Chest pain, typically in the center or left side, may be a sign that a person is having a heart attack. However, other conditions, such as gastroesophageal reflux disease (GERD), can also cause chest pain.

Doctors refer to pain from heart attacks and other conditions that affect the cardiovascular system as cardiac chest pain. Pain that does not come from the cardiovascular system is called noncardiac chest pain.

Gastroesophageal reflux disease (GERD) can cause heartburn, which is a common type of noncardiac chest pain.

While heart attacks are a life-threatening medical emergency, heartburn is not. Therefore, being able to recognize the difference between cardiac and noncardiac chest pain is essential.

In this article, we discuss the symptoms of GERD and heart attacks along with the differences between cardiac and noncardiac chest pain. We also cover other causes of both types of chest pain.

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Many conditions can cause chest pain, including acid reflux.

Acid reflux occurs when acid from the stomach leaks up into the food pipe, or esophagus. One of the most common symptoms of acid reflux is heartburn, which is a painful burning sensation in the center of the chest just behind the breastbone, or sternum.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, a person who experiences acid reflux more than twice a week for a few weeks may have GERD. Close to 20 percent of people in the United States have GERD.

Other symptoms of acid reflux and GERD can include:

People with persistent symptoms of acid reflux or GERD should see a doctor.

Heart attacks occur when the blood supply to the heart muscles becomes completely blocked. If a person does not receive immediate treatment, part of the heart muscle can die.

A common symptom of a heart attack is pain or discomfort that typically occurs in the center or left side of the chest. This pain may come and go, and its severity can range from mild to severe. It can also sometimes feel like heartburn or indigestion.

However, not everyone who has a heart attack experiences chest pain. The symptoms of a heart attack can vary considerably from person to person, and they may come on slowly or very suddenly.

Other symptoms of a heart attack might include:

  • intense pressure or tightness in the center of the chest
  • a feeling of heaviness or weakness in one or both arms
  • pain, numbness, or a tingling sensation in the arms, neck, jaw, lips, or stomach
  • difficulty breathing or shortness of breath
  • nausea and vomiting
  • dizziness or lightheadedness
  • fatigue
  • breaking out in a cold sweat

Anyone who suspects that they or someone else is having a heart attack should immediately call 911 or go to the emergency room.

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A person experiencing recurring or severe chest pain should speak to a doctor.

When trying to distinguish between cardiac and noncardiac chest pain, a person needs to consider the following three factors:

  • the location of the pain
  • how the pain feels
  • the accompanying symptoms

We discuss each of these in more detail below:

Location of chest pain

Both cardiac and noncardiac chest pain can occur in the center of the chest behind the breastbone.

However, cardiac chest pain can spread across the chest and even affect other parts of the body, such as the:

  • arms
  • back
  • shoulders
  • neck or throat
  • jaw
  • teeth

Noncardiac chest pain, such as heartburn, tends to remain localized, meaning that it does not spread to other areas. Heartburn typically develops behind or underneath the breastbone.

How the pain feels

Some of the words that people use to describe cardiac chest pain are:

  • pressure
  • squeezing
  • heaviness
  • fullness
  • tightening
  • aching
  • burning

In contrast, noncardiac chest pain tends to feel like an intense stabbing or burning sensation just beneath the surface of the skin.

Coughing, breathing, or moving can affect the intensity of noncardiac chest pain, while the severity of cardiac chest pain usually remains stable, even when resting.

Accompanying symptoms

The symptoms accompanying chest pain can be an important indication of whether it is cardiac or noncardiac.

The symptoms that can occur along with cardiac chest pain may include:

  • shortness of breath
  • irregular heartbeat
  • dizziness or lightheadedness
  • numbness
  • pain or discomfort in other parts of the body, such as the arms, neck, jaw, shoulders, and back

Symptoms that indicate that the chest pain is from heartburn or GERD can include:

Causes of cardiac chest pain can include:


Coronary artery disease (CAD), also called ischemic heart disease or coronary heart disease, occurs when fatty deposits build up in the arteries that supply blood to the heart muscle.

Over time, these deposits can restrict blood flow, which can cause a type of chest pain called angina. CAD can also lead to heart attacks and heart failure.

People often describe angina as a feeling of pressure, squeezing, burning, or tightness behind the breastbone. This pain can spread to other parts of the body, including the arms, jaw, neck, and shoulders.

Angina often occurs during physical activity, and stress can also bring it on. If the pain continues after rest, this can be a sign of a heart attack.

People who are unsure whether they are experiencing angina or a heart attack should call 911 immediately or go to the emergency room.


