Heart Pain: What Can Cause It and Which Signs Matter

A stabbing pain on the left side of your chest — and you're already googling "heart attack." Calm down: in most cases chest pain is not related to the heart, but it's better to have this checked by a doctor rather than a search engine. Let's break down what exactly can hurt, which numbers matter, and when every minute counts.

Can the heart hurt: what exactly is felt

It can. In angina, it's discomfort behind the breastbone — pressing, squeezing, burning; people often point to their chest with a clenched fist. The pain radiates to the left shoulder and the inner surface of the left arm, to the neck, less often to the jaw and teeth on the left, the right shoulder, between the shoulder blades, or to the epigastric region. An attack lasts from 1 to 15 minutes and resolves when you stop the exertion. It is triggered by physical work, strong emotions, a heavy meal, cold, or a rise in blood pressure. With pericarditis the picture is different: sudden sharp, stabbing pain that worsens on a deep breath or when you lie down.

What can cause heart pain: cardiac causes

Angina — the heart doesn't get enough blood through narrowed coronary arteries, most often due to atherosclerosis. A heart attack produces a similar picture but is life-threatening. Pericarditis is inflammation of the sac around the heart. Less often, pain on exertion occurs with pronounced left ventricular hypertrophy, for example in aortic valve stenosis or hypertrophic cardiomyopathy. Angina occurs in 2–5% of people aged 45–54 and in 10–20% aged 65–74. The risk of cardiac causes is higher if you have:

• smoking;
• obesity, diabetes, high cholesterol, or high blood pressure;
• heart attacks and angina in relatives younger than 60;
• age — the older you are, the higher the probability.

Pain in the heart area not from the heart: other causes

Most often it's not the heart. Heartburn and indigestion cause pain after eating, belching, a bitter taste, a feeling of fullness. Chest muscle strain happens after injury or unusual exertion, worsens on inhalation, and subsides at rest. Anxiety, depression, and a panic attack cause sharp continuous pain against a background of stress plus rapid heartbeat, sweating, dizziness. Breast infection, pneumonia, or pleurisy manifest with pain on inhalation, cough with yellow-green sputum, and fever. Shingles begins with tingling and a rash that turns into blisters. Other causes include costochondritis — inflammation of the chest joints — and pulmonary embolism.

Myth: stabbing pain is always "nerves." Fact: sharp stabbing pain that worsens on inhalation or when lying down has been described in pericarditis, and that is a cardiac cause.

Can the heart hurt with normal blood pressure and pulse

An angina attack can be triggered by physical exertion, strong emotions, cold, a heavy meal, as well as a rise in blood pressure. A panic attack may involve a rapid heartbeat. Angina and heart attack are assessed by the character of the pain, provoking factors, radiation, and accompanying symptoms — sweating, nausea, shortness of breath, dizziness. The cause of pain cannot be determined by blood pressure and pulse alone; the doctor takes into account the character of the pain, its triggers, and associated signs.

Sharp, constant, and aching pain: how the signs differ

Sharp, stabbing, worse on inhalation or when lying down — the signature of pericarditis. Pressing, squeezing, burning behind the breastbone for 1–15 minutes that eases at rest — typical angina. Squeezing pain that spreads to the arm, neck, jaw, abdomen, or back and is accompanied by sweating, nausea, dizziness, or shortness of breath — the scenario of a heart attack. Constant pain without light intervals — that is the sign you don't wait out: pain that does not pass is on the list of reasons for emergency help. The word "aching" alone says nothing about the cause; the doctor focuses on triggers, duration, and accompanying symptoms of the pain.

When heart pain requires urgent medical attention

Pain that comes and goes, or pain that passed quickly but left you anxious, is a reason to make a routine appointment with a doctor. The doctor will assess the character of the pain and risk factors and decide which examinations are needed. But if the pain is sudden, does not pass, presses or squeezes, and is accompanied by sweating, nausea, dizziness, or shortness of breath, you cannot wait for an appointment — this is described below.

Chest pain by itself is not a reason to call an ambulance; 103/112 — if the pain is sudden and does not pass, presses or squeezes, radiates to the left or right arm, neck, jaw, abdomen, or back, and along with it there is sweating, nausea, dizziness, or shortness of breath.

This material is for reference: it does not replace a doctor's consultation — neither a paragraph from the internet nor blood pressure monitor readings will make a diagnosis.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer