms may include:

• Sudden shortness of breath
• Chest pain
• Rapid heartbeat
• Lightheadedness or fainting
• Cough, sometimes with blood
• Low oxygen levels

Risk factors can include:

• Recent surgery
• Prolonged immobility
• Long-distance travel
• Previous DVT or pulmonary embolism
• Active cancer
• Pregnancy/postpartum state
• Estrogen-containing medications
• Certain clotting disorders

A swollen or painful leg occurring together with chest pain or shortness of breath is particularly concerning for possible venous thromboembolism.

Also see Calf Pain — When to Worry About a Blood Clot vs Muscle Strain.

Or

Also see Leg Swelling — When to Worry About a Blood Clot vs Fluid Retention.

Suspected pulmonary embolism requires emergency evaluation rather than routine outpatient monitoring.

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Pneumothorax: A Collapsed Lung

A pneumothorax occurs when air enters the space between the lung and chest wall, potentially causing part or all of the lung to collapse.

It can cause:

• Sudden chest pain
• Shortness of breath
• Rapid breathing
• Rapid heart rate
• Reduced oxygen levels

A large or tension pneumothorax can become life-threatening.

Sudden significant chest pain combined with difficulty breathing requires emergency evaluation.

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Aortic Dissection: Rare but Dangerous

An aortic dissection occurs when a tear develops within the wall of the aorta, the body’s largest artery.

Although much less common than musculoskeletal chest pain or reflux, it is a medical emergency.

Symptoms can include:

• Sudden severe chest pain
• Severe upper-back pain
• Pain extending toward the neck or back
• Shortness of breath
• Loss of consciousness
• Stroke-like symptoms
• Severe abdominal pain⁶

The pain is sometimes described as tearing or ripping, although not every patient will describe it that way.⁶

Sudden severe chest or back pain—particularly with fainting, neurologic symptoms, or severe shortness of breath—requires immediate emergency evaluation.

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When Should You Go to Urgent Care for Chest Pain?

This question requires caution.

Urgent care can evaluate some clearly low-risk, stable chest complaints, particularly when a musculoskeletal or other non-emergency cause seems likely.

Examples may include:

• Localized chest-wall soreness after exercise
• Minor chest-wall injury
• Pain reproducible with movement
• Persistent mild symptoms requiring examination
• Cough-associated chest discomfort in an otherwise stable patient

However, chest pain can be difficult to risk-stratify without appropriate testing.

Current guidelines recommend obtaining a 12-lead ECG promptly when acute coronary syndrome is suspected.²˒³

Depending on the presentation, an evaluation may also require tests unavailable at many urgent care centers, particularly serial high-sensitivity cardiac troponin measurements. High-sensitivity troponin is the preferred biomarker for detecting myocardial injury.¹

Therefore, an urgent care clinician may appropriately refer a patient to the emergency department even when the eventual diagnosis turns out to be benign.

The purpose of that referral is not to predict that the patient definitely has a heart attack.

It is to ensure that dangerous conditions can be safely excluded.

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When Is Chest Pain an Emergency?

Call 911 or seek emergency medical care for new or unexplained chest discomfort with concerning features such as:

• Pressure, squeezing, heaviness, or significant tightness
• Pain lasting several minutes or repeatedly returning
• Symptoms triggered by exertion
• Shortness of breath
• Cold sweating
• Nausea or vomiting
• Lightheadedness or fainting
• Significant weakness
• Pain spreading to an arm, shoulder, jaw, neck, back, or upper abdomen
• Sudden severe chest or upper-back pain
• New neurologic symptoms
• Coughing blood
• Chest pain with significant breathing difficulty
• Chest pain associated with a new swollen or painful leg¹˒⁵˒⁶

If you think you may be having a heart attack, the American Heart Association recommends calling 911 immediately.⁵

Do not delay emergency evaluation because the discomfort seems mild, because you are young, or because you believe anxiety or heartburn might be responsible.

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How Do Healthcare Professionals Evaluate Chest Pain?

Evaluation starts with the history.

