Non-cardiac chest pain: Causes, triggers, and what to do when it’s not your heart

When your chest hurts, your first thought is usually non-cardiac chest pain, chest discomfort that mimics heart problems but stems from other sources like the esophagus, muscles, or nerves. It’s known as non-cardiac chest pain, and it’s far more common than most people realize—up to 50% of chest pain visits to emergency rooms turn out to be something other than a heart issue. The good news? It’s rarely life-threatening. The bad news? It can feel exactly like a heart attack—tightness, pressure, burning, even pain shooting into your arm or jaw. That’s why so many people end up in the ER, only to walk out with a diagnosis of acid reflux or a strained muscle.

Most cases of non-cardiac chest pain come from three main sources. The biggest culprit is GERD, gastroesophageal reflux disease, where stomach acid backs up into the esophagus and triggers burning pain behind the breastbone. It often happens after meals, when lying down, or after eating spicy or fatty foods. Then there’s esophageal spasm, a condition where the muscles of the esophagus contract abnormally, causing sudden, severe chest tightness that can last minutes. It’s rare but intense, and it’s often mistaken for heart trouble. And don’t overlook musculoskeletal chest pain, pain from inflamed ribs, strained chest muscles, or even a pinched nerve in the neck or spine. A simple twist, heavy lifting, or even coughing hard can trigger it.

It’s not always physical, either. Anxiety and panic attacks can cause chest tightness, rapid breathing, and a racing heart—all symptoms that mirror cardiac events. The body doesn’t distinguish between a real threat and a perceived one. If you’ve been under stress, sleep-deprived, or dealing with chronic worry, your chest pain might be your nervous system sounding the alarm.

What you won’t find in most guides is how often these conditions overlap. Someone with GERD might also have a tight upper back from sitting at a desk all day. Someone with anxiety might also be drinking too much coffee, which worsens both heartburn and panic. That’s why treating just one piece rarely fixes the whole puzzle. The right answer often involves looking at diet, posture, stress levels, and even medication side effects—all things that show up in the posts below.

Below, you’ll find real-world breakdowns of treatments that actually work—like how certain antidepressants help with nerve-related chest pain, why some beta-blockers are safer than others if you have chest tightness from anxiety, and what over-the-counter remedies help or hurt. No fluff. No guesswork. Just what’s backed by evidence and what people are actually using to feel better.