Central Chest Pain – Causes of Pain in the Middle of the Chest

What is central chest pain?

Pain in the middle of the chest (central chest pain) is often a cause for concern as it is associated with cardiac conditions which may have serious implications. However, there are a number of causes of central chest pain that are unrelated to the heart or great blood vessels, but may be equally as serious or even benign in nature. As a general rule of thumb, chest pain associated with difficulty breathing, dizziness and fainting should be treated as a medical emergency and immediate medical attention is needed. Other symptoms like pain radiating down the arm, especially the left arm and excessive sweating for no known cause should also warrant a medical assessment.

Causes of Pain in the Middle of the Chest

The more centrally located structures of the chest includes :

  • breastbone (sternum)
  • mediastinum
  • heart and part of the great blood vessels
  • trachea and bronchi
  • esophagus
  • thoracic spine

While pain in the middle of the chest may be related to these structures, it is not uncommon for pain to radiate or refer from other regions, like the upper middle abdominal area (epigastric region). The concomitant signs and symptoms are of significant value when assessing the possible causes of central chest pain.

Chest Wall

The more common causes of central chest pain associated with the chest wall are often related to the chest muscles and the breastbone (sternum) and related skeletal structures like the costal cartilages and ribs.

Muscle strain is possibly the leading cause of acute chest wall pain and may be related to strenuous activities. Breastbone pain may be more serious and longer lasting and can vary from fractures to growths, inflammation of the costal cartilages and joints (costochondritis) or injury linked to blunt force trauma without fractures. These causes are discussed further under chest wall pain.

Common symptoms include chest pain when breathing, especially upon inspiration, moving and coughing, tenderness of the chest and occasionally skin symptoms and localized swelling.

Heart and Blood Vessels

An acute myocardial infarction (heart attack) should always be excluded when there is a sudden chest pain radiating down the arm, associated with breathlessness, sweating, nausea and dizziness. These patients also tend to be extremely anxious with a feeling of impending doom and in the typical presentation, clutching the chest. High risk patients, especially those diagnosed with angina pectoris, need emergency medical care.

Other conditions that may initially be less severe in clinical presentation but equally serious in acute settings includes pericarditis, heart valve disease, aortic dissection, and pulmonary embolism.

Some of the common symptoms includes varying degrees of breathlessness, dizziness, nausea and vomiting or fainting. Symptoms such as coughing up blood-tinged froth is indicative of conditions like pulmonary embolism whereas chest pain that ease when leaning forward may be a strong indication of pericarditis.

  • Myocardial infarction/ischemia(heart attack)
    • Tightness, crushing or squeezing chest pain, especially after exertion or stress
    • Pain referring to arm, jaw, shoulder, back
    • Shortness of breath (dyspnea)
    • Sweating
    • Dizziness or fainting
    • Nausea and/or vomiting
    • Anxiety
  • Aortic Dissection
    • Sudden, severe chest pain
    • Dizziness, fainting
    • Weakness, paralysis and other symptoms of a stroke (confusion, disorientation)
    • Shortness of breath
    • Paleness (pallor)
    • Sweating
    • Dry mouth

Airways and Lungs

The most likely respiratory cause for pain in the middle of the chest is tracheitis which is inflammation of the trachea (windpipe). While bronchitis may also be responsible, it is not associated with significant pain except in the case of bronchial carcinoma (cancer). Most respiratory conditions present with cough and sputum and are usually infectious in nature. The infection may affect surrounding parts of the respiratory system and other symptoms like a hoarse voice when the larynx is involved and pulmonary edema (fluid in the lungs) when the lungs are affected may also be present.

Respiratory

  • Tracheitis
    • Dry cough, often painful
    • Stridor (abnormal breathing sounds)
    • Dysphonia (hoarse voice)
    • Sore throat (pharyngitis)
    • Fever in infectious causes
  • Pulmonary Embolism
    • Sudden shortness of breath
    • Pain similar to a heart attack
    • Bloody cough or blood-tinged mucus
    • Abnormal breathing sounds (wheeze)
    • Paleness (pallor) or blue-tinge of the skin (cyanosis)
    • Dizziness or fainting

Gut

Inflammation of the esophagus (esophagitis) may occur for a number of reasons but the most common cause is related to acid reflux. This can cause acute chest pain that may mimic heart attack pain in acute cases and a dull, persistent ache of the central chest may be present in chronic cases (GERD). There are various other types of esophagitis that may also play a part in gastrotintestinal chest pain. Esophageal ulcers or an esophageal tear may also be responsible for central chest pain.

Gastrointestinal

Gastrointestinal causes usually presents with pain when hungry, during or after eating, along with nausea, vomiting and a change in appetite.

