Chest pain may be caused by a variety of heart (cardiac) and noncardiac conditions.

Among the most common noncardiac causes of chest pain are:

• Indigestion (dyspepsia). Discomfort in the upper abdomen. It is sometimes accompanied by a feeling of fullness, belching, bloating and nausea.
  
  
• Heartburn. A burning sensation in the chest or throat caused by the backup (reflux) of stomach acid into the esophagus. Chest pain related to heartburn typically follows a meal and lasts anywhere from a few minutes to a few hours. The pain may occur more often when the patient bends over or lies down.
  
  
• Gastroesophageal reflux disease (GERD). A chronic condition in which the valve (sphincter) that closes the esophagus from the stomach weakens or relaxes and lets acid and partly digested food move up into the throat.  The acid can damage the esophagus, which lacks the protective mucus of the stomach. Heartburn is a common symptom of GERD.
  
  
• Strain or inflammation of the muscles and tendons. Muscle-related chest pain may occur as the result of physical activity involving the chest muscles, injury or coughing. Persistent muscle-related chest pain may occur in people with chronic pain syndromes such as fibromyalgia, myofascial pain syndrome or arthritis. Chest pain related to sore muscles often occurs when a person twists from side to side or raises the arms. Uncommon causes of musculoskeletal chest pain include rib-tip syndrome, sternalis syndrome, sternoclavicular hyperostosis and xiphoidalgia.
  
  
• Asthma. A condition in which inflammation of the airways restricts airflow into and out of the lungs.
  
  
• Psychological factors. Anxiety, hyperventilation (rapid or deep breathing often triggered by anxiety), panic, stress and emotional upsets may cause feelings of pressure in the chest.

Cardiac causes of chest pain include:

• Angina.  This is recurrent chest pain caused by inadequate blood flow through the heart. It may cause a feeling of tightness or pressure in the chest. Angina is usually triggered by physical or emotional stress, and often disappears within minutes after the stressful activity is stopped. Angina is generally associated with coronary artery disease (CAD).
  
  
• Heart attack. Also known as a myocardial infarction, a heart attack occurs when an area of heart muscle dies or is permanently damaged as the result of an inadequate supply of oxygen to that area. This can trigger a feeling of pressure, fullness, squeezing or a crushing pain lasting longer than a few minutes. The pain may radiate to other areas of the body including the back, jaw, neck, shoulders and arms. In some cases, chest pain related to heart attack is accompanied by shortness of breath, sweating, dizziness and nausea.
  
  
• Coronary artery spasm. Also known as Prinzmetal’s angina or variant angina, this is a condition in which the muscles in the wall of an artery in the heart temporarily and abruptly contract. As a result, the artery is constricted and blood flow is temporarily slowed. Chest pain related to this condition may occur during periods of activity or rest.
  
  
• Pericarditis. Inflammation of the pericardium, the sac-like covering of the heart. This condition is often characterized by sharp, piercing and centralized chest pain. Patients may also have a fever. Usually triggered by a viral infection, pericarditis can also result from conditions including Lyme disease and lupus.
  
  
• Aortic dissection. A condition in which there is bleeding into and along the wall of the aorta (the main artery leading from the heart). It may be associated with a sudden, severe, sharp, stabbing, tearing, or ripping sensation in the chest. The pain may also radiate to other areas including the shoulders, neck, arms, jaw, abdomen or hips. The condition usually results from traumatic injury to the chest or uncontrolled high blood pressure.
  
  
• Aortic aneurysm. Widening or bulging of part of the aorta. Aneurysms often have no symptoms, but some patients may experience abdominal, back or chest pain. A ruptured aortic aneurysm is a life-threatening emergency that often causes sudden, severe pain.
  
  
• Cardiac syndrome X. A condition in which patients experience chest pain similar to angina without actually meeting the diagnostic criteria for CAD.
  
  
• Endothelial dysfunction. Endothelium is the inner lining of cells in the blood vessels. Endothelial dysfunction is characterized by the failure of the endothelial cells to function normally. As a result, the cells lose their ability to control the dilation of the blood vessels.
  
  
• Myocarditis. This is an inflammation of the heart muscle. The chest pain associated with this condition may mimic the pain caused by a heart attack.
  
  
• Cardiomyopathy (enlarged heart). Conditions including chronic diseases, alcoholism, heart attacks and viral disease can cause the heart to become abnormally big, thick and stiff. A variation known as Takotsubo or stress cardiomyopathy, sometimes called broken heart syndrome, is often preceded by emotional or physical distress.
  
  
• Mitral valve prolapse. The mitral valve controls blood flow between the heart’s left atrium and left ventricle. In patients with mitral valve prolapse, one of the flaps moves back into the atrium when the heart beats. As a result, blood can flow from the ventricle back into the atrium. This condition may cause intermittent (coming and going) chest pain.
  
  
• Aortic stenosis. A condition in which the heart’s aortic valve is narrowed or obstructed. This prevents it from opening correctly. As a result, blood flow from the left ventricle to the aorta is blocked. The chest pain associated with this condition may be described as a crushing or squeezing sensation, pressure or tightness. The pain may increase with exercise and be relieved with rest.
  
  
• Cardiac tamponade. A condition in which fluid accumulates in the pericardium. Causes of cardiac tamponade include pericarditis, trauma, heart attack and complications of kidney disease.

Additional lung-related (pulmonary) causes of chest pain include:

• Pneumonia. A condition in which the lungs are inflamed as the result of an infection.
  
  
• Bronchitis. A condition in which the lining of the airways that connect the trachea to the lungs (bronchial tubes) becomes inflamed. Patients with this condition may experience chest pain or feelings of soreness or constriction in the chest.
  
  
• Pulmonary embolism. A condition in which an artery in the lung becomes blocked (usually by one or more blood clots). Chest pain associated with this condition may appear under the breastbone (sternum) or on one side of the chest. The pain may feel sharp or stabbing, aching or dull, or like a burning or heavy sensation. The pain may intensify with deep breathing, coughing, eating or bending over.
  
  
• Pneumothorax. A condition in which air or gas collects in the space surrounding the lungs (plural space). The sudden sharp chest pain caused by this condition may intensify with deep breathing or coughing.
  
  
• Pleurisy. A condition in which the lining of the lungs (the pleura) is inflamed. It often causes localized pain on the chest wall. Patients with this condition may experience pain with each breath, and pain that intensifies with deep breathing and coughing.
  
  
• Pleural effusion. A condition in which the fluid between the layers of the membrane that lines the lungs and chest cavity accumulates. Patients with this condition may experience sharp chest pain that intensifies with deep breathing and coughing.
  
  
• Histoplasmosis. Caused by Histoplasma capsulatum, histoplasmosis is a fungal infection that primarily affects the lungs. Patients with this condition may experience chest pain, especially when inhaling.

Additional causes of chest pain related to the digestive system include:

• Gastric ulcer. Also known as a stomach ulcer, a gastric ulcer is an erosion in the lining of the stomach. Pain related to an ulcer may intensify when the stomach is empty.
  
  
• Gallbladder disease. A condition in which the gallbladder is inflamed (cholecystitis), infected or obstructed. Gallbladder disease can cause abdominal pain that radiates to the chest. Pain associated with the gallbladder often intensifies after a meal, particularly one containing fatty food.
  
  
• Gallstones. Also known as cholelithiasis, gallstones are stone-like masses. They are formed when liquid stored in the gallbladder (bile) hardens. People with gallstones may experience abdominal pain that radiates to the chest.

Other causes of chest pain include:

• Injured ribs or sternum. Bruises or fractures of the ribs or sternum can cause chest pain. Chest pain due to such trauma is typically localized and sharp. Motor vehicle accidents or other sources of severe trauma to chest can cause a condition known as flail chest, in which multiple rib fractures alter the chest wall.
  

A sternal or rib fracture may also result from osteoporosis, a bone-thinning disease most common in women after menopause, or stem from bone weakness caused by certain forms of cancer, such as multiple myeloma.

• Costochondritis. A condition in which the cartilage connecting the sternum and ribs becomes inflamed. Chest pain associated with this condition may occur suddenly and be intense. Patients with costochondritis will typically experience chest pain when the sternum or the ribs near the sternum are pushed on.
  
  
• Transitory benign chest wall pain. Brief and often sharp pain that is sporadic and not harmful. It occurs more often in children and young adults.
  
  
• Sarcoidosis. A condition in which inflammatory lumps form in organs, most often the lungs. Sometimes sarcoidosis affects the heart, which can also cause chest pain.
  
  
• Pinched nerve. Nerve damage caused by compression, constriction or stretching of a nerve. A pinched nerve can trigger localized and sharp chest pain. Even a herniated disc in the spine can radiate pain to the chest.
  
  
• Esophageal spasm. A condition in which muscles in the esophagus contract irregularly. The condition can begin suddenly with no known cause and may resolve on its own. Pain can range from mild to excruciating.
  
  
• Esophagitis. Inflammation of the esophagus. 
  
  
• Achalasia. A disorder of the esophagus in which the valve in the lower esophagus does not open properly to allow food to enter the stomach. As a result, food backs up into the esophagus, causing gastric pain. Chest pain associated with this condition may increase after eating or radiate to the back, neck and arms.
  
  
• Barrett’s esophagus. A chronic condition, associated with GERD, in which the lining of the esophagus is replaced by tissue similar to intestinal tissue.
  
  
• Nutcracker esophagus. A condition in which contractions of the esophagus are abnormally strong during swallowing. It is often caused by GERD.
  
  
• Shingles (herpes zoster) Infection of the nerves with the varicella-zoster virus. Shingles can cause a painful, blistering rash on the back and chest wall. Chest pain associated with this condition may be described as sharp and burning pain. It may develop before the blisters appear.
  
  
• Hiatal hernia. A condition in which part of the stomach protrudes upward into the chest through a gap in the diaphragm.
  
  
• Pancreatitis. A condition in which the pancreas is inflamed or infected. Abdominal pain associated with pancreatitis can radiate to the chest.
  
  
• Sickle cell anemia. An inherited condition in which red blood cells, which are usually disc-shaped, become crescent shaped. Chest pain is a common symptom.
  
  
• Cancer. Cancer involving the chest (e.g., lung cancer), or cancer that has spread to the chest from another part of the body can cause chest pain.