Pain in the Middle of the Chest: 6 Causes & When to Worry

Medical review: Dr. Ana Luiza Lima
Cardiologist
January 2023
  1. Causes
  2. When to worry

Pain in the middle of the chest is often a sign of a less urgent condition, like gastritis, costochondritis or even excess gas. There is no need to worry worry or become anxious, especially if you do not have any history of cardiac issues, like high blood pressure, obesity or high cholesterol.

Middle chest pain can often be suspected to be a heart attack, but a heart attack is actually one of the rarest causes of middle chest pain. When you do have a heart attack, you will likely also experience difficulty breathing, tingling in one of your arms, pallor and nausea in addition to the pain. 

If you suspect you may be having a heart attack, you should proceed immediately to the hospital for testing, like an ECG and cardiac enzyme blood work. If confirmed, treatment can be started promptly.

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What causes pain in the middle of the chest?

Middle chest pain can be a sign of: 

1. Excess gas

Excess intestinal gas is one of the most common causes of chest pain and can often by confused for an infarct. Being uncertain about what the pain is can cause anxiety, which worsens the pain, and contribute to the idea that it is, in fact, a heart attack. 

Pain caused by excess gas is commonly experienced in people with constipation, but it can also occur with other situations, like taking probiotics or fighting the urge to have a bowel movement. Learn more about the causes of gas accumulation in the intestines. 

Other symptoms: In addition to chest pain, you may also notice bloating or sharp abdominal pain. Read more about other common symptoms of gas

What to do: You can massage the abdomen to try releasing any accumulated gas in the intestines, and drink teas like fennel tea or cardamom tea, which help to absorb gas. Some medications, like simethicone, can help, but should be used as directed by a doctor. You can also check out these steps to getting rid of gas in addition to some natural home remedies.

2. Costochondritis

Sometimes, pain in the middle of the chest can occur due to inflammation of the cartilage that connect the ribs to the sternum (the bone in the middle of the chest). It is common for this pain to become stronger when squeezing the chest or when you are lying face down. 

Other symptoms: Feeling of a bruised chest and pain that worsens with palpation of the area, breathing or coughing. 

What to do: Apply a warm compress on your sternum to help relieve pain. Treatment should be done with anti-inflammatory medication, prescribed by a doctor. 

3. Heart attack

Although this is the first suspicion when chest pain is felt, heart attacks are not as common as believed to be and typically occur in people with risk factors like excess weight, high cholesterol or cardiovascular diseases like hypertension. 

Other symptoms: Normally, a heart attack will additionally cause cold sweats, nausea or vomiting, pallor, shortness of breath and a heavy left arm. The pain also tends to worsen with time, and starts off as a mild chest tightness. Understand the symptoms of a heart attack so that you can easily identify one. 

What to do: If you suspect you are having a heart attack, proceed immediately to the hospital or call 911. 

4. Gastritis

Gastritis is inflammation of the stomach and is one of the most common causes of middle chest pain. It is common for the pain to emerge from the upper stomach and stay in the middle of the chest. The pain may even radiate to the back. 

Gastritis is most frequent in people with poor eating habits, and it may also occur with stressful lifestyles, as excess worrying can alter stomach pH. 

Other symptoms: Gastritis usually causes a full stomach sensation, lack of appetite, heartburn and frequent burping. Read more about the symptoms of gastritis and complete our online quiz if you suspect you may have gastritis. 

What to do: To decrease stomach inflammation and relieve symptoms, you can drink water with a few drops of lemon or drink potato juice. Both of these methods help to increase stomach pH to reduce inflammation. Gastritis can also be caused by an H. pylori infection, in which case you should seek a consult with a gastroenterologist (especially if you pain persists for over 3 or 4 days). You may find these gastritis home remedies beneficial to complement your medical treatment. 

5. Gastric ulcers

In addition to gastritis, another common stomach problem that causes middle chest pain is a gastric ulcer. Generally, ulcers are a consequence of untreated gastritis that has injured the stomach lining and caused wounds.

Other symptoms: Ulcers cause a sharp pain that radiates to the back and chest. Other signs of an ulcer are frequent nausea, heavy stomach and vomiting, which may even contain small quantities of blood. Check out other common symptoms of ulcers

What to do: You should consult your doctor if you think you may have an ulcer. It may be necessary to start medications that reduce stomach acid and protect the stomach lining, like pantoprazole or lansoprazole. A light diet with easy-to-digest foods can help prevent worsening of the ulcer. See what foods are allowed and which should be avoided when treating an ulcer

6. Liver problems 

In addition to stomach problems, liver changes can also cause pain in the middle of the chest. Although liver pain is most felt in the right abdomen, below the ribs, it is also possible for this pain to radiate to the chest. 

Other symptoms: It is common to also experience constant nausea, weight loss, headache, dark urine and yellow skin or eyes. Read more about symptoms of liver disease that you should not ignore. 

What to do: If you suspect a liver problem, you should see your doctor for diagnosis and treatment as necessary. 

When to worry

You should seek medical attention if you suspect a heart attack or any cardiac problems. Although heart attacks are rare, you should go the emergency room for assessment regardless, as this is a very serious condition. 

If you don’t think your pain is related to a heart attack, but you experience it for over 2 days, you should see your doctor. A consult with your doctor is also advised if your pain is accompanied by: 

  • Vomiting with blood 
  • Arm tingling 
  • Yellow eyes and skin 
  • Difficulty breathing 

In addition, if you have risk factors like excess weight, high cholesterol or high blood pressure, and frequently experience middle chest pain, you should see your doctor for a follow-up. 

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Edited by Tua Saude editing team in January 2023. Medical review completed by Dr. Ana Luiza Lima - Cardiologist in May 2022.
Medical review:
Dr. Ana Luiza Lima
Cardiologist
Physician who studied Medicine at the UFPE in 2008 and specializes in Cardiology. Licensed to practice under licence #16886 of the CRM-PE, Brazil.