Chest Pain: When It’s Not Your Heart — And When It Could Be

Chest pain? Is it your heart?

Chest pain is one of the fastest ways to send the human brain into full panic mode.

Your thoughts usually go from: “That’s odd” → “I should sit down” → “I’m actively dying.”

Understandably so. Chest pain feels serious — and sometimes it is. But here’s the reality most people don’t hear until they’re already sitting in the ER:

• Most chest pain is not caused by the heart

• And some heart attacks don’t cause dramatic chest pain at all

Both statements are true at the same time — which is exactly why chest pain is so confusing.

Let’s walk through this calmly, the way a doctor would.

The Most Common Causes of Chest Pain (That Aren’t Your Heart)

1. Muscle, Rib, or Chest Wall Pain

This is one of the most common causes of chest pain doctors see.

Chest pain is more likely musculoskeletal if it:

• Gets worse when you move, twist, or lift

• Hurts when you press on the area

• Changes with deep breathing

Muscles, ribs, and cartilage strain more easily than people realize — from coughing, poor posture, workouts, or even sleeping awkwardly.

2. Acid Reflux (GERD)

Heartburn can be shockingly convincing.

GERD-related chest pain often causes:

• Burning or pressure behind the breastbone

• Pain that worsens after eating or lying down

• A sensation that something is “stuck” in the chest

Many people are stunned to learn their “heart pain” is actually stomach acid irritating the esophagus.

3. Anxiety or Panic Attacks

This one deserves emphasis.

Panic attacks can cause:

• Chest tightness or pressure

• Shortness of breath

• Racing or pounding heart

• Sweating, nausea, dizziness, tingling

• 
  

The symptoms are very real.The danger is not.

Panic can perfectly imitate a cardiac emergency — which is why it’s so terrifying.

The Part That Really Matters: Heart Attacks Aren’t Always Painful

Movies taught us the wrong lesson.

Not every heart attack involves crushing pain and dramatic collapse.

Some heart attacks feel like:

• Pressure or heaviness rather than sharp pain

• Discomfort in the jaw, neck, shoulder, arm, or upper back

• Shortness of breath without chest pain

• Sudden nausea, cold sweats, or unexplained fatigue

• A vague but intense feeling that “something is wrong”

These subtler symptoms are especially common in women, older adults, and people with diabetes.

That’s why doctors don’t rely on pain alone — we look at patterns.

When Should Chest Pain Be Taken Seriously?

🚑 Seek urgent medical care if chest discomfort is:

• New, severe, or getting worse

• Triggered by physical exertion

• Associated with shortness of breath, sweating, nausea, or dizziness

• Spreading to the arm, jaw, neck, or back

• Accompanied by an unexplained feeling of impending doom

Doctors would rather rule out a heart problem 100 times than miss it once.

You are not wasting time.You are doing the right thing.

The AskADoc Takeaway

• Most chest pain is not cardiac

• Some heart attacks don’t hurt the way you expect

• Your job is not to diagnose yourself — it’s to notice patterns and act when something feels wrong

When in doubt, get checked.That’s not overreacting.That’s common sense.

Stay healthy this Christmas,

Dr. Joanna

— AskADoc Weekly