Non-Heart Chest Pain: 2 Major Causes

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2 Major Causes of Chest Pain That Are Not From Your Heart

Like any other joint, the rib joints can get inflamed and painful. The pain can make you think you’re having a heart attack. (Always get it checked out if possible though because you might be.)

by James Hubbard, MD, MPH

More than once I’ve had a patient complain of severe chest pain and we just can’t figure out what it is. There are no other signs or symptoms. A few days later a rash develops in the area of the pain, and we have a diagnosis—shingles.

Other times the patient just knows it’s a bad case of indigestion. Antacids even help it. It’s not until we get an EKG (heart tracing) that we find out he/she’s having a big ol’ heart attack.

One of the more difficult diagnostic dilemmas in medicine is to completely rule out heart trouble as your cause for chest pain. So if you’re having pain, don’t assume. Get it checked out. My last post has tips for what to do until you can. In this post, though, I’m going to go over some causes and treatments for non-heart chest pain.

Chest pain almost always comes from one of four places:

  1. The chest wall (ribs, spine, and muscles).
  2. The heart or blood vessels.
  3. The lungs or the lining of the lungs.
  4. The esophagus.

Shingles and anxiety are two exceptions.

As you might imagine, there are many potential causes of non-heart chest pain. But in my experience, the two most common are costochondritis (rib pain, for short) and indigestion.

1. Costochondritis

This chest-wall pain is so easy to miss and yet so easy (most of the time) to diagnose.

A rib is not just one long, curved bone going around half the chest. It has joints. Yes, joints. Why? They move just enough to help expand your chest to take in air and contract it to blow the air out.

In the back of the chest, joints connect the ribs to the spine. In the front, some of your rib bones connect to the sternum (breastbone) by way of cartilages. The place where the rib attaches to the cartilage is a joint. So is the place where the cartilage attaches to the sternum. And, like other joints, these can get stressed and inflamed.

Try feeling them now. It’ll help you know where to feel later if they become a source of pain. The costochondral joints (rib to cartilage connections) are located approximately along the nipple line running vertically. In my experience this joint causes the most trouble. The sternochondral joints (cartilage to sternum connections) run along the edge of the breastbone.

Common causes for pain in these joints are repetitive pushing and pulling, a chronic cough, or large breasts.

Costochondritis symptoms: Chest pain in those areas. It can be worse with deep breaths or arm movements.

Signs: Tenderness. Touching the joint area makes the pain worse, and it’s the same type of pain you’re already having.

Treatment: Anti-inflammatories, like ibuprofen (Advil) or naproxen (Aleve), can help, as can a heating pad on moderate temperature or warm towels for about twenty minutes every two to four hours. And, of course, don’t do the activity that you think has caused the pain. If you have large breasts, wear a good support bra. If the pain is severe, doctors can inject the joint with numbing medicine for temporary relief. Sometimes, a steroid is added for longer-lasting relief.

Books adThe Survival Doctor’s guidebooks. They do an anxious heart good.

2. Indigestion

The problem with indigestion is sometimes, a heart attack can feel like a bad case of it. So get to a hospital if your “indigestion” discomfort is prolonged, worse, or different than usual; if there’s associated sweating or shortness of breath; or if it just won’t go away.

Indigestion symptoms: A burning or cramping in the chest. Sour fluid can come back up in your throat.

Signs: This is primarily a symptom diagnosis. Sometimes, your mid-upper abdomen can be tender. But if it’s more than a little tender, you should be thinking of other possible causes, such as pancreatitis (inflammation of the pancreas) or an ulcer. Both the pancreas and the stomach are located in that area. Both problems can be serious and need to be checked out by a doctor ASAP.

Treatment: Antacids such as Tums, Rolaids, or Maalox. A half-teaspoon of baking soda mixed in a glass of water can be a quick fix, but taking too much (say, the dose mentioned several times a day for over a week or two) can mess with your body’s acid-base balance and be very unhealthy. Over-the-counter meds, like Tagamet, Pepcid, and Prilosec, help but tend to take longer to work.

