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Heart Pain: Symptoms & Causes

by Josephine Andrews
Published: Last Updated on 451 views

Pulling or stabbing pain in the heart area initially feels very threatening. In most cases, however, they are harmless because the heart is rarely the cause. Read here what heart pain feels like and what causes it!

quick overview

  • Description: Dull or stabbing pain in the region of the heart just behind the breastbone (between the second and fifth ribs)
  • Causes: There are different triggers for heart pain, rarely the heart itself is the cause.
  • When to the doctor? Heart pain should always be checked out by a doctor. Call an ambulance if the pain is severe and lasts for several minutes!
  • Treatment: Treatment of the underlying disease, in the case of a psychological cause eg behavioral therapy
  • Diagnostics: Physical examination, ECG , heart ultrasound, X- ray , angiography, lung examination, blood test, diagnostics by a psychotherapist
  • Prevention: Healthy lifestyle


The heart is at the level of the second to fifth ribs, just behind the breastbone. It is not in the middle of the chest, but is slightly offset to the left. Many people perceive pain in the immediate area of ​​the heart as heart pain (medical: cardiac pain, cardiac pain). But they don’t necessarily come from the heart. Stress, tension or diseases of the lungs or the gastrointestinal tract can also cause stinging in the heart area. Where the pain actually comes from is often difficult to pinpoint.

What does heartache feel like?

Pain that occurs in close proximity to the heart is extremely distressing for sufferers. The symptoms range from a slight tugging in the heart area to a stabbing pain to very severe pain in combination with feelings of anxiety, nausea and shortness of breath (pain of annihilation). Many sufferers also describe a dull feeling of pressure behind the breastbone.

In most cases, heart pain is harmless, but it can also be a sign of a life-threatening situation!

Causes and risk factors

Heart pain usually has no recognizable cause, the heart itself is only very rarely the trigger.

mental causes

Most often, the cause of heart pain lies in the psyche, doctors speak of “functional heart pain” (also “nervous heart pain”). Triggers are usually unresolved inner conflicts and psychological stress.

The so-called “ cardiac neurosis ” (cardiophobia) is a clinical picture in which people live in constant fear of suffering a heart attack. Physically, they are perfectly healthy.

Those affected get caught in a vicious circle: the fear of a heart attack causes the body to release stress hormones. These cause blood pressure and heart rate to rise. Those affected misinterpret the body’s reaction as a harbinger of a heart attack, which in turn increases the fear.

Heart pain is sometimes associated with depression, anxiety, or panic disorders. Lovesickness can also literally cause heartache.

Broken Heart Syndrome is a special form of psychological heart pain . It mainly affects women. Severe emotional stress triggers symptoms similar to those of a heart attack. The vessels that lead to the heart muscle are not clogged, but cramp – presumably due to the constant influence of stress hormones. As a result, the heart muscle is no longer supplied with sufficient oxygen, similar to a heart attack.

Physical causes of heart pain

Heart palpitations that occur at rest, i.e. independent of physical exertion, are usually the result of tension or an unfavorable lifestyle (nicotine, alcohol, drugs, lack of sleep, lack of exercise).

Possible causes for this include:

  • Overload and incorrect loading after physical activity (muscle tension, sore muscles)
  • Back or spine problems (deformities, herniated disc; pain lessens when adopting a different posture)
  • Broken ribs or sternum
  • Intercostal neuralgia (nerve pain along the intercostal nerves; pain increases with coughing and laughing)

If the heart pain occurs during physical exertion, however, there is a suspicion of heart disease. Particular caution is required if the pain occurs in fits and starts, is very severe and radiates into the arm or shoulder. The symptoms are an indication of angina pectoris , which if left untreated can lead to a heart attack.

