The all-too-common scene of people clutching their chest and collapsing to the ground has been dubbed a Hollywood heart attack. But unlike the movies, many instances of chest pain, especially the temporary pain, have nothing to do with the heart at all.
According to the American Heart Association, chest pain accounts for more than 6.5 million emergency department visits and nearly 4 million outpatient clinic visits each year in the United States. However, notably, most of these cases turn out to be non-cardiac related.
To be clear, you should never ignore any chest discomfort, whether it’s pain or a tightness, pressure, squeezing, or burning sensation, and if you experience any new chest pain, contact your doctor right away. But understanding the many possible causes can help ease your fear of the worst and help you find a solution, says Daniel Sands, MD, a primary care physician at Harvard Beth Israel Deaconess Medical Center.
“We’ve often been taught that chest pain is a warning sign that you should see a doctor,” says Dr. Sands, and it’s solid, safe advice. But more often than not, chest discomfort has a non-cardiac cause.
A long list of causes
Dr. Sands points out that only a “small percentage” of women experience chest pain due to cardiac causes — of course, this depends on each woman’s specific risk factors for heart disease — and, especially for women, heart attacks don’t always cause chest pain.
“If a 25-year-old woman comes in complaining of chest pain and is healthy and has never had heart disease, then the likelihood of heart disease is extremely low,” he says. “But if you have a 60-year-old woman who smokes, has high blood pressure, high cholesterol, diabetes and a family history of heart disease, then the likelihood of heart disease is very high, and you would send her straight to the emergency room.”
There are many other conditions that can cause chest pain or discomfort, ranging from mild to severe.
- Gastroesophageal reflux disease (GERD)
- Gallstones
- asthma
- Anxiety and panic attacks
- Ulcers
- COVID
- Esophageal spasms
- Costochondritis (inflammation of the cartilage that connects the ribs to the breastbone)
- Pleurisy (inflammation of the tissue that separates the lungs from the chest wall)
- Pulmonary embolism (blood clot in the lungs)
- Aortic dissection (rupture of the aorta)
- Pericarditis (inflammation of the sac that surrounds the heart).
Find the clues
How do I know if I most likely have chest pain? do not have Could it be something to do with the heart? Dr. Sands offers these clues:
- It is brief, lasting only a few moments.
- I can climb stairs and exercise without the pain getting worse.
- It is triggered by eating and only occurs immediately after a meal or if you eat certain foods.
- This only occurs when you make certain movements, such as bending or straightening.
- It only happens when I cough or take a deep breath.
- The pain is localized to a small spot, and rubbing the area makes the pain better or worse.
“No matter what symptoms you’re experiencing, you should always see a doctor if you have chest pain, as you may need treatment for another problem,” says Dr. Sands.
“Don’t panic,” he says. “A doctor can diagnose if something serious is going on and work with you to find solutions to help you feel better.”
Conversely, a heart attack or other serious problem “usually manifests as long-lasting chest pain that doesn’t go away quickly,” says Dr. Sands. Look for symptoms like chest pain that lasts more than a few minutes; shortness of breath; jaw, neck, or back pain; pain in one or both arms; nausea, weakness, fainting, or dizziness. If you experience any of these signs, call 911 or have someone drive you to an emergency room.
But if you’re not sure what’s causing your chest pain or why, “call your doctor right away,” says Dr. Sands. “Even if it’s over the phone, answering a few questions can sometimes tell you whether you need to be seen.”
Image: © Povozniuk/Getty Images