Prevention: The above, and avoid heavy meals or food that brings the indigestion on. Avoid excessive caffeine. Stop smoking. Other risk factors are being overweight and lack of exercise.


You really shouldn’t self-diagnose chest pain unless you absolutely can’t get medical help. It’s too risky. Even heart doctors need to get tests, and still the diagnosis may be iffy.

Next post, I go over a few more non-heart causes of chest pain.

Have any of you ever had chest pain? What did it turn out to be? How did you treat it?

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  • Please Help

    Hey just seeing if I can get a quick reply. I just did a round of antibiotics and steroids for what the nurse practitioner believed to be walking pneumonia (tightness in my chest, fatigue, cough that had lasted for over a month etc.). I’ve been finished with the pills for four days or so but I’ve been experiencing extreme fatigue, shortness of breath and tonight very acute chest pain in my middle to left side. It’s late and going to the ER, while an option, may just get me a listen of my heart and a new round of antibiotics. Two questions: would you reccomend I go? And what should I ask them to do if I do decide to go.

    • James Hubbard, MD, MPH

      I can’t tell you what to do. That’s a judgement call for you to make. If you’re extremely short of breath or the pain is keeping you awake, you might consider it. Whenever you go, all you need to do is explain like you did in the comment, they’ll check you and should know what to do from there.

  • Kalman

    I have
    experienced similar chest pain for over a month. It began with a sharp pain on
    the left side of chest here my heart is, so I thought I had a heart attack. I went to the hospital to get
    it checked out. After heart monitoring and ultrasound tests of the heart
    and lungs my doctor said there was nothing to worry about and it was because of
    stress. A few days later I started to have left abdominal pain(rarely) and tingling
    on the right side of my chest as well as on the left side. Also noticed that chest wall
    is tender to the touch. I don’t know if there is something serious.

  • Kalman

    I have
    experienced similar chest pain for over a month. It began with a sharp pain on
    the left side of chest where my heart is, so I thought I had a heart attack. I went to the hospital to get
    it checked out. After heart monitoring and ultrasound tests of the heart
    and lungs my doctor said there was nothing to worry about and it was because of
    stress. A few days later I started to have left abdominal pain(rarely) and tingling
    on the right side of my chest as well as on the left side. Also noticed that chest wall
    is tender to the touch. I don’t know if there is something serious.

    • James Hubbard, MD, MPH

      Sounds like you should follow up with your regular doctor. If you don’t have one, you should find one.

    • James Hubbard, MD, MPH

      Sounds like you should follow up with your regular doctor. If you don’t have one, sounds like you should get one.

  • Joe

    My chest pain actually feels as if I need to stretch…I sit for a living and unfortunately get trapped gas more often than I’d like to discuss…I know this is trapped gas b/c a year or so ago I started doing Yoga and what was interesting was that the more I did the workout the more I burped…not a little but a lot and loud….I also yawned quite a few times…I’ve stopped working out and really need to return as the pressure on my upper stomach and chest area sometimes feels like a burp is on top of ever it (just burped) and the pressure is lighter….good grief

  • gloria

    hello i am writing this in hopes to get some type of answer, I have been feeling these heat spots on my head and bad shoulder and neck pain also lately i have felt this pulsating more like throbbing pain on the left back side of my head, it comes ang goes . I also have been feeling pain in my chest more under my ribs, the pain on my neck ive had for a year and i feel like sometimes my nerves ae the cause because i feel a pain on the left side from my head all the way to my feet and sometimes its hits my lest side of my hip bad i cant move or walk on that leg. i have went to the d and they wanted to send me to get a wave test done because on my hot spot on my head and sometimes my eyes feel weird i have also a lot of twitching in my face sometime i research the symptoms i have and a lot of times i freak out because i have read several possible diagnosis like aneurysm , or optical neuralgial or somethings like that please help

    • James Hubbard, MD, MPH

      Gloria, sorry but I can’t make a specific diagnosis without a direct exam. My suggestion is you follow your doctors recommendations. He/she has seen you and can make informed suggestions and tests customized for you that you’re not going to find anywhere on the internet.