Signs of angina pectoris:

  • pain behind the breastbone
  • palpitations, palpitations
  • tightness in the chest
  • Dizziness, nausea, shortness of breath
  • sweating
  • Feelings of oppression, fear, fear of death

In women, an impending heart attack often manifests itself through non-specific symptoms such as nausea, pain in the upper abdomen and shortness of breath. Attacks of severe heart pain, which typically occur in men, may be completely absent!

Examples of other heart conditions that may cause heart pain include:

In some cases, heart pain is caused by lung disease radiating to the area around the heart. It is characteristic that the stinging in the heart increases when breathing (in) or coughing.

Examples of possible lung diseases are:

pulmonary embolism

  • lung infection
  • bronchitis
  • tuberculosis
  • pneumothorax
  • COPD
  • lung tumors
  • bronchial asthma
  • pleural effusion
  • Inflammation of the middle lining (mediastinitis)

Due to the local proximity, diseases of the gastrointestinal tract also trigger (supposed) heart pain. The following diseases can be considered as triggers:

  • Heartburn (reflux disease): It is typical that the pain occurs mainly at night or when lying down. In a horizontal position, stomach acid rises more easily into the esophagus , causing pain.
  • inflammation of the esophagus
  • Inflammation of the stomach lining (gastritis)
  • gallstones, biliary colic

heart pain in children

Heart pain in children is usually harmless because its cause is usually not in the heart. Much more frequently, it is complaints in the immediate vicinity of the heart that are interpreted by children as heart pain.

Possible causes are:

Inflammation of the costal cartilages (costochondritis): The costal cartilages connect the ribs to the breastbone. If this area becomes inflamed, there is mostly one-sided – more left-heavy – pain along the breastbone. The pain lasts seconds or minutes, affected children sometimes breathe very deeply. The cause of the inflammation is usually carrying heavy backpacks or school bags on one side.

Tietze syndrome: Tietze syndrome manifests itself in a manner similar to costochondritis, but is much less common. Typical of this is pain along the breastbone, and the affected area is also swollen and warm. Older teenagers and young adults are mainly affected, the cause is unknown.

Pinching in front of the heart (precordial pain): Precordial pain is a pinching sensation between the ribs that is often misinterpreted as a pinching heart. It appears and disappears suddenly and occurs at rest or with slight exertion. Typically, the pain worsens when the child breathes.

Sliding rib syndrome: Ribs eight through eleven are connected by connective tissue rather than cartilage. If this connection is weakened, for example by a fall or a blow, the ribs slip and pain occurs.

Heart disease: Examples of heart diseases that occur in childhood and can cause heart pain include cardiomyopathy , aortic stenosis, coronary artery abnormalities and pericarditis . However, they are very rare in children.

Heart pain that occurs when the child is physically active is a possible sign of heart disease. It is best to consult your pediatrician!

Lung disorders: Examples include pneumothorax, pulmonary embolism, inhalation of foreign objects, and severe cough associated with bronchitis. Heart pain that occurs simultaneously with shortness of breath and a chronic cough can be an indication of childhood asthma.

Risk factors for heart pain

People who lead an unhealthy lifestyle generally have a higher risk of cardiovascular disease.

Risk factors include:

  • overweight
  • Unhealthy diet (eg, lots of meat, fat , and sugar; low in vegetables, fruit, and fiber such as whole grains)
  • Excessive nicotine and/or alcohol consumption
  • lack of exercise
  • constant stress

When to the doctor?

Anyone who feels heart pain should have the cause clarified by a doctor. In most cases, the pain is harmless and goes away on its own. But especially if heart pain occurs repeatedly during or after exercise, those affected should not hesitate to seek medical advice.

If the pain is very severe and lasts several minutes, the emergency doctor must be called immediately. Additional symptoms such as sweating, tightness in the chest, shortness of breath and a strong feeling of anxiety indicate an impending heart attack. This applies in particular if you have previous illnesses such as coronary heart disease or if you have had a heart attack in the past.