  • Esophagitis
    • Difficulty swallowing (dysphagia)
    • Painful swallowing (odynophagia)
    • Chest pain varies from heart burn to cardiac-like pain
    • Nausea
    • Vomiting
    • Lack of appetite
  • Esophageal rupture
    • Severe chest pain, sometimes starting as high up as the neck and extending a low down as the abdomen
    • Difficulty swallowing
    • Nausea
    • Vomiting, often blood (hemoptysis)
    • Shortness of breathing and rapid breathing
    • Rapid heart rate
    • Fever
    • Blood in stool (melena)

Other Causes

  • Gallbladder and bile duct disease like cholecystitis and cholangitis
  • Gallstones or bile duct stones
  • Gastric carcinoma (stomach cancer)
  • Pancreatitis or pancreatic cancer
  • Peptic ulcer
  • Hiatal hernia
  • Mediastinal tumors
  • Subphrenic abscess

Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. By using this website and the comment service you agree to abide by the comment terms and conditions as outlined on this page

  • Wayne

    Hi I went to the emergency room because I was feeling strange.My legs have been swelling with pitting edema ,and I have a fatty liver.. And Barrett’s esophagus..my C K test came back at 477. I am male and 50 years old..Why do you think the C K test came back so high..I do not work out.or do anything strenuous .

  • Hi Wayne. The CK test is an indicator of muscle damage. Many people confuse this with CK-MB that specifically indicates damage to the heart muscle although the troponin tests is now preferred over CK-MB. There are several possibilities why the CK test may have come out high and it is difficult for us to say why it may have come out so in your case. You need to speak to your doctor who is overseeing your case and is familiar with all the details.

    Remember that any ER visit must be followed up with a visit to your family doctor within a day or two, even if there was no significant findings when you went to the ER. Some medication and infections can cause muscle damage which in turn can lead to elevated CK readings. So do not only focus on physical activity and strain. But your doctor will be in the best position to discuss these possibilities with you and possibly run further tests if necessary.

  • Shontel Hoskin

    I have a chest pain in the middle of my chest that comes and goes.I told my Dr. she did a ekg and told me she heard a murmur in my heart.I had not been on my HIGH BLOOD PRESSURE MEDS in a while so we tried them first. Its been about a week and the chest pains don’t come as strong as they where, but real light..how long should I wait before I should be concerned? I also have acid reflux

  • Hi Shontel. You don’t mention your age and other important details of your medical history but nevertheless the fact that you do have high blood pressure puts you at risk of cardiovascular disease. You should be concerned and this needs further investigation. See your doctor as soon as possible and she may refer you to a cardiologist for further assessment if she has concerns. Acid reflux may also cause chest pain and not that typical sensation that we associated with heartburn. While the pain you are experiencing could be reflux, it is better to be cautious and first exclude a possibly cardiac problem.

  • Joey

    I have this pain on the heart area (basically under/inside my left chest. If I touch it, it hurts more (as when I am able to feel the bones) and sometimes my left arm hurts when I do that. I got many tests done and I been told it’s not the heart, but what is it? Docs been unable to tell me anything. Just one ARMY medic said that I may need “alcohol shots” on the area to relieve the pain. But nobody tells me what it may be. Any suggestions? (p.s. I been having this for more than 20 years)

  • Hi Joey. It’s good to know that the doctors have excluded a heart condition. The fact that the pain increases with touch/pressure and it has been going on for 20 years without other symptoms does make a heart condition an unlikely cause. Nevertheless you should always bear the possibility of a heart problem in mind and have it checked should other symptoms like dizziness, nausea and/or shortness of breath arise. This pain that you have described seems to more likely related to the chest wall and not an internal organ. It could have arisen from a past event where there was chest wall trauma and maybe a broken rib was undiagnosed. It could also be muscular. Condition like shingles would also have been a consideration if it arose relatively recently and there were some skin symptoms. These are just some of the possibilities. You need to consult with a specialist physician who could then delve further into the matter with diagnostic investigations. Ask your doctor for an appropriate referral.

  • Joey

    Thank you so much. I also forgot to mention that when I am tired, very tired, the pain starts, lasts for hours.

  • Hi Joey. As advised in the previous reply, it is best to speak to your doctor again and get a referral. This could be related to the heart as tiredness is usually a result of physical exertion which may strain the heart. But your doctor will advise your further.

  • lillie

    Hi I’m a little over three months pregnant .I woke up two days ago sore like my chest and back needed to pop. I have this sharp pain right between my breast in center of my chest .and i . Hurts to lean forward are to sneez are caught it hurts my chest so bad like a big squueze tightening crampy like pain . I had really pain full head ACH up threw my neck is tender … This is still goin on this bout third day it wasint eased up what could it be should I be worried …?????

  • Hi Lillie. You don’t mention your age or other medical history which could be relevant for certain conditions like heart disease. If it is entirely a musculoskeletal issue then it may be worth noting that pregnancy causes many changes in your body that could contribute to your condition. Even though your tummy may not be very distended so early in the pregnancy, the high level of different hormones that occurs in pregnancy can have an effect on the cartilage and joints. Coupled with the enlarging breasts this could put further strain on the chest wall. It may be something to be concerned about but we cannot say for sure. Follow up with your doctor.