  • Cher

    Hello Doctor, what a frustrating day I have had and I am so relieved that I am not alone. Have just returned from the MD to follow up on my headache, chest pain, pressure in head, neck and chest. Blook work two weeks ago revealed mild anemia but not low iron. Low Potassium (3.1) and a low alkaline phosphatase at 34. My chest pain has been very severe at times each day and I am very weak and dizzy. The Doctor was concerned about the low potassium because I take Lisinopril 40mg for hypertension which can raise potassium. By the way, 39 year old female, 142 pounds, recently gained 8 pounds since quitting smoking 7 months ago. I do consume a lot of diet coke which I have been advised to stop. Was diagnosed with COPD last summer but have been breathing great since quitting smoking. Have a history of volatile blood pressure and it has been suggested by a physician several years ago that I should be tested for hyperaldosteronism. My doctor is going to revisit that in a month if I am not improved after decreasing lisinopril to 20mg, stopping the buproban which I took for smoking cessation and increasing lorazepam. So, it seems to me that he is not concerned but I am so debilitated by the pain and pressure in my head, neck and chest that I have difficulty driving and performing my daily tasks. Work at home bookkeeping for the business that we own and I have 4 boys (ages 3,9,11, and 12). Admittedly have a stressful life, always have…but I am not depressed. I recently found a hobby that I love but I haven’t felt well enough to spend time or energy on it. What bothers me the most is that I do not believe my doctor takes me seriously. At times the pain is so bad that I cry. Feels like I am being stabbed in the chest. I have 15 year old saline breast implants and I have been referred to plastic surgery to see if there could be a problem with them. I have much tenderness in my left breast and especially above and beneath my armpit. Rechecked my potassium today after taking K chloride for a week and it was normal as well as the alk phos. He had mentioned a bone condition that could explain the bone pain I have. My biggest fear is that something is being missed. I have been so sick, running low grade (intermittent) fevers and having night sweats. The pain I have in my ribs has woken me each night and has become progressively worse. I saw a physiatrist last summer and the exercises he prescribed did not help. I still do them though. My vitamin D had been low at 12 in the fall and it was thought that that could cause my pain but it has only worsened and now my level is 34. I have also had terrible terrible acne lately and two really really large boils on my back, one on my spine and another adjacent to that about 1 inch away as the first was healing thanks to antibiotics. What scares me is the low potassium, why did that occur and how could that relate to the pain…which I am having a bad bout of even as I type. I am so tired of doctors thinking I am nuts. Every time I have had a health concern, it has been a nightmare getting to the bottom of it. when I was 24, I suffered from pelvic pain for more than a year and was passed from doctor to doctor and had numerous tests before I finally got to doctor who knew immediately what was wrong. Very severe pelvic adhesions which were immediately relieved by surgery and thankfully my fertility was spared!! Sorry about the long post. I am very frustrated. I am so desperate to feel better!! Any thoughts?

    • James Hubbard, MD, MPH

      Cher, it never hurts to get a second opinion from another doctor just to make sure. I’d suggest an internal medicine specialist or endocrinologist.

