Why You Feel Chest Discomfort — A Physician Explains Chest Pain Without Panic

Chest discomfort is one of the most anxiety-provoking symptoms for patients. The immediate fear is usually a heart attack, yet in everyday medical practice, many cases of chest pain arise from non-cardiac causes. A calm, structured understanding helps distinguish dangerous pain from benign conditions and prevents unnecessary panic.

General Readers
Chest discomfort does not always feel the same. It may be described as tightness, heaviness, burning, stabbing, or pressure. Some people feel it in the center of the chest, while others notice it on one side or spreading to the shoulder, back, or neck.

Common non-cardiac causes include:
• Acid reflux or indigestion
• Muscle strain
• Anxiety or panic attacks
• Poor posture
• Costochondral inflammation

Most of these causes are uncomfortable but not life-threatening.

Medical Students
Chest pain should be approached systematically. Cardiac, pulmonary, gastrointestinal, musculoskeletal, and psychogenic causes must all be considered. The quality, duration, and triggers of pain often point toward the diagnosis.

Important distinguishing features:
• Exertional pain suggests cardiac origin
• Positional or reproducible pain suggests musculoskeletal cause
• Burning pain related to meals suggests reflux
History remains the most powerful diagnostic tool.

Young Doctors
Clinical assessment should begin with ruling out life-threatening causes. Evaluate risk factors such as age, hypertension, diabetes, smoking, and family history.

Initial assessment includes:
• Vital signs
• Cardiovascular and respiratory examination
• ECG when indicated
Avoid prematurely attributing chest pain to anxiety without proper evaluation.

General Practitioners
In primary care, the majority of chest pain cases are non-cardiac. However, patient fear is significant and must be addressed empathetically. Reassurance should be based on careful examination and appropriate investigations.
Management often includes lifestyle advice, short-term medication, and clear guidance on when to return for reassessment.

Pathophysiology
Chest pain arises when pain receptors are stimulated in the heart, lungs, esophagus, chest wall, or surrounding structures. Acid exposure, muscle inflammation, ischemia, or nerve hypersensitivity can all produce similar sensations.
The brain’s interpretation of chest signals is strongly influenced by anxiety and past experiences.

When to See the Doctor
Urgent medical attention is required if chest pain:
• Occurs with exertion
• Is severe or crushing
• Radiates to the arm, jaw, or back
• Is associated with breathlessness, sweating, or nausea
• Occurs in individuals with known heart disease
Prompt evaluation can be lifesaving.

Chest discomfort is common and often benign, but it should never be ignored. A balanced approach—neither panic nor neglect—ensures safety, reassurance, and appropriate care.

Dos and Don’ts

Do
• Seek medical advice for new or unexplained chest pain
• Note triggers and relieving factors
• Manage stress
• Maintain heart-healthy habits

Don’t
• Ignore exertional chest pain
• Self-diagnose heart disease
• Overuse painkillers
• Delay emergency care when symptoms are severe

FAQs
Is all chest pain related to the heart?
No, many cases are due to digestive or muscular causes.

Can anxiety cause chest pain?
Yes, anxiety can produce real and intense chest discomfort.

Does normal ECG rule out heart disease?
It reduces risk but does not always rule it out completely.

Should young people worry about chest pain?
Serious causes are less common, but evaluation is still important.

Can posture cause chest pain?
Yes, poor posture can strain chest wall muscles.

By Dr. Mohammed Tanweer Khan
A Proactive/Holistic Physician
Founder of WithinTheBody.com