8 Causes of Chest Pain That Aren't a Heart Attack

You might be wondering how someone could mistake the symptoms of acid reflux for a heart attack, but there’s a reason why it’s called heartburn, after all.

Gastroesophageal reflux occurs when a person’s stomach contents—including the gastric acids that help break down food—back up into the esophagus, the tube that connects the throat and stomach. Stomach acid is highly acidic, hence, the burning sensation behind your breastbone; on the pH scale, it scores about a 2, falling somewhere between battery acid and vinegar. (Our stomachs are lined with protective membranes that shield it from the corrosive effects of acid, while our esophagus does not.)

The occasional reflux is fairly common and probably nothing to worry about, but if you’re experiencing it twice a week or more, you may have gastroesophageal reflux disease (GERD). Left untreated over time, GERD can cause asthma, chest congestion, and a condition called Barrett’s esophagus, which may increase your chances of developing a rare type of cancer.

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Weekend warriors, take note: If you haven’t lifted anything heavier than a MacBook for more than a few years, you might want to rethink that CrossFit class you signed up for.

It’s possible for someone to mistake a strained chest muscle for something more serious, like a heart attack, says Dr. Jellis. “I had a patient who came in with chest pain and he was worried he was having a heart attack,” she says. “After taking his history, I learned he had moved [to a new house] and hadn’t lifted heavy furniture in years. But he did the right thing, coming in.”

Doctors don’t expect patients to be able to tell the difference between a heart attack and a pulled chest muscle, she says, but a good rule of thumb is that if you can press on the wall of the chest and it feels even more painful, it’s more likely to be a musculoskeletal injury than a problem with your ticker.

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An estimated 13% to 36% of adults who show up to the emergency room or their doctor’s office with acute chest pain are diagnosed with costochondritis, or inflammation where a rib bone meets up with the cartilage, according to a 2009 review in the journal American Family Physician. Although doctors can’t always pinpoint what triggered the condition, the culprits can range from viral infections to chest injuries. Typically, people feel a type of pressure on their chest wall and—similar to a strained muscle—a tenderness when they press on the area.

In this case, a doctor will probably start by taking your medical history and doing a physical exam. “A physician is going to want to rule out cardiac and other serious issues first,” says Dr. Jellis. “It’ll most likely be a diagnosis by exclusion.” If you do have costochondritis, the pain typically goes away in a few days or weeks; taking over-the-counter painkillers can help.

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The virus that causes chickenpox lingers in your body long after the spots have faded. In fact, varicella-zoster can reactivate in adulthood (usually in people older than 50) as a disease called shingles. The first symptoms include itching and burning skin. If the area over the chest is affected, someone might mistake this new pain for a heart attack or other cardiac issue, says Salman Arain, MD, an interventional cardiologist with McGovern Medical School at the University of Texas Health Science Center at Houston and the Memorial Hermann Heart & Vascular Institute-Texas Medical Center. A few days later, however, the telltale rash can appear, followed by blisters.

If you think you have shingles, you should call your doctor ASAP. Antiviral medications can lessen the pain and shorten the duration of the symptoms, but only if you take them within 72 hours of the rash appearing. If it’s too late to take antivirals, your doctor can prescribe a prescription painkiller.

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If you’ve been battling a viral infection for the last few days, then suddenly wake up to a sharp, stabbing pain in your chest, you may have developed pericarditis, an inflammation in the layers of tissue that surround our heart, says Dr. Arain.

Respiratory infections are often to blame, though other culprits include autoimmune disorders like lupus and rheumatoid arthritis. Although pericarditis is usually benign, says Dr. Arain, it can really impact your quality of life.

Your doctor may diagnose your condition after ordering a CT scan, EKG, or chest x-ray. Chances are, however, your pericarditis will clear up in a few days or weeks simply by resting or taking over-the-counter pain medicine like ibuprofen, which also helps quell inflammation.

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Just because a person’s chest pain isn’t heart attack-related doesn’t mean that it isn’t dangerous. One example: acute pancreatitis—the sudden inflammation of the pancreas, which is located just behind the stomach. “Intense abdominal pain can radiate up to the chest,” says Dr. Arain. “And the pain from pancreatitis is usually a deep-seated, intense pain.” Oftentimes, pancreatitis occurs when gallstones (usually made of hardened cholesterol) trigger inflammation in the pancreas—something that’s more likely to occur in women than men. If you think you have pancreatitis, you should get medical attention right away; you’ll probably have to stay in the hospital for a few days to get antibiotics, IV fluids, and pain medication. Your doctor will also want to do blood work and order other tests, like a CT scan or abdominal ultrasound.

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Coronary artery disease (CAD) is a type of heart disease caused by a buildup of plaque in the arteries that supply blood to the heart. Over time, cholesterol deposits lodge themselves in the walls of these arteries, which can blocks off blood flow and cause chest pain. While CAD can cause a sudden heart attack, it can also contribute to heart failure and arrhythmias. If you do receive a coronary artery disease diagnosis, your doctor may want to start you on statins, insert a stent into one of the arteries, or schedule you for bypass surgery.

Which brings us back to the number one rule cardiologists gave us: If you’re experiencing chest pain, it’s important to get it checked out, stat.

“One of the biggest public health messages has been to get people to take action when they have chest pain,” says Dr. Hayes. “And we still have people who ignore their pain, who feel chest pain but who don’t think heart attack… I understand being worried about, what if the ambulance shows up in my driveway and I come back and it was just indigestion? And that’s why I specifically say, ‘There have been enough people who have died at home thinking it was indigestion and it was really a heart attack.’ If it’s a new symptom and you’ve never had it before, or the pain is coming or going or getting worse, call 911—don’t call your girlfriend or your husband or drive yourself. Just call.”

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Having a panic attack can certainly feel like a heart attack; people often believe they're dying when they are having one. In addition to chest pain, symptoms can include a pounding heart, sweating, shaking, nausea, dizziness, and a feeling of going crazy.

Panic attacks tend to crop up suddenly with no warning. You may be prone to them if you have a family member with a history of panic attacks, if you're dealing with major life changes and ongoing stress (such as a serious illness of a loved one), or if you recently survived a traumatic event (such as a robbery or car accident).

If you think you've experienced a panic attack, it's smart to visit your primary care doctor. Your doc may refer you to a psychologist or psychiatrist.

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