In most cases, heart pain is harmless, only rarely is a serious heart disease behind it. It is all the more important that a doctor clarifies the cause of the pain. The first point of contact is usually the general practitioner. He carries out initial investigations and – if necessary – initiates further steps. The doctor who specializes in heart disease is the cardiologist. If the heart pain is psychological, a psychotherapist will take care of the further diagnosis.

First, the doctor clarifies whether it is a medical emergency. If there is a suspicion of an imminent heart attack, the patient is immediately taken to a hospital and treated in intensive care.

If there is no emergency, the doctor will carry out various tests to determine the cause of the heart pain.

First, the doctor asks about the medical history (anamnesis), he asks the following questions, among others:

  • How long have you had heart pain?
  • How does the pain feel (dull, stabbing, chest tightness)?
  • Does it radiate to other parts of the body?
  • Have you ever had heart pain before?
  • Was there a triggering event or are there specific situations in which the pain recurs, such as during exercise or at night?
  • Has the pain changed? Has he gotten stronger?
  • Do you have a family background? Do you know of any family members who suffer/have suffered from heart pain?
  • Do you have previous illnesses (cardiovascular diseases or others) and if so, are they being treated?
  • Are you currently taking any medication? If so, which ones and in what dosage?
  • Do you have a diagnosed allergy?
  • Do you smoke? Do you drink alcohol? Do you exercise regularly?
  • Do you suffer from stress in everyday life?

A detailed physical examination follows. The doctor listens to the heart and lungs with a stethoscope, measures the pulse and blood pressure and thus gets an initial impression of the patient’s condition.

If this first examination indicates an organic disease as the cause of the heart problems, the doctor will carry out further examinations.

These include:

  • Electrocardiogram (ECG)
  • Ultrasound examination of the heart (echocardiography, heart echo) and possibly the carotid arteries
  • Display of the coronary vessels (coronary angiography)
  • Laboratory tests: including determination of troponin , a protein compound that is increasingly released when the heart muscle is damaged
  • pulmonary function test
  • Examination of the spine and muscles

If no physical triggers of the pain can be identified, the suspicion of “psychogenic cardiac pain” is obvious. In this case, the doctor will refer the patient to a psychotherapist if requested. He takes over the further diagnosis and initiates an appropriate therapy.

What to do with heart pain

How heart pain is treated depends on its cause. If there is a disease of the heart, the doctor treats it with appropriate medication. In rare cases, surgical interventions are necessary to eliminate the cause of the pain. An example of this is the setting of a bypass if a coronary artery is blocked during a heart attack.

Muscle tension is treated with massage, acupuncture and relaxation techniques ( e.g. Jacobson ’s progressive muscle relaxation ). Autogenic training and breathing exercises may also help reduce heart pain.

The psychotherapist treats psychologically caused heart pain with behavioral therapy. The patient learns that the heart itself is not the cause of his symptoms and how to face his fears. The aim is to break the cycle of fear and pain.

Home remedies for heart pain

Heart pain caused by physical illnesses require conventional medical therapy. Supportive naturopathic treatments are possible.

  • Hawthorn: promotes cardiac blood flow and increases cardiac output
  • Ginkgo : improves blood circulation
  • Buckwheat : promotes blood circulation in the smallest blood vessels ( capillaries )
  • lily of the valley
  • Adonis herb
  • Valerian and St. John’s wort: have a calming and sleep-inducing effect

Home remedies can at best complement conventional medical treatment, but cannot replace it. Also, do not take any supplements on your own for heart pain. Talk to your doctor about which remedies are best for you.


Since heart pain can have various causes, it can only be prevented to a limited extent. In any case, a healthy lifestyle that significantly reduces the risk of cardiovascular disease is helpful:

  • Eat a healthy and balanced diet.
  • Avoid alcohol and nicotine.
  • Exercise regularly.
  • Stay active even if you have heart disease! Have regular check-ups with the cardiologist and take the prescribed medication carefully.
  • Reduce stress.

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