Heart attack symptoms can look like other conditions. Here are five things that could be causing pain.

Published: September 20, 2023 | Updated: October 30, 2023

Most people are familiar with the typical way someone shows they are having a heart attack: gasping, clutching their chest and so on. Despite what’s depicted in movies and TV, sometimes chest pain is just chest pain. And sometimes a heart attack has very subtle symptoms. Here are five ways to tell the difference.

Millions of Americans go to the emergency room every year complaining of chest pain. Only about 20% of them are having a heart attack. Pain, pressure, aches and other feelings in the body can mean different things.

“Chest pain and the potential for an issue with the heart should be taken seriously,” said Abdullahi O. Oseni, M.D., interventional cardiologist with Norton Heart & Vascular Institute. “While there are many conditions that can cause chest pain, we want to rule out anything more dangerous.”

Causes of chest pain

There are several conditions that can make your chest hurt. Those include:

GERD

Heartburn is a condition where stomach acids push up into your esophagus, the tube that connects your mouth with your stomach. This can happen once in a while, maybe after you eat spicy food. It causes a burning feeling in your chest. If heartburn happens often, the lining of the esophagus can become irritated and gastroesophageal (GAS’-troh-eh-soff-uh-jee-ul) reflux disease, also known as GERD, can develop.

“GERD can feel like a heart attack,” Dr. Oseni said. “It can feel like burning, squeezing or pressure in the chest that can last hours.”

Like a heart attack, the pain can spread down your arms or to your back.

Chest pain caused by GERD can be managed and treated by:

• Maintaining a healthy weight
• Avoiding certain foods and beverages such as alcohol, caffeine, fatty foods and peppermint
• Not lying down after a meal
• Avoiding eating large meals
• Elevating the head when you lie down
• Stopping smoking
• Taking a prescription antiacid

Talk to your doctor about more ways to treat GERD.

Similar to GERD, gas pain can be mistaken for a heart attack. Sometimes, gas can push stomach acids into the throat, or it can build pressure in the stomach that radiates into the chest.

Chest pain from muscle strain

If you have ever “overdone it” with a physical activity and been sore, you may have had musculoskeletal (muss-kyuh-low-SKELL’-eh-tul) chest pain. This kind of pain affects the bones, muscles and nerves of the chest wall. Injury or overuse are the most common causes of musculoskeletal pain.

Symptoms of musculoskeletal pain include:

• Pain that happens or gets worse with certain movements
• Pain during deep breaths, coughing or sneezing
• Swelling, tenderness or bruising in the area

Most of the time, musculoskeletal pain goes away on its own. Some home treatments include:

• Taking over-the-counter pain medicine such as ibuprofen
• Cold or hot compresses
• Gentle stretching
• Reducing the activity that causes the pain, until the pain goes away

Emotional stress and anxiety

The link between mind and body is powerful. When we believe we are in danger, our body responds, moving into fight, flight or freeze mode. Muscles clench, breathing becomes shallow and rapid, and the mind races. While everyone reacts to anxiety differently, anxiety-induced chest pain can feel like:

• Sudden sharp, shooting pain
• Persistent chest aching
• An unusual muscle twitch or spasm in your chest
• Burning, numbness or a dull ache
• Stabbing pressure
• Chest tension or tightness

People having anxiety attacks often say it feels like a heart attack, so it’s best to have a health care provider check you.

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Treatment for muscle pain from anxiety and stress includes:

• Exercise and yoga
• Meditation
• Dietary changes such as reducing alcohol and caffeine intake and eating more vegetables and lean meats
• Getting enough sleep
• Reducing stress as much as possible
• Anti-anxiety medications

Angina

Angina (an-JY’-nuh) is another cause of chest pain. It happens when the heart doesn’t get enough oxygen-rich blood. It can feel like pressure or squeezing in your chest. The pain may be felt in your shoulders, arms, neck, jaw, abdomen or back. Angina pain even may feel like indigestion. Some people don’t feel any pain but have other symptoms like shortness of breath or fatigue.

Angina is a symptom of a heart issue, such as coronary heart disease (CHD), also known as coronary artery disease (CAD), or coronary microvascular disease (MVD).

Angina usually happens because one or more of the coronary arteries is narrowed or blocked, also called ischemia (uh-SKEE’-me-uh).

Depending on the type of angina you have, there are many factors that can trigger angina pain. The symptoms also vary based on the type of angina you have.

Pain in your chest: Location is key

“If you come to the emergency room or the clinic, we will ask you where the pain is,” Dr. Oseni said. “We also will ask about the kind of pain you’re having.”

Knowing where and what kind of pain you have will help the health care team figure out what is causing it.

Common areas of pain include:

• Center of the chest
• The back
• Jaw and neck
• Arms
• Left arm

Chest pain that’s not a heart attack?

These symptoms are more likely to mean you are having a heart attack:

• Pain, pressure, tightness, squeezing or burning in the chest
• Gradual onset of pain over the course of a few minutes
• Constant pain in the middle of the chest
• Pain in the left arm, neck, back or jaw
• Pain with other symptoms, such as nausea, vomiting, difficulty breathing or cold sweat

These symptoms are less likely to suggest a heart attack:

• Sharp pain when breathing, sneezing or coughing
• Sudden stabbing pain in the chest that lasts only a few seconds
• Pain only on one side of the body or in one specific area
• Pain that lasts for hours or days without other symptoms
• Pain that happens with a specific body movement

“It’s better to be safe than sorry, so we want to see you if you have any unusual pains, or you have these symptoms together,” Dr. Oseni said.

When to seek medical help for chest pain

“If you have a condition that your doctor knows about and is treating, but your symptoms change suddenly or significantly, you should call the doctor,” Dr. Oseni said. “You don’t have to rush to the emergency room, but you definitely should be seen by the health care professional you have been seeing.”

Sudden severe chest pain or discomfort that is different from anything you have felt before means you should call 911 or have someone take you to the emergency room. Minutes count when it comes to your heart, so the sooner you can be checked out by a health care team, the better.

“For most people, it will not be cardiac or life-threatening, but we don’t want to miss anyone,” Dr. Oseni said. “There is no need to be embarrassed about a ‘false alarm’ if it turns out to be gas or something less serious than a heart attack.”