A clinician may ask:

• When did the pain begin?
• Did it start suddenly or gradually?
• What were you doing when it began?
• Where exactly is the pain?
• Does it radiate?
• What does it feel like?
• How severe is it?
• Is it constant or intermittent?
• Does exertion trigger it?
• Does movement affect it?
• Does breathing make it worse?
• Does pressing on the chest reproduce it?
• Does eating affect it?
• Are you short of breath?
• Are you nauseated or sweating?
• Have you fainted?
• Do you have cardiovascular risk factors?
• Have you recently traveled or been immobilized?
• Have you had a previous blood clot?

Vital signs are important because abnormal blood pressure, heart rate, respiratory rate, temperature, or oxygen saturation can provide important clues.

The examination may evaluate:

• Heart sounds
• Lung sounds
• Chest-wall tenderness
• Pulses
• Leg swelling
• Signs of infection
• Abdominal findings
• Neurologic status

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What Tests Are Used for Chest Pain?

Testing depends on the patient’s risk and suspected diagnosis.

Electrocardiogram

An ECG/EKG records the electrical activity of the heart.

Guidelines recommend obtaining an ECG promptly—ideally within approximately 10 minutes of arrival—when patients present to a clinical or emergency setting with possible cardiac chest pain.²

However, an important limitation is that one normal ECG does not automatically rule out acute coronary syndrome.²

Further evaluation depends on the clinical situation.

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Cardiac Troponin

Troponin is released into the bloodstream when heart muscle is injured.

Current guidelines favor high-sensitivity cardiac troponin for evaluating suspected acute myocardial injury.¹˒²

Depending on the clinical situation, measurements may need to be repeated over time.

This is one reason a patient with concerning chest pain may need an emergency department rather than an urgent care clinic.

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Chest X-Ray

A chest X-ray may help identify conditions such as:

• Pneumonia
• Pneumothorax
• Certain rib injuries
• Other pulmonary abnormalities²

But a normal chest X-ray does not rule out every serious cause of chest pain.

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Additional Testing

Depending on the suspected diagnosis and risk level, further evaluation may include:

• CT imaging
• CT pulmonary angiography
• D-dimer testing
• Echocardiography
• Coronary CT angiography
• Stress testing
• Other laboratory studies

The correct test depends on what condition clinicians are trying to confirm or exclude.

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Can You Tell Whether Chest Pain Is Serious by Pressing on It?

Not reliably.

Pain that can be reproduced by pressing on the chest makes a musculoskeletal cause more likely, particularly when combined with other supportive findings.³

But no single physical examination finding should be used by itself to exclude dangerous cardiovascular or pulmonary disease.

This distinction is important.

Medicine rarely works like:

“It hurts when I press it, therefore it cannot be my heart.”

Instead, clinicians combine:

History + risk factors + vital signs + physical examination + ECG/testing when appropriate.

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Can Young People Have Serious Chest Pain?

Yes.

Age strongly influences cardiovascular risk, but being young does not make someone immune to serious disease.

Potential causes of significant chest pain in younger people include:

• Myocarditis
• Pericarditis
• Pulmonary embolism
• Pneumothorax
• Congenital or structural heart disease
• Certain arrhythmias
• Substance-related cardiovascular complications
• Rare vascular disorders

At the same time, musculoskeletal conditions, anxiety, reflux, and respiratory illnesses remain common explanations.

Age should therefore be considered as one component of risk assessment, not as a guarantee.

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Is Chest Pain From Anxiety Dangerous?

Anxiety-related chest pain itself is not the same as a heart attack.

However, diagnosing anxiety as the cause requires appropriate consideration of medical alternatives.

This is especially important when symptoms are:

• New
• Different from previous panic attacks
• Exertional
• Persistent
• Associated with fainting
• Associated with significant shortness of breath
• Associated with cardiovascular risk factors

If medical evaluation supports panic or anxiety as the cause, treatment of the underlying anxiety can reduce recurrent symptoms and improve quality of life.²

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Frequently Asked Questions

Why does my chest hurt?

Chest pain can originate from the heart, lungs, esophagus, ribs, cartilage, muscles, nerves, or other structures. Common outpatient causes include musculoskeletal chest-wall pain and reflux, while important dangerous causes include acute coronary syndrome, pulmonary embolism, pneumothorax, and aortic dissection.²˒³

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What causes sharp pain in the chest?

Sharp pain can occur with musculoskeletal strain, costochondritis, pleurisy, pneumonia, pulmonary embolism, pneumothorax, pericarditis, and other conditions.

