Chest pain sends over 7 million people to the emergency room every year. That makes sense since any kind of aching in your chest can be downright terrifying. But experiencing chest pain doesn’t automatically mean you’re in grave danger.
While cardiovascular events can certainly happen to young, otherwise healthy people, and heart disease is the leading killer of women in the United States, most chest-related emergency room visits aren’t life-threatening, according to a 2016 study published in JAMA that investigated records for over 42 million patient visits to the ER. These visits are often not even rooted in physical issues at all and are tied to mental health instead.
Chest pain is different for everyone, and there’s no true way to diagnose it on your own (nor should you try). With that said, there are some potential ways to differentiate between physical and mental causes of chest pain in the moment.
These are common signs your chest pain could be physical.
1. You recently lifted or otherwise moved something heavy.
“The rib cage, the muscles between the ribs, and where they connect to the back and breastbone are actually pretty sensitive to trauma,” Aaron Baggish, M.D., director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center in Boston, tells SELF. “People hurt their [chests] all the time and don’t realize it.”
For instance, you can strain a muscle or tendon in your chest if you lift weights without warming up properly or safely working yourself up to that level of weight over time. This type of injury can even happen if you’re shoving your sofa across the room to refresh your space. Basically, if you’ve been exerting your upper body recently, that could be the cause of your chest pain.
2. You feel general discomfort anywhere between your chin and your belly button, or even lower.
This sounds vague, but Dr. Baggish points out that many organs in the chest, like the heart, lungs, and esophagus share the same nerve supply. Anything in that area that gets inflamed or damaged can cause discomfort in a pretty large swath of your body, he says.
For instance, a pulmonary embolism, or when blood supply to a lung gets blocked by a blood clot, can cause chest pain, according to the Mayo Clinic. Other symptoms include shortness of breath (trying to take deeper breaths might make your chest pain worse), feeling light-headed or dizzy, having a rapid pulse, coughing up blood, and fainting. (This offending blood clot usually happens in the legs; signs of that include pain, swelling, discolored skin, and warmth in the affected leg.)
Another common cause of chest pain is acid reflux or its more severe relative, gastroesophageal reflux disease (GERD). Acid reflux happens when stomach acid reverses into your esophagus, creating symptoms like chest pain, heartburn, problems swallowing, a lump in your throat, and more, according to the Mayo Clinic. Acid reflux becomes GERD if you experience a mild version of these symptoms at least twice a week or a moderate to severe version at least once a week.
3. You’re about to get your period.
Cyclic breast pain might be your issue. This discomfort occurs in the two weeks leading up to your period due to hormonal fluctuations, according to the Mayo Clinic. It typically causes a dull, heavy ache that affects both breasts, so it might feel like your whole chest hurts. It may also feel like you pumped air into your breasts, swelling them up.
Of course, you might be used to this pain heralding your period’s arrival every month. But it could take you by surprise if, say, you’ve recently gone off hormonal birth control that stabilized your typical hormonal shifts.
4. Your chest pain always happens when you’re exposed to certain triggers.
When you think of asthma symptoms, you might immediately envision someone gasping for air. But asthma can also cause chest pain and tightness due to airway inflammation, according to the National Heart, Lung, and Blood Institute (NHLBI). Common triggers behind this include pollen, dust mites, animal dander, cold air, smoke, exercise, and more.
You might think you’d obviously know if you had asthma, but it’s possible to develop this condition without realizing it. So, if you notice issues like chest pain and shortness of breath every time you dust your place or cuddle with your friend’s dog, asthma could be your problem.
5. You have risk factors for heart disease.
“Chest pain is very much about the person who gets the chest pain,” says Dr. Baggish. This means that people who have risk factors for heart disease are more likely to have chest pain from a serious heart problem than other people, he explains. Those risk factors include high blood pressure, high cholesterol, diabetes, a cigarette smoking habit, being overweight or obese, a lack of exercise, being over 55 for women (this drops to 45 for men), and having a family history of the disease.
