Ask The Doctor

Not Every Chest Pain Is a Heart Attack

Dear Dr. Garner,

I am 43 years old and have a problem that is starting to worry me.

When I sleep, I am awakened with severe pains under my right breast. I have to turn around in different directions. Sometimes I have to get up altogether.

Also, I notice that when I press on the spot, it hurts. I can even make the pain worse by pressing hard.

I don’t have any heart problems as far as I know.

How do I know if the pain is something I should be concerned about?

Chest Pain in



Dear Chest Pain,

Thank you for sharing your situation and for your question. In general, a person can never be too cautious about which pain is serious and which is most likely not related to the heart.

Most of the time, chest pain is more annoying than serious.

There are some symptoms that can help differentiate heart pain from other less serious pain. For instance:

  1. A person tends to know his or her body better than anyone. If pains recur enough, you begin to recognize it. The pain may not be related to the heart, but related to the stomach, muscles or joints.
  2. Usually with heart pain there is a feeling that an elephant is sitting on your chest. In addition, the pain may spread to the back, neck, jaw, and arms, most notably the left arm. There may be accompanying shortness of breath, sweating, dizziness or nausea.
  3. Chest pain accompanied by a sour taste in the mouth with trouble swallowing, pain that you can point to with one finger and pain that gets better or worse upon changing your body position, is less likely to be heart related.
  4. Pain may be due to digestion problems, including heartburn, swallowing and feeling a lump in the throat.
  5. Pain that occurs on the right side of the chest may be related to the gallbladder.
  6. Chest pain that feels like a knife in your chest may be related to the pancreas.
  7. Pain may be caused by muscle, bone or joint problems. An example is a condition known as costochondritis, which is related to inflamed joints in the chest, where the ribs attach to the breast bone. Sore muscles or an injured rib can be very painful.
  8. Other chest pain may be related to problems in the lungs, such as: blood clots, fluid build-up, pneumonia or a collapsed lung.
  9. Conditions of the mind can mimic chest pain, including panic attacks, which may resemble signs of a heart attack.
  10. Infections, such as shingles, which is related to chickenpox, can cause severe pains. Luckily, there is a vaccination available. People over 50 should ask their doctor.

When you visit your doctor, he or she will initially perform some tests, such as an EKG, blood work and chest X-ray to help determine the cause of your chest pain.

Other tests, such as an echocardiogram, MRI and stress test, may be helpful as well.

I believe your pain is related to costochondritis, or inflamed joints where the ribs attach to the breast bone. The pain usually occurs when taking a deep breath, or with coughing. It is also most severe when the person assumes certain positions.

It is often mistaken for a heart attack. The pain of a heart attack is more widespread while costochondritis pain can be identified as a specific spot on the chest, which can be worsened by pushing the finger into the area where the pain is located. Pain associated with the condition is very sharp.

It usually subsides on its own, or with the help of anti-inflammatory medication, or injection of medicine into the joint causing the pain.

The bottom line is that not all chest pain is a heart attack, but it is best to err on the side of caution.

If you experience chest pain that feels like there is a weight on your chest along with shortness of breath, nausea or pain down your left arm, seek immediate medical attention.

Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET-TV, Tuesdays at 8 p.m. on Time Warner Channel 97 and Cablevision Channel 30.

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