Sharp pain is less characteristic of myocardial ischemia than pressure or heaviness, but sharp pain is not automatically benign.²

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Why does my chest hurt when I breathe?

Pain worsened by breathing is often called pleuritic chest pain.

Potential causes include:

• Chest-wall strain
• Costochondritis
• Respiratory infection
• Pneumonia
• Pulmonary embolism
• Pneumothorax
• Pleuritis

Sudden pleuritic pain accompanied by shortness of breath deserves prompt medical evaluation.

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Why does my chest hurt when I move?

Musculoskeletal chest-wall pain becomes more likely when twisting, lifting, arm movement, or certain positions reproduce the discomfort.

Costochondritis can also worsen with movement or deep breathing.⁴

However, new or concerning chest pain should still be evaluated according to the overall clinical picture.

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Can acid reflux cause chest pain?

Yes.

Acid reflux can cause burning or discomfort behind the breastbone and can sometimes resemble cardiac pain.

Do not assume unexplained chest pain is reflux when warning signs for a cardiac or pulmonary problem are present.

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Can anxiety cause chest tightness?

Yes.

Anxiety and panic attacks can cause chest tightness, palpitations, rapid breathing, dizziness, sweating, and other physical symptoms.

Also see Chest Tightness at Night — What It Means and When to Worry.

New chest symptoms should not automatically be attributed to anxiety without considering other causes.

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Is left-sided chest pain always heart-related?

No.

Muscle strain, costochondritis, rib problems, reflux, anxiety, and lung conditions can all cause left-sided pain.

At the same time, cardiac symptoms may occur centrally or elsewhere rather than strictly on the left side.

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When should I worry about chest pain?

New or unexplained chest pain deserves particular concern when associated with pressure, squeezing, exertion, shortness of breath, sweating, nausea, fainting, radiation to the upper body, sudden severe onset, coughing blood, or neurologic symptoms.¹˒⁵˒⁶

Call 911 when symptoms suggest a medical emergency.

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The Bottom Line

If you’re asking “Why does my chest hurt?”, there is no single answer.

Chest pain can come from the:

• Heart
• Lungs
• Chest-wall muscles
• Ribs and cartilage
• Esophagus
• Stomach
• Nerves
• Other nearby structures

Musculoskeletal chest-wall pain, costochondritis, reflux, respiratory conditions, and anxiety can all cause chest discomfort. But dangerous conditions such as acute coronary syndrome, pulmonary embolism, pneumothorax, and aortic dissection must be considered when the presentation warrants it.²˒³

A few patterns can provide clues, but none should be used as a home diagnostic test.

Movement-related or reproducible pain may suggest a musculoskeletal source.

Burning after meals may suggest reflux.

Pressure or heaviness with exertion raises concern for myocardial ischemia.

Sudden chest pain with shortness of breath requires consideration of serious pulmonary and cardiovascular conditions.

Most importantly, do not use pain intensity alone to determine whether chest pain is dangerous. Potentially serious cardiovascular disease can sometimes present with symptoms that seem relatively mild.¹˒²

If chest discomfort is new, unexplained, persistent, worsening, or associated with emergency warning signs, seek appropriate medical evaluation.

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References

1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation. 2021;144:e368-e454. American Heart Association.
2. American Academy of Family Physicians. Chest pain evaluation: updated guidelines from the AHA/ACC. American Family Physician. 2023;107(2):204-206.
3. American Academy of Family Physicians. Chest pain: evaluation in the office setting. FP Essentials. 2026.
4. Mayo Clinic. Costochondritis: symptoms and causes. Updated September 5, 2025.
5. American Heart Association. Warning signs of a heart attack. Reviewed December 12, 2024.
6. Mayo Clinic. Aortic dissection: symptoms and causes. Updated 2025.

Medical disclaimer:
This article is for general educational purposes only and does not provide an individual diagnosis or replace evaluation by a qualified healthcare professional. Chest pain can sometimes represent a medical emergency. Call 911 or seek emergency medical care for new or unexplained chest pain accompanied by concerning symptoms such as difficulty breathing, fainting, sweating, significant weakness, pain spreading to the arm, jaw, back or neck, or other emergency warning signs.