7 reasons for chest pain (not lung-related)

What causes chest pain? What could it be? Is it serious?

All of these questions may be going through your mind. You may even be thinking of the worst possible things (i.e. is it cancer?). Even though literally millions of people struggle with chest pain it can usually be managed quite effectively. But every now and then it may cause a bit of a health scare.

You may be happy to hear that in most cases, chest pain actually has little to do with the lungs themselves. Read on.

The lungs themselves actually do not produce pain because they do not contain the sensory nerve endings to actually hurt. Pain associated with lung disease may be related to a complication related to the airways or the pleura (the thin membrane lining the lungs), but it is not really caused by the lung tissue.

There are plenty of other organs in the chest which can cause pain. Let’s explore some of them, starting from the center of the chest and moving outwards:

1. The esophagus

The esophagus is the “tube” that carries food down towards the stomach. Conditions affecting the esophagus can actually cause chest pain.

The most common situation is “heartburn”. This type of pain is generally located in the front side of the chest, behind the sternum (retrosternal pain). It is typically described as a “burning” sensation moving upwards from the stomach. It is generally associated with acid reflux (gastroesophageal reflux). If you are prone to acid reflux, this may sometimes explain the chest pain. It is actually quite common for patients to present to the emergency room due to heartburn, worried that it may be related to a heart attack! Some reassurance, antiacid medication, dietary changes and stress reduction (!) are usually enough to control this type of pain.

Esophageal spasm is another potential cause for chest pain. This is not a frequent occurrence, but it can be worrisome for some people and may require some input from a gastroenterologist. Essentially the muscles lining the esophagus constrict and cause a spasm, which can be painful. Usually this happens when there is some underlying irritation of the esophagus (due to acid reflux), abnormal functioning of the swallowing reflex, too hot or too cold food/drink intake etc. In esophageal spasm, the constriction of its muscles does not occur in a wave-like pattern (as would be needed to push food downwards).

2. The airways

Although not very common, chest pain related to the large airways may occur.

Normally the pain follows a chest infection, an episode of acute bronchitis or episodes of severe coughing. These situations cause some mechanical strain to the large airways (trachea and bronchi). The pain is usually located in the center of the chest, just behind the sternum and is usually worsened by coughing. There may be some discomfort with deep breathing in the same area. Normally you would be able to identify the cause (acute chest infection).

3. The heart

The heart is about the size of your fist and sits in the center of the chest with the tip pointing to the left (in most cases, as it can be reversed in some individuals). Cardiac pain is normally related to ischemic heart disease – the blood vessels feeding the heart are not able to provide enough blood flow to match the oxygen needs of the heart muscle.

Very severe chest pain should always be investigated by a doctor. Ruling out a myocardial infarction (heart attack) is essential when there is severe, continuous, crushing chest pain. Prompt treatment in the first few hours after a heart attack is essential to preserve the viability of the heart muscle and prevent complications.

Angina is a type of cardiac pain which can occur after exertion in individuals with known ischemic heart disease. Normally there is a sensation of strong chest tightness and pain irradiating down the left arm, or sometimes towards the jaw or stomach. Normally there is also associated shortness of breath. Some people may experience atypical angina, where instead of pain there may be a sensation of indigestion. Those who suffer with poorly controlled or complicated diabetes may also not experience the usual pain of angina (silent ischemia).

4. The large vessels

Very rarely, severe shearing chest pain can be associated with a condition called aortic dissection. This tends to occur suddenly, and the pain is usually severe. As mentioned above, if you have severe chest pain you should go see a doctor immediately.

In aortic dissection, the inner lining of the aorta (the main blood vessel leaving the heart) becomes detached. It can be a life-threatening condition if not detected early.

5. The pleura

The lungs and the inner side of the chest wall are covered by a very thin membrane called the pleura. This membrane allows the lungs to easily slide up and down with breathing. The pleura does contain nerve endings and inflammation or injury to the pleural surface will cause chest pain.

Pleuritic chest pain is generally rather sharp in nature, typically one-sided (left or right) and increases during deep breathing.

There are multiple situations in which the pleura may be affected. These may include:

  • pleural irritation during an episode of pneumonia
  • viral infection causing pleuritis (inflammation of the pleura)
  • air in between the pleural membranes (pneumothorax). It can happen spontaneously or may be due injury, a complication of a chest procedure, complication of another lung disease.
  • fluid build-up between the pleural membranes (pleural effusion). It can have numerous causes, most commonly due to heart failure (heart not pumping blood as well as it should), as a complication of a chest infection (pneumonia, tuberculosis), pulmonary embolism, cancer, other conditions affecting several body systems (i.e. autoimmune disease such as rheumatoid arthritis), end-stage liver disease, end-stage kidney disease etc.
  • bleeding between the pleural membranes – most commonly due to injury, accidents etc.

6. The chest wall

Sometimes chest pain can be due to the ribs and muscles between them. Most commonly, this type of pain occurs after an injury or mechanical stress (i.e. rib fracture, pulling a muscle during intense exercise, heavy exercise, sports etc.)

There are also nerves which run in the spaces in between the ribs (intercostal nerves). Sometimes these can become inflamed / irritated and cause pain. Certain viral infections such as herpes zoster can also cause intense nerve pain affecting the intercostal muscles (in this case a typical blistering rash is also noted along the painful area).

7. The spine

Let’s not forget that probably the most common cause of chest pain is actually related to the spine (vertebrae and intervertebral disks). A lot of people work in offices and sit on chairs for many hours every day. Our body was never designed to be static in this way. Sitting in a chair in front of a computer or hunched over documents puts a lot of strain on the spine. The muscles of the spine need to work very hard to maintain our posture in this position. Over time this leads to back pain, especially in the middle part of the spine – many will then worry this is chest-related.

Heavy lifting with a bent back is also very dangerous for the spine, as the intervertebral disks are in a disadvantageous position. In this position the weight is not distributed equally over the intervertebral disk (which acts like a cushion between the vertebrae). Because the disk contains a soft center, this may then protrude through one part of the disk, causing pain or compression of nerves coming out of the spine. Spinal damage can be very hard to fix so prevention is very important. Always try to have a correct posture when lifting anything heavy (lift with your legs, not your back – keep your back straight throughout!).


Chest pain can be very complex. There are many potential causes for it and most of them may not be directly related to lung disease.

It is very important to go see your doctor urgently if you are experiencing severe chest pain, as this can be related to a life-threatening condition. If there is a known respiratory disease or other severe conditions affecting other body systems, new onset chest pain may be the sign of a complication. In the majority of cases where there is stable and mild chest pain, the cause may be mechanical strain on the chest wall and spine.

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