Top Causes of Chest Pain: 5 Signs You Could Be Having a Heart Attack

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Let's talk about the causes of chest pain. Have you ever had chest pain that was bad enough for you to go to the ER and you get there, you have a million-dollar workup only to be told that your chest pain is not a heart attack and that it is non-cardiac?  But when you get home you're still having chest pain?  This is actually not an uncommon scenario because there are many causes of chest pain that are not heart attacks and not even heart-related.

So today we're going to talk about chest pain. I'll give you the types of chest pain. I'll talk about the different causes of chest pain. And when it comes to heart attacks I'll give you five signs and symptoms that you may be having a heart attack and not even know it.


Heart Disease and Chest Pain

There are so many different causes of chest pain and many of them have nothing to do with the heart. The issue is that heart disease is the number one cause of death in the United States, so if you are having chest pain that's related to heart disease, you definitely don't want to miss it.

This is very important, if you're having any type of chest pain that is prolonged or if you just don't feel comfortable, if you feel like it may be a heart attack, don't waste time. Call 911 or go to the emergency room. Don't try to make the decision at home.

This discussion, however, will help you to distinguish some of the more obvious causes of chest pain that are non-cardiac.

causes of chest pain

Types Chest Pain

There are many different types of chest pain.

Stabbing Pain:

You can have a stabbing chest pain that feels like there's a knife kind of going in and out of your chest area.

Dull and Electric Chest Pain:

Dull chest pain or electric chest pain kind of goes through you from one side to the other or in the middle of the chest and it just hits real quickly, almost like an electric shock.


Tight Pressure:

Tight pressure chest pain typically feels like an elephant is on your chest, and the chest pain can come and go. If it's chest pain that comes and goes pretty quickly then it's not likely to be heart pain, but it's possible.

If however, you have a pain that has a long duration and certainly if it feels like a tightness, something heavy on your chest, that could very well be a serious pain.

Again any pain that is causing you to be unsure and you think that it might be a heart attack, don't hesitate to get evaluated by your doctor, or call 911 if it's severe.


Anatomy Of The Chest

Now let's talk about the anatomy of the chest. There are many things in the chest other than just the heart. You start off with the layers, you have the skin layer and then you have the subcutaneous fat or the fat right under the skin.

Then you have the breast bone or the sternum. And of course, next to the heart on either side, you have the lungs and the pleura which covers the lungs. Before you get to the heart there is the sac or the pericardium in which the heart sits, and then of course you have the spine as well.

There's also the aorta, that large artery that leaves the heart. It's also in the chest area. My point is, that there are many things in the chest other than the heart that could be related to chest pain. I didn't even mention the esophagus, the tube that connects the mouth to the stomach, it is also in the chest area.

With all of this anatomy right here in the chest area, it's really not surprising that there are many things other than just heart attacks or heart disease that can cause chest pain.


What Causes Chest Pain?

Chest pain can be scary. You may not know what's causing it and you may think that you're having a heart attack. In many cases, chest pain can be caused by something simple like indigestion or a pulled muscle. So now let's talk about some of the top causes of chest pain and I'll go layer by layer. Let's start with the skin.


Shingles or the reactivation of the chicken pox virus is something that can cause chest pain especially if you get the shingles right in the dermatome or the skin area that involves the chest, particularly the left chest. So it could wrap around the front of the chest to the back and it can be chest pain.

Now typically the shingles will present with some type of a blister-like rash, so if you have someone who presents with chest pain and they have their shirt on and the physician does not get a full or detailed history and physical, they could just think that it's heart pain just because it's on the left side, but it's important to pay attention to your skin and make sure you don't have any lesions because shingles could be a cause of chest pain.

Musculoskeletal Pain

Musculoskeletal pain could also be a cause of chest pain. You can have a sore sternum or breast bone. You can also have issues or inflammation in the musculoskeletal area. Now typically this pain can be reproduced, meaning that when you are examined and the doctor pushes you at the site of the pain if it's musculoskeletal, then it will probably hurt when it's pushed, whereas chest pain due to cardiac disease typically is not reproducible just by a simple touch.

Blood Clots In The Lungs

And then moving on to the lungs, you can get blood clots in the lungs or pulmonary emboli. And this happens if you have a blood clot from somewhere in the body like in your lower extremity, a deep venous thrombosis in the leg and that blood clot breaks off travels to the lungs and it starts to block arteries of the lung and literally causes lung death, this is a pulmonary embolism. It can also be fatal, and so it's very serious. In addition to chest pain, you may have tachypnea or fast breathing and you can get lightheaded as well. Please be sure to watch my YouTube video on DVT or blood clots after you finish reading this article.



Other lung pathology that can cause chest pain includes pneumonia. Pneumonia is an infection of the lungs that can cause chest pain, coughing, and difficulty breathing. It's a serious illness, so if you have any of these symptoms, see your doctor right away.


Pneumothorax is a condition where air leaks out of the lungs and accumulates in the space between the lungs and the chest wall. This can cause severe chest pain and shortness of breath.  If you experience any of these symptoms, it's important to seek medical help right away.


Pleurisy is an inflammation of the membrane that lines the lungs and chest cavity, and it can cause sharp chest pain when you breathe in or cough. While pleurisy can be caused by a number of things, including infection or injury, it's often associated with autoimmune diseases like rheumatoid arthritis. If you're experiencing chest pain, it's important to see your doctor to determine the cause and get treatment as soon as possible.


And then you have the actual sac around the heart or the pericardium, you can get something called pericarditis. Pericarditis is an inflammation of the pericardium, which is the thin layer of tissue that surrounds and protects your heart. It can be caused by a number of things, including infection, autoimmune diseases, or cancer. Pericarditis chest pain tends to be positional and most people tend to feel better when they're leaning forward.  When you have a typical heart attack or heart disease-related chest pain it's usually not positional, it more depends on exertion, but we'll get into that.

Aortic Dissection

Another cause of chest pain could be aortic dissection. Now the aorta is a very large artery, the largest artery that leaves the heart. And the wall of the aorta has layers to it. If you get a break, tear, or a defect in the wall of the aorta, usually associated with very high blood pressure, then it's possible for blood to start seeping into that defect into the wall causing an aortic dissection. This could cause severe chest pain. It can also cause severe back pain, but it's not a heart attack. Again having uncontrolled high blood pressure can put you at risk of having an aortic dissection. This condition can be deadly if left untreated, so it's important to know the symptoms and how to get help if you experience them.

Please be sure to watch my YouTube video on the top 21 most frequently asked questions I get about high blood pressure and the truth behind high blood pressure.

GERD or Gastro Esophageal Reflux Disease

Another cause of chest pain can be GERD or Gastro Esophageal Reflux Disease. GERD is a common source of chest pain. This condition is caused when the stomach acid backs up into the esophagus. Symptoms can vary from mild to severe and can include chest pain, heartburn, and regurgitation.

If you have GERD, then that pain can feel just like burning chest pain, but it's not cardiac. So keep that in mind if you're someone who has chest pain, you go in you get a whole workup and they say it's not a heart attack, make sure that you ask if you could have Gastro Esophageal reflux disease.

common causes of chest pain

Gallbladder Disease

Gallbladder disease can also cause chest pain. So if you're someone with an inflamed gallbladder, if you have gallbladder stones or cholecystitis then this pain can also be referred to the chest.

Esophageal and Heart Artery Spasms

There are many other causes of chest pain as well that aren't necessarily heart attacks. If you're having esophageal spasms that can cause chest pain. You can also have heart artery spasms or coronary artery spasms which can make it feel like you're having a heart attack. While both of these conditions can cause chest pain, they are treated differently.

One interesting fact about heart artery spasms is that often beta blockers like Metoprolol, and Atenolol, which are typically given because they're generally good for heart disease, can actually make it worse.

These are just some of the many possible causes of chest pain that are not heart attacks. Just remember, if you are experiencing chest pain, don't try to decipher it at home. If the pain is prolonged, if it's getting worse or if you're just not comfortable and you don't know, activate the Emergency Medical System and call 911 immediately or call your doctor, and get it checked out.


So now let's talk about the chest pain that's associated typically with a heart attack. This will be a crushing pain, substernal pain. Patients may describe it as an elephant sitting on their chest. This is a pain that doesn't come and go, it's not electric, it's not a quick prick, it's not a quick stab. It's something that's going to hang around and you know that it's there. It may also be associated with some other symptoms other than chest pain. And that's what we're about to talk about because I'm going to give you five signs and symptoms that you may be having a heart attack and not even know it.


5 Signs And Symptoms That You May Be Having A Heart Attack And Not Even Know It.

1. Nausea and Vomiting

One symptom could be nausea and vomiting. There are people who present with nothing else but nausea and vomiting, especially people who are diabetic. When you're diabetic you oftentimes have neuropathy, especially if you're an uncontrolled diabetic or a new diabetic.

This means that your nerves may not be wired in the same way for your heart pain to present as chest pain. And so there are some patients who only present with nausea and vomiting, and that is their warning symptom of a heart attack. They can also present with stomach pain or epigastric pain in the upper part of their stomach.

2. Shortness of Breath

Oftentimes people think that if you're short of breath it's just associated with a lung problem or maybe asthma or COPD (emphysema). They may even be aware that you can get shortness of breath with anemia, but the shortness of breath could be your only presenting symptom of a heart attack.

3. Shoulder Pain

If you're having a heart attack, that pain could be referred to your shoulder, it could be referred to your left shoulder, and it could even be referred to your right shoulder as well. So please don't be fooled. You can have arm pain, shoulder pain, neck pain, and jaw pain. Again this could be a symptom of a heart attack that you could miss because it's not chest pain.

There are patients who have come to the ER and had shoulder X-rays, had full workups for shoulder and arm pain, and the real result is a heart attack or myocardial infarction.

In addition to arm and shoulder and jaw and neck pain, it could also present as more of a tingling. You get a tingling of the arms or even the hands as well. Not necessarily just pain in the extremities.

signs and symptoms that you may be having a heart attack

4. Diaphoresis

Diaphoresis or being sweaty can be a sign that you're having a heart attack and you may not even know it. So if you're breaking out into a cold sweat, if you're wet, clammy, especially if it's associated with some of the other signs and symptoms we've discussed, this could definitely be a sign or a symptom of a heart attack.

5. Extreme Fatigue

Yes, something as nonspecific as being extremely tired could be a symptom that you're having a heart attack and you may not even know it. So please pay attention to your body and if you notice that your energy level is way off, make sure you are evaluated by your physician.


Chest pain can be caused by a variety of things, some minor and some life-threatening. If you are experiencing any chest pain, it is important to seek medical attention right away. In this article, we have outlined the top causes of chest pain and five signs that you may be having a heart attack. Knowing these signs could save your life.

If you are experiencing chest pain, and especially if you are also experiencing any of the signs of a heart attack, don't hesitate to call 911 or go to the nearest emergency room. Better safe than sorry!

If you found the information to be helpful and informative, please be sure to share it with someone you care about.

Dr. Frita - Frita McRae Fisher, M.D.
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