Common Reasons for Sudden, Sharp Chest Pain

Chest pain is scary. And it can be serious. But there are lots of possible reasons you could experience a sudden stabbing pain in your chest. And many of them have nothing to do with your heart at all, says cardiologist Ajay Bhargava, MD.

Dr. Bhargava explains common causes of sudden chest pain — and when you should consider it an emergency.

Understanding sudden chest pain

Chest pain can be tough to explain. Especially if you’ve never felt it before. We’re focusing here on sudden chest pain: Pain that comes on without warning or explanation.

You may be feeling any — or many — of a wide range of painful sensations. Chest pain can be sharp or dull, throbbing or crushing, burning or tearing, tight or sore and much more.

Once you’ve characterized the type (or types) of pain you’re feeling, it’s time to think about intensity and duration. Ask yourself these questions:

• Is the pain mild, moderate or severe?
• What were you doing when the pain started?
• How long have you been in pain?
• Does the pain come and go? Or is it constant?
• What (if anything) eases the pain (or makes it stop altogether)?
• Do you have other symptoms?

Most common causes

If you’ve experienced chest pain before, you aren’t alone. In fact, chest pain accounts for 5% of all ER visits. And while the sensation is scary, the cause often isn’t.

According to a 2016 study that’s still cited today, less than 6% of people who go to the emergency room for chest pain actually have a life-threatening problem.

That doesn’t mean you should ignore the pain, of course. It could still signal something serious. Dr. Bhargava shares some of the many possible causes of sudden, sharp chest pain.

Heart attack

Chances are, when you hear “chest pain,” your brain goes straight to heart attacks. It’s an understandable reaction. We all know somebody whose chest pain turned out to be what doctors call a myocardial infarction.

Typical heart attack pain feels like heaviness, tightness or pressure. That pain sometimes extends into your arm, jaw, neck, stomach or back. These symptoms can last for minutes to hours.

Other common symptoms include:

• Shortness of breath
• Cold sweats
• Nausea or vomiting
• Dizziness or lightheadedness

Aortic dissection

Aortic dissection occurs when the layers of the aorta, your heart’s major blood vessel, tear apart. It often feels like a sharp, ripping pain in your chest and back.

This isn’t a sharp pain that eases after a minute. It’s a pain you can’t ignore. And you shouldn’t. An aortic dissection is an emergency.

Coronary artery disease

Coronary artery disease causes a painful sensation in the chest called angina. But that pain’s usually described as heaviness, achiness, tightness or pressure — not a sharp, sudden blast.

“The pain is usually brought on by exertion and goes away with rest,” Dr. Bhargava says.

Heart inflammation

There are different types of heart inflammation. Each can cause chest pain.

• Myocarditis is an inflammation of the heart muscle. It may cause sudden, sharp pain. But it can also cause pain that builds gradually over time. It depends on what’s causing the inflammation.
• Pericarditis is an inflammation of the pericardium — the fluid-filled sac that surrounds your heart. With pericarditis, your chest pain often eases when you sit up and lean forward.

Heart rate issues

Your chest can start hurting when your resting heart rate goes too high (tachycardia) OR too low (bradycardia). Most of us expect our heart to beat between 60 and 100 times a minute when we aren’t moving around.

• A resting heart rate over 100 beats per minute (bpm) is considered tachycardic.
• Bradycardia is a resting heart rate under 60 bpm.

When it comes to heart rate problems, what’s most important is what’s normal for you. If your heart’s beating too fast or too slow, you’ll probably have other symptoms in addition to chest pain, like shortness of breath, dizziness and excessive sweating. You need to get immediate medical attention.

Pulmonary embolism

Sharp chest pain could signal a pulmonary embolism (PE), a blood clot that lodges in the lungs. PEs interrupt the flow of blood and oxygen to your lung, which makes them a life-threatening emergency.

