Chest pain is one of the scariest symptoms a person can feel. The fear of a heart attack is real, but chest pain does not always mean a heart attack. It can also come from muscles, the lungs, or panic attacks.
This guide covers how to tell muscular, lung, and heart chest pain apart, the red flags that mean you should not wait, and how the ER tells them apart fast.
Why Chest Pain Is Hard to Diagnose at Home
The chest holds the heart, lungs, esophagus, ribs, and many large muscles. All of them can produce sharp or aching pain that radiates and confuses you.
According to MedlinePlus, chest pain can have many causes besides a heart attack, including sore muscles, digestive problems, and lung diseases. Self-diagnosis is unreliable because symptoms overlap heavily.
Knowing the patterns helps you decide between waiting it out and calling 911.
Muscular Chest Pain: How It Feels
Muscular chest pain can come from a pulled chest muscle, costochondritis, or strain of the muscles between the ribs, according to MedlinePlus.
Common signs:
- Sharp pain that worsens with a deep breath or cough. It eases when you stop moving and breathe quietly.
- Tenderness when pressed. Pressing where the rib joins the breastbone hurts.
- It can feel like a heart attack. MedlinePlus says to call 911 for chest pain because costochondritis can feel similar.
For another muscular cause that mimics heart pain, see our slipping rib syndrome guide.
What does a pulled chest muscle feel like?
A pulled muscle, or strain, happens when a muscle is stretched too much and part of it tears, according to MedlinePlus. Too much physical effort and falls can cause it.
Signs of a strained muscle include:
- Pain and trouble moving the injured muscle.
- Swelling, or discolored and bruised skin.
Heart attack symptoms can differ in women. MedlinePlus says women are more likely to feel tired for no reason. If that comes with chest pain, do not assume it is a muscle. Go to the ER.
Lung-Related Chest Pain: Pleurisy, Pneumonia, and PE
Lung problems can also cause chest pain. MedlinePlus notes that pneumonia and pleurisy often cause sharp pain that gets worse with a deep breath or cough.
Common signs:
- Pain that worsens with deep breaths. Each inhale produces a sharp catch.
- Cough, fever, or colored mucus. Suggests pneumonia or bronchitis.
- Sudden shortness of breath. Especially after a long flight, surgery, or sitting still for hours.
- Coughing up blood. Always an ER visit.
MedlinePlus notes that a pulmonary embolism (blood clot in the lung) often presents as sudden chest pain with shortness of breath and can be fatal if untreated.
Heart-Related Chest Pain: Heart Attack, Angina, Pericarditis
Heart-related chest pain may feel like tightness, heavy pressure, squeezing, or crushing pain, according to MedlinePlus.
Common signs:
- Pressure or crushing sensation in the center of the chest.
- Pain that spreads to the jaw, neck, arm (often left), or back.
- Other body symptoms. Cold sweats, nausea, lightheadedness, shortness of breath.
- Pain that lasts more than a few minutes or returns repeatedly.
The CDC notes that heart attack symptoms can also include unusual tiredness and nausea or vomiting, and that women are more likely to have these other symptoms.
Is It Heartburn or a Heart Attack?
Heartburn is a painful burning feeling in your chest or throat, caused by stomach acid backing up, according to MedlinePlus. A heart attack can feel the same. MedlinePlus notes that heart attack discomfort can feel like pressure, squeezing, heartburn, or indigestion, and often lasts more than a few minutes.
Treat “heartburn” as a possible heart attack if it comes with pain in the arms, back, neck, or jaw, shortness of breath, a cold sweat, nausea, or lightheadedness. Women are more likely than men to have symptoms other than chest pain, including indigestion, nausea, and extreme fatigue (Office on Women’s Health).
Do not wait to see if an antacid works. The ER can check your heart with an EKG.
4 Key Differences That Help You Decide
These four clues from MedlinePlus can help you decide how fast to act. They cannot rule out the heart.
| What you notice | What it can point to | What to do |
| Sharp pain that gets worse with a deep breath or cough | Lung problems such as pneumonia or pleurisy, or costochondritis. It can also be pericarditis, an inflamed sac around the heart. | Get checked today. A heart problem can feel this way too. |
| Pain and tenderness when you press on the chest | Costochondritis, inflamed cartilage where the ribs meet the breastbone | MedlinePlus still advises calling 911 or going to the ER for chest pain. |
| Tightness, heavy pressure, squeezing, or crushing | A heart attack or angina | Call 911. |
| Pain that spreads to the arm, shoulder, neck, jaw, or back, or comes with sweating, nausea, dizziness, or shortness of breath | A heart attack | Call 911. |
No single clue rules out a heart problem. MedlinePlus notes that heart attack pain can be mild or feel like bad indigestion. If you are not sure, get checked. ER of Irving is open 24/7 and does not turn anyone away.
Red Flags That Need Emergency Care
Call 911 or go to the nearest ER if you have any of these:
- Pressure or squeezing in the center of the chest lasting more than a few minutes
- Pain spreading to the jaw, arm, or back
- Shortness of breath with chest pain
- Sudden severe chest pain with sweating, nausea, or fainting
- Coughing up blood
- Severe pain after long travel or recent surgery (PE risk)
Do not drive yourself if cardiac symptoms are present. Call 911. MedlinePlus notes that emergency medical services can start treatment as soon as they arrive.
How ER of Irving Tells Them Apart
At ER of Irving, the chest pain pathway uses imaging and labs to rule the dangerous causes in or out fast:
- EKG to check for cardiac changes
- Troponin blood test to look for heart muscle damage
- Chest x-ray for pneumonia, collapsed lung, or fluid
- CT scan if pulmonary embolism is suspected
- Physical exam for tenderness, breath sounds, and muscle involvement
FAQs
How long does muscular chest pain last?
Costochondritis pain often goes away in a few days or weeks, according to MedlinePlus. MedlinePlus also advises contacting your provider if chest pain lasts longer than 3 to 5 days.
Can lung problems feel like a heart attack?
Yes. A pulmonary embolism can mimic a heart attack with chest pain and shortness of breath. The ER uses CT imaging and blood tests to tell them apart.
What is costochondritis?
Inflammation of the cartilage that connects ribs to the breastbone. MedlinePlus says it causes sharp pain that gets worse with a deep breath or cough, and tenderness when pressed.
Can anxiety cause real chest pain?
Yes. Panic attack symptoms can include chest pain, a fast heart rate, and shortness of breath. MedlinePlus notes a panic attack may be mistaken for a heart attack. The ER can rule out cardiac causes safely.
Is chest pain on the left side always the heart?
No. Chest pain has many possible causes, including sore muscles, lung problems, and heartburn. The ER tests for cardiac causes regardless.
