Sharp chest pains — Heart attack? Stress? Heartburn?

Dear Alice,

For the past year now, I have been getting sharp chest pains. Sometimes it feels like I am about to have a heart attack. I find it painful to breathe for the couple of seconds that it happens. The sharp pains occur mostly in the lung/heart area. However, I have also felt them in the lower chest area as well. I don't know what is causing this.

Also, it occurs most frequently during the school year. I should also note that during the school year, I tend to eat greasy fatty foods. However, I had my cholesterol level checked (95) which is low. These pains come any time of day, while I am sleeping, walking, sitting, etc. I am 21-year-old female, if that helps.

By the way, I have a doctor's appointment back home later this month. But I want to have an idea why this happening. Others mentioned to me things about stress, something about a dog's heart, and I was even thinking that it might be cancer.


Dear Worried,

The good news for you is that in most healthy young people, chest pain is not caused by the heart. There are many conditions that can cause sharp chest pains, heart attack being just one of them. Because you noted that the pains occur most frequently during a stressful times of year (school) when you're eating a less-than-ideal diet, the culprit of your pains may be heartburn or some similar gastric upset triggered by stress and greasy food.

It might put your mind at ease to be able to distinguish between symptoms of a heart attack and symptoms of other conditions like heartburn or anxiety. A heart attack is usually marked by a feeling of pressure, tightening, or crushing pain in the center of the chest, and that pain spreads to the back, neck, jaw, shoulders, and arms — especially the left arm. Heart attack is also usually accompanied by shortness of breath, sweating, dizziness, and nausea.

In contrast, heartburn feels like a burning or a sharp pain in the chest, upper abdomen, or neck. It can also feel like there's food stuck in your throat. Heartburn usually occurs when a person is stressed out, lays down after a heavy meal, eats especially fatty or greasy foods, or eats too much too quickly. In these cases, stomach acid backs up in the esophagus causing a burning or painful feeling. Frequent heartburn may indicate the presence of gastroesophageal reflux disease known as reflux or GERD. If you think your pain may be associated with heartburn, you can try to avoid lying on your back after heavy meals, exercising after eating, and eating overly greasy and fatty foods, or try taking antacid medication to see if the chest pains abate.

Anxiety and panic attacks can also produce chest pain, sweating, and shortness of the breath, all of which mimic a heart attack. Stress can also trigger heartburn. Stress-management tools or relaxation exercises (a search for either of these terms in the Go Ask Alice! archives will likely turn up useful results) might be useful if you think stress could be contributing to your situation.

Because non-cardiac chest pain can be hard to distinguish from a more serious heart condition, it's a good idea to go to make an appointment with a health care provider who can more specifically and accurately diagnose your condition. He or she can prescribe medication and discuss lifestyle changes that could significantly reduce recurrence of these distressing symptoms.

Don't hesitate to make your appointment sooner if you feel any of your symptoms are consistent with heart problems and call for emergency help if you feel the situation warrants. In the meantime, you might try some of the ideas suggested here. Hopefully this arms you with info for your appointment and soothes your worry,

Last updated Mar 23, 2015
Originally published Oct 01, 1993

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