Collapsed lung

When you think of collapsed lungs (pneumothorax), you probably imagine dramatic injuries and dire illnesses. But sometimes it just … happens. It’s called a spontaneous pneumothorax.

Even if the condition is a medical mystery, it still needs urgent medical attention.

Chest infection

Conditions like bronchitis, pneumonia and pleurisy can be extremely sneaky sources of chest pain. Yes, most chest infections cause other symptoms, too. But your situation could be one of the exceptions that prove the rule.

Broken rib

Did you know spontaneous rib fractures are a thing? They are! It can happen to anyone, but it’s most likely if you have osteoporosis, an underlying bone condition, or if you do a lot of heavy lifting. Something as simple as coughing could be enough to cause a break!

The chest pain from a broken rib is sudden and sharp. It may hurt to breathe or move.

Abdominal pain

Odd as it may sound, chest pain may be a sign that something’s amiss in one of your abdominal organs. Gallbladder disease, gastritis and pancreatitis can all cause chest pain. So can an ulcer. Even a bad case of gas can cause chest pain!

Acid reflux or GERD

It’s probably not your first guess. But it should definitely be up there. Issues with your gastrointestinal tract are an extremely frequent source of ER admissions for chest pain. In fact, about 30% of people who go to the ER for chest pain turn out to have gastroesophageal reflux disease (GERD).

Also known as acid reflux, GERD usually causes an easy-to-recognize burning sensation in your throat or chest — classic heartburn. But sometimes, GERD causes sharp chest pain and pressure.

“The pain and pressure are sometimes due to spasming of the esophagus, or food pipe,” Dr. Bhargava explains. Esophagitis, an inflammation of the lining of the food pipe that connects the throat to the stomach, can do the same thing.

With these conditions, pain is more likely after eating or lying down. You might also have a hard time swallowing.

Costochondritis or intercostal muscle strain

Your heart is protected by bones, muscles, joints and connective tissue. And if they’re strained or damaged, it can be extremely painful.

If you recently hauled a heavy box or worked out too hard at the gym, you might develop a case of costochondritis — inflammation of the cartilage around your sternum. Dr. Bhargava says a bad case can cause significant pain. So can an injury to one of the muscles between your ribs.

Anxiety and panic disorders

Anxiety and panic attacks can sometimes be so severe that they’re mistaken for heart attacks. There’s good reason for that: There’s a lot of overlap between the symptoms.

If you aren’t sure what’s causing your chest pain, Dr. Bhargava says it’s always best to consult with a healthcare provider for advice. Ditto if anxiety or panic attacks are a frequent problem.

Other causes

We’ve discussed a lot of different conditions. But when it comes to causes of random stabbing chest pains, we’re still only scratching the surface.

“Unfortunately, it can be tough to pinpoint the cause of chest pain on your own,” Dr. Bhargava notes. “We need to run tests to understand where the pain is coming from. And you simply can’t do that at home.”

All chest pain deserves a doctor

All chest pain should be followed up by a provider. But how do you know if yours is a medical emergency? It’s a judgment you need to make based on:

• Your age
• Your overall health
• Your risk profile
• The type of chest pain you’re having
• Chest pain severity
• How long it lasts

If you’re young, otherwise healthy, the pain eases up after a few minutes and it doesn’t come back, it’s probably not urgent, Dr. Bhargava says. Especially if you don’t have any other symptoms. But you should definitely follow up with your primary care doctor.

If the pain is severe or isn’t going away, that’s a different story. Ditto for experiencing other symptoms that could indicate a heart or lung problem. Call 911 or local emergency services if you’re experiencing chest pain and:

• Shortness of breath
• Excessive sweating
• Nausea or vomiting
• Dizziness

It’s important to keep your medical history in mind as you evaluate your symptoms. Play it safe and go to the hospital if you have risk factors for heart disease.

“Err on the side of caution and see a doctor right away,” Dr. Bhargava advises. “It’s always better to be safe and have it evaluated.”

The bottom line? When in doubt, have it checked out.