Myocarditis is a rare form of cardiovascular disease that causes inflammation of the heart muscle. This inflammation can lead to chest pain, heart failure, or sudden death.

According to the National Organization for Rare Disorders, myocarditis commonly develops without an identifiable cause. However, doctors often diagnose people with myocarditis following a viral or bacterial infection.

Myocarditis produces symptoms similar to those of other heart conditions, such as chest tightness and fatigue. Leaning forward can help relieve chest pain resulting from myocarditis.

Other symptoms of myocarditis include:

  • slow heart rate
  • irregular heartbeat
  • dizziness or lightheadedness
  • loss of consciousness

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a thickening of the muscle wall in the heart.

People can inherit genes from their parents that increase their risk of developing HCM. However, HCM can also occur as a result of high blood pressure, diabetes, or thyroid disease.

The symptoms of HCM include:

  • chest pain that often results from exercise
  • shortness of breath
  • fainting
  • fluttering heartbeat or heart palpitations

Pulmonary hypertension

Pulmonary hypertension refers to high blood pressure in the arteries that supply the lungs.

Common symptoms include shortness of breath and chest pain, which may occur or worsen with physical activity. Over time, symptoms may become more frequent as the disease progresses.

People with pulmonary hypertension may also experience:

  • fatigue and weakness
  • fainting, lightheadedness, or dizziness
  • irregular heartbeat
  • a dry cough that may bring up blood
  • swelling of the legs or feet that results from fluid buildup

Causes of noncardiac chest pain can include:


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Pneumonia can cause shortness of breath and chest pain.

Pneumonia is a chest infection that causes the tiny air sacs inside the lungs to become inflamed and fill with fluid.

A common symptom of pneumonia is chest pain that typically worsens when a person inhales deeply or coughs. The chest pain can range from mild to severe.

Other symptoms of pneumonia can include:

Peptic ulcer

A peptic ulcer is an open sore in the lining of the stomach or small intestine. Bacterial infections and long-term use of nonsteroidal anti-inflammatory drugs can lead to peptic ulcers.

Peptic ulcers can cause a painful burning sensation that starts in the abdomen and extends to the chest. This pain can come and go and may get better when a person eats or takes an antacid.

Other symptoms of peptic ulcers can include:

  • bloating
  • belching
  • nausea and vomiting
  • dark stools
  • unexplained weight loss
  • loss of appetite
  • lightheadedness

However, not everyone with peptic ulcers experiences symptoms.


Costochondritis is an inflammation of the cartilage around the breastbone. This inflammation can cause tenderness and sharp chest pain that may feel similar to the pain of a heart attack.

The pain from costochondritis usually affects the left side of the chest, but it can sometimes affect both sides. Deep breathing, coughing, and physical activity may make the pain worse.

Possible causes of costochondritis include severe coughing, chest injuries, infections, and overexertion.

Esophageal spasms

Involuntary spasms or contractions of the food pipe can cause intense chest pain. These spasms can come on suddenly and sometimes last for several hours.

Other symptoms of esophageal spasms may include:

  • intense pain or tightness in the chest
  • feeling as though something has become stuck in the throat
  • stomach contents coming up the food pipe
  • difficulty swallowing

It is not always clear why esophageal spasms occur, but risk factors include GERD, anxiety, and high blood pressure.

Panic attack

A panic attack refers to a sudden attack of intense anxiety and fear. These attacks can last for between a few minutes and several hours, and a person may feel as though they are having a heart attack.

Symptoms of a panic attack can include:

  • chest pain
  • pounding, rapid, or irregular heartbeat
  • trembling or shaking
  • shortness of breath
  • a sensation of choking or suffocating
  • nausea
  • dizziness or lightheadedness
  • numbness
  • sweating
  • feelings of doom, loss of control, or unreality

A person may have a panic attack in response to a stressful event, but an attack can also occur unexpectedly. Recurrent panic attacks are a symptom of panic disorder.

Heartburn is a symptom of acid reflux and GERD that causes a painful burning sensation in the center of the chest. This sensation can sometimes feel similar to the chest pain that people experience during a heart attack or attacks of angina.

A heart attack is a medical emergency, so being able to tell the difference between heartburn and cardiac chest pain is crucial. If chest pain spreads to other areas of the body, such as the arms or jaw, or occurs alongside symptoms such as shortness of breath and a feeling of tightness in the chest, it might be a sign of a heart attack. If chest pain lasts for more than a few minutes, call 911 immediately.

A person who suspects that they or someone else is having a heart attack should immediately call 911 or go straight to the emergency room. It is also advisable to see a doctor about any unexplained chest pain, even if it goes away on its own.