6. Your chest pain happens when you’re exerting yourself physically, is reproducible, and is quickly relieved by rest.
These are the classic features of angina, a symptom of an underlying heart problem such as coronary heart disease that can crop up when your heart isn’t getting enough oxygen-rich blood, according to the NHLBI. (Coronary heart disease is the most common form of the condition.) The discomfort associated with angina is often described as pressure, tightness, or a burning sensation. You might also feel discomfort in your neck, jaw, throat, abdomen, or back, or feel nauseous or short of breath.
As an example of what this might look like, you might go out for a run and start to feel uncomfortable when you really push yourself, but then realize the discomfort subsides when you slow down, Dr. Baggish says. Of course, some level of discomfort can be totally normal in this situation—it’s about disproportionate pain, tightness, or burning that you know aren’t usual for you personally at this level of exertion.
7. You feel pain on the left side of your chest or pain that’s radiating into other parts of your body.
Your heart is on the left side of your body, so pain in that area can be associated with a cardiovascular event like a heart attack, the NHLBI explains. In addition to straight-up pain, this might feel like squeezing, pressure, or fullness.
However, a heart attack can also cause these symptoms in the center of your chest, according to the NHLBI. Whichever way it presents, the chest pain will often last for more than a few minutes, recede, then return.
Although chest pain is the most common sign of a heart attack in men and women, women are more likely to experience lesser known symptoms like pain radiating into the back, shoulders, and jaw, shortness of breath, nausea, vomiting, and fatigue, the NHLBI explains.
Here are the signs your chest pain might be mental.
1. It’s accompanied by an overwhelming amount of panic.
“Panic … can absolutely produce the sensation of chest pain, and we see it all the time,” says Dr. Baggish. “It’s real. People feel it.” In fact, some studies suggest panic disorder—repeated bouts of panic attacks causing all-encompassing fear and other symptoms—are the most common reason people seek emergency medical treatment for what turns out to be non-cardiac chest pain.
2. It comes with other symptoms of panic attacks.
Someone who’s having something like a heart attack might feel panicked, so experiencing intense fear along with your chest pain isn’t enough to say you’re having a panic attack.
Instead, panic attacks involve an acute rush of fear and at least four of the below symptoms:
- Chest pain or discomfort
- Heart palpitations or a rapid heart rate
- Trembling or shaking
- Feeling short of breath or smothered
- Feeling as though you’re choking
- Nausea or abdominal discomfort
- Feeling dizzy, unsteady, light-headed, or faint
- Experiencing chills or, alternately, stifling heat
- Numbness or tingling sensations
- Derealization (feeling like reality is confusing or no longer exists) or depersonalization (feeling detached from your thoughts, feelings, and body)
- Fear of losing control or that you’re “going crazy”
- Fear of dying
If you keep experiencing random episodes of full-on terror along with these symptoms, panic attacks are likely your issue, Manish Kumar Jha, M.D., assistant director of the Mood and Anxiety Disorders Program at the Icahn School of Medicine at Mount Sinai, tells SELF.
3. In addition to the above, your chest pain is fleeting and subsides after a short period of time on its own.
Since panic attacks tend to peak within 10 minutes, Dr. Jha notes that any related chest pain often happens quickly: “It could be over before you have the opportunity to go to seek care.”
Chest pain due to physical causes like angina or a heart attack can also fade after a few minutes. Keeping the other symptoms of these conditions in mind can offer some hints as to whether your chest pain might be physical or mental.
You shouldn’t just try to soldier through your chest pain and whatever might be causing it.
If you’re dealing with chest pain that is persistent, is severe, or worries you for some other reason, you should always seek medical attention. Yes, even if you think it’s “just” because of anxiety, Dr. Jha says. You shouldn’t have to suffer through that.
When you get in to see a doctor, they will likely try to rule out physical issues with tests such as blood work or an electrocardiogram (EKG) to record electrical signals in your heart, Dr. Jha explains. If they think you might be having a panic attack, they will typically focus on evaluating you psychologically to cement that diagnosis, according to the Mayo Clinic. Either way, once they’ve figured out the source of your chest pain, they can offer treatments to help you feel better physically and have more peace of mind.