First, let’s start with the answer: NO. Chest pain isn’t always a sign of a heart attack, or even of a heart problem. We’ll try to sort out the various causes of chest pain here to help you understand it better.

BUT: As with our other solutions pages, the data presented here was not meant to replace a doctor’s advice. In any case of chest pain, you should visit a doctor, and only use this page as a reference.

Also note that in time we will add the diseases shown below to the site, so make sure to bookmark this page for future reference.

Where is it coming from?

As can be seen in this picture, we can divide the causes for chest pain to those coming from the heart, the lungs, or the gastrointestinal tract (or simply gastro. This includes everything from the esophagus to the end of the intestines). Another category is others.

Heart

There are several things originating in the heart that can cause chest pain:

1. Angina – This is the pain which is caused when the heart’s arteries are clogged. (When they are completely clogged, a heart attack occurs). The pain in angina is felt under the breast bone (around the center of the chest) like a deep pain. It usually lasts less than 30 minutes and can radiate to the neck, the jaw or the left arm. It can be accompanied by breathlessness, cold sweat and nausea or vomiting.The pain of angina usually gets worse with physical exertion and is relieved by rest or by taking a drug called nitroglycerine.
2. Heart attack – The pain here actually is the same as the one in angina. The only difference: It tends to last longer (more than 30 minutes), it’s more intense, and usually rest or nitroglycerine don’t help. Of course, the only way to really differentiate between those two is to do an ECG and blood tests.
3. Pericarditis – This is an inflammation of the coverings of the heart. The pain here is different – it’s sharp (and not dull as in angina or a heart attack). It radiates to the trapezius muscle. Breathing makes it worse. It’s relieved when you lean forward and gets worse when you lie down.
4. Myocarditis – This is an inflammation of the heart muscle. The pain is similar to that seen in pericarditis.
5. Aortic dissection – This is a rupture of the aorta (the main artery in our body). It’s a life threatening condition. The pain here starts suddenly and feels as if someone stabbed you with a knife. It tends to radiate to the back, between the shoulder blades.

Lungs

1. Pneumonia – Pneumonia can also cause chest pain. The pain here is aggravated by breathing and is sharp. With pneumonia usually come other things such as breathlessness, fever, cough and phlegm.
2. Pleuritis – This is an inflammation of the coverings of the lungs. The pain here is also sharp, and aggravated by breathing.
3. Pneumothorax – Pneumothorax is a collapse of the lungs, caused by the accumulation of air between the lungs and their coverings, making it hard for them to expand and for you to breath. The pain here is usually one-sided, sharp, starts suddenly and is aggravated by breathing.
4. Pulmonary embolism – A pulmonary embolism is the discharge of a clot from the body which reaches the blood vessels in your lungs, causing blood not to cross the lungs properly – meaning you won’t get enough oxygen into your blood. This is life threatening. The pain here starts suddenly, it’s sharp, and it’s aggravated by breathing.
5. Pulmonary hypertension – This happens when you have hypertension in the blood vessels in your lungs. Usually along with the pain comes breathlessness and pressure with physical exertion.

Gastro

1. Gastroesophageal reflux disease – The pain here is caused by acid going back from the stomach to the esophagus. You feel it under the chest bone (in the middle of the chest), and it feels like burning. Along with it can come an acid taste in the mouth. It’s aggravated by meals or lying down and is relieved by taking antacids.
2. Esophageal spasm – This is a condition in which the esophagus’ muscles contract periodically for unknown reasons. It can cause pain under the chest bone, which is aggravated by swallowing. Like angina, it can also be relieved by taking nitroglycerin.
3. Mallory-Weiss tears – This is a tear in the esophagus that can be caused by vomiting strongly. (It’s more common in alcoholics).
4. Boerhaave’s syndrome – This isn’t a tear, but rupture, of the esophagus. It can also be caused by vomiting, but also by other things which can damage the esophagus. The pain here is severe and is aggravated by swallowing.
5. Peptic ulcer disease – This is caused by ulcers (or wounds) in the intestine or stomach. The pain here is usually in the upper abdomen, and usually relieved by antacids.
6. Pain from the bile system – The bile system releases bile, which helps us digest food. Pain from that system is usually located in the upper right abdomen, can be accompanied by nausea or vomiting, and is usually aggravated by fatty foods.
7. Pancreatitis – This is an inflammation in the pancreas. The pain is usually severe. It’s located in the upper abdomen and can radiate to the back.

Others

1. Pain from muscle or bone – Sometimes, a strained muscle or a hurting bone in the chest can cause pain. This pain is usually localized to a specific area, and it gets worse upon touching the area.
2. Anxiety – An anxiety attack can also cause chest pain. It will feel like “tightness” in the chest.
3. Herpes zoster – Herpes zoster is caused by the same virus that causes chickenpox. This virus “sleeps” in our body, and under certain circumstances can “wake up” and reach the skin, where it can cause a rash and pain (with the pain usually coming before the rash).
4. Disease in the spine – It can also radiate to the chest. It can be aggravated by movement, and usually lasts between seconds to hours.

As you can see, there are a lot of reasons for chest pain, and many of them look and feel the same. The above list can give you a clue, but, again, nothing replaces the judgment and experience of a doctor.

What next?

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Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Understanding Heart Attacks – Part 3 – Myocardial Infarction
3. Stroke – A Heart Attack In The Brain
4. Abdominal Pain – Is It Serious?
5. Acute Pericarditis – Inflammation of Your Heart’s Covering