  • Ger There

    Hi, I M 73 F, have a Meitral Prolaspe … Have battled 3 mos with sever Gastritis & Diverticulosis Been on track with diet , seems to B better, Fell off this wk had a juicy Hamburger & 2 scones. THis morning woke up with cramping , ran to bathrm, after I had prickly chest pains . went away , had BF then did chores. Has hit me several times today. seems to B settled in center of my chest.. Had AKG last wk , all seemed ok, being fitted tomorrow for monitor & test coming up. Could this B related to Acid Reflex ? R prickly or needle like pains possible heart or?

  • Hi Ger. Hopefully you have received some feedback after a 24 hour monitoring. Yes, sometimes acid reflux can cause pains that are not the typical heartburn that would be expected. There is no way of knowing for sure until you do the necessary tests. Sometimes it can be easily identified when the pain eases with antacids. Cardiac pain would not respond to antacids while acid reflux would. However, it is best to leave the diagnosis to a doctor.

  • Jess

    Hi, I’m female, 49, overweight but I’ve never been a smoker. I have had frequent problems with acid reflux and heartburn, but tonight, this feels very different. I have a squeezing sensation right in the center of my chest (as opposed to burning). When I was lying down (on my side), it was getting worse, and I could also feel it in the back of my tongue. I have no other symptoms. Sitting up made it feel much better. Still, I took two aspirin, just in case. I don’t have high blood pressure. There is almost no history of heart disease in my family, but last year my mother (who has good cholesterol and normal blood pressure) had an aortic aneurysm (she smoked for 40 years (ages 20-60, she is now 76). Should I go to the ER? I hate it there.

  • HI Jess. Hopefully you have been to the ER by now and the necessary tests have been conducted. If not then please do so immediately. You don’t have to be a smoker, have high blood pressure or have a family history to suffer with heart disease. It is more common in your age group and contrary to popular belief, it is not mainly men that have heart disease. It is quite common in women of your age group and can at times even be a silent heart attack, where you had mild to no symptoms and just go with normal life only to find out later that you had a mild heart attack. The squeezing sensation as opposed to heartburn is a concern but sometimes acid reflux can present atypically. Similarly a heart attack can present as acid reflux. There is just no way of knowing for sure and it is better to be cautious and have an EKG. The ER doctor will advise you further.

  • Vanessa

    Hello! I’m a 16-year-old girl and I have a central chest pain (it goes little down of the sternum) for more that 1 week. I went to the doctor before 3 days he did me a cardiogram and he examined me and he told me that everything is ok and it’s just stress (it’s true that I had a lot stress) but now I have not, but I still feel that discomfort. I am not tired or I’m not getting easily tired when I’m running or something, I just feel a discomfort ( and a little strange when I take deep breaths) I don’t know if it’s matter but I’m 88.18 Ibs or 40 kg and my height is: 531.49 feet or 1,62 metres. I had never had a health problem and I have never taken a pill… What might it be?

  • butyoumad

    I noticed about two months ago, I was driving to work on the freeway, and i felt a tightening pain in my chest. I did not feel nauseous. I was not sweating. No bad taste in my mouth. I do not smoke, never did. I do not have high blood pressure. I am 52 yr old female. I am 40 pounds overweight. I exercise for few weeks, then I stop for few weeks; I go back and forth with that. I do have high cholesterol. I am borderline diabetic; and heart disease, and diabetes does run in my family. I take no meds whatsoever..other than Dr. Schultz organic vitamins and Superfoods from American Botanical Pharmacy in Marina Del Rey, CA. I am right now feeling this tight pain again in the middle of my chest. No other symptoms at all, except the tight, painful chest. I move in different positions and that slightly alleviates pain, but then it comes back in few minutes. Pain comes and goes. It is not excruciating, but very significant. And when I swallow, it feels like a large item is slowly stuck traveling through my windpipe/chest…?…What the heck??

  • Olanrewaju

    Hi, ‘m 29 and have been feeling chest pain for like 8 to 10 years now. Back then i used to feel dizzy a lot of times like when i want to stand up from a sitting or lying position, the dizziness comes for like 5 t0 10 seconds and goes back, i have experienced slumping / fainting back then. Before the fainting/ slumping comes i feel dizzy, cold through all my body, light headed and i would just noticed i am standing up. The chest pain feels like my chest is contracting or squeezing then i will just do some stretching, sit upright and it relieves me. The dizziness/light headedness, contracting chest, and a bit slow breathing comes and goes even till now but not all the time. Please what might be the cause as i can’nt recall any of my family member having heart problems. I am 8’3″ tall, slim and its been happening for 8-10 years. And haven’nt been so sick in all those years to require me going to hospital. But i definitely know something is not right Please help.

  • Megan

    What type of doctor should My daughter see for bone pain in the middle of her chest, pain on my side, trouble breathing. She is 31 years old and had a disc replaced in my neck in October and now all this pain. She exposed to mold through a moldy aire conditioner. She feels so bad and doctors send her here and there. Help my daughter.