  • Renee

    Back on October 5, 2013 i went to a local fair and took my daughter on the merry go round. I was just sitting on a bench with her, but i got extremely dizzy, and thought I was going to pass out. It took about 10 minutes for me to feel normal again, once I was off. That was the first time I felt scared and that something might be going on with me. A week after that I was laying down for bed, when my heart had a sharp pain and made me sit up. My heart rate had increased and seemed to be beating harder. I felt light headed and my arms suddenly became heavy. I was unable to fall asleep, and stayed up until 5am wondering what was going on. Symptoms persisted for almost 2 weeks, day and night. Had TONS of blood work done and NOTHING. Went to the ER, even called 911. At one point I had 2 days where off and on I had trouble moving my fingers. I had tingling and numbness in my arms and hands and one night I couldn’t move my legs for about 5 minutes.
    Saw a Cardiologist, had an EKG and Echo. Nothing looked abnormal. Saw a Neurologist, had a CT scan on my chest and my brain. Nothing looked abnormal. I even went to a chiropractor, thinking it could be pinched nerves. Then as suddenly as it came, it went away. January 10th and 11th at night the pounding heart, lightheaded and weak feelings came back. then went away. January 22nd and 23rd those same symptoms came back. Here i am this morning, and I ‘m still having the symptoms of feeling lightheaded, weak, tingling in forearms and hands. I cut out my 1 cup of coffee on Jan 12, thinking it could be causing a problem. PLease help. What is going on.? I eat relatively healthy, I’m an active person, I quit smoking 2 years ago, I have 2 young kids and I’m so scared that I might have something seriously wrong with me.

    • javagirl22

      did they check you for low iron levels?

    • James Hubbard, MD, MPH

      Renee, Sounds like you’ve been checked pretty well. Is it possible the first bout (which possibly could have been triggered by watching the merry-go-round) scared you so much that you could be having anxiety? That you’re hyperventilating at times, which can sometimes cause temporary tingling, even temporary cramping and loss of muscle strength? If you think it’s possible, there is treatment. Here’s some my post on non-prescription therapies. I’m certainly not saying that’s definitely what it is. But it is one of the things to consider in the list of possibilities.

  • Coryy

    21 year old male, chest pain above the nipple line on the left side of my chest, sometimes i can feel my heart pounding, My Doc had me do a lay down ECG and a blood test, both came out normal, and was told she believed it to be anxiety….. kinda hard for someone to believe it could just be in their head lol

    • James Hubbard, MD, MPH

      Coryy. If you have concerns with the doctor’s diagnosis, get a second opinion. Also be sure to read the above post about costochondritis.

  • NewDay3

    Many years ago I had 2nd degree hear block from Lyme disease. They had to put an Iv port directly onto my chest and the tube went straight into the large vein leading to my heart (cant think of what its called). I now have chest pains every day for the last 2 years. The pain is right below my left breast tissue near my sternum. Is it possible there is swelling scar tissue from the Iv port causing this? It feels like the pain is in my heart, but ive been checked and my heart is healthy plus it would have killed me by now Ha

    • James Hubbard, MD, MPH

      That would be impossible for me to say. Generally, veins don’t cause pain unless it is an acute injury.

  • Nikki

    I have had some serious health issues lately… So I had a baby 6 months ago, found out I had hyper and now have hypothyroid, low vitamin D , an enlarged spleen, and enlarged lymph nodes in my chest and neck, my gallbladder taken out 4 weeks ago, and an emergency appendectomy 3 weeks ago! I have had multiple d dimers done (not since this last surgery tho), MRI of my head, chest CT and X-rays, and blood work… Everything came back okay… 3 days ago I woke up with a horrible left arm ache that was so bad I could barely use my arm. I also have chest pains… They are not 100% consistent but I do have a slight dull ache almost all day and some sharp stabbing pains only in the left side! Right now I feel okay the pain isn’t so bad and no stabbing feeling… I get myself all worked up about blood clots because of all the surgery I have had so close together… Everything I read says a PE or any blood clotting will hurt terribly bad and I don’t feel like that’s what’s wrong but I’m really starting to worry about this pain… My arm pain by the way feels a lot better today but I still have the chest pains, I also feel as though sometimes I get dizzy and have shortness of breath but it’s not consistent in any way? Could this be anxiety??

    • James Hubbard, MD, MPH

      I definitely could be anxiety, but you should talk to, or see, your doctor to rule out other problems.