Burning Chest Pain: Heartburn or Something More Serious?

What a burning feeling in the chest means

Burning is a description of the quality of pain, and several organs can produce it. The esophagus (food pipe) is the usual source, because its lining is sensitive to acid. The heart can also produce a burning or heavy discomfort when its muscle is short of oxygen, and some people, particularly women, older adults and people with diabetes, describe angina as burning or indigestion-like. Nerves and skin produce burning when irritated, as in shingles.

Because the heart and esophagus share nerve pathways, the brain cannot always tell which one is hurting. That is why doctors take any new burning chest pain seriously until a heart cause has been considered.

Can burning chest pain be heart-related?

Yes. A burning sensation does not rule out the heart. Clues that point toward the heart rather than reflux:

No single clue is reliable. Antacids sometimes appear to help heart pain because the pain eases on its own. If you are unsure, get checked.

Causes of burning chest pain

Digestive causes

• Heartburn and GERD: stomach acid washes up into the esophagus. It causes burning behind the breastbone that rises toward the throat, a sour or bitter taste, and is worse after large meals, alcohol, coffee, chocolate, fatty food and lying down.
• Esophagitis: an inflamed esophagus from reflux, pills (such as doxycycline, NSAIDs and bisphosphonates swallowed without enough water), infection or allergy (eosinophilic esophagitis). Swallowing may hurt.
• Peptic ulcer and gastritis: burning in the upper belly that can reach the lower chest, often relieved or worsened by eating.
• Esophageal spasm: squeezing or burning pain that mimics angina, sometimes triggered by very hot or cold drinks.

Heart and blood vessel causes

• Angina: pressure, tightness or burning with exertion that eases with rest, caused by narrowed coronary arteries.
• Heart attack: similar pain lasting longer than a few minutes or occurring at rest, often with sweating and breathlessness.
• Pericarditis: sharp or burning pain that worsens lying flat and improves leaning forward.
• Aortic dissection: sudden, severe tearing pain into the back. Rare but life-threatening.

Lung causes

• Chest infections and bronchitis: a raw, burning feeling behind the breastbone with coughing.
• Pulmonary embolism: chest pain with sudden breathlessness, often sharp and worse breathing in.
• Irritant inhalation: smoke or chemical fumes burn the airways.

Nerve, skin and chest wall causes

• Shingles: burning, tingling or stabbing pain in a band around one side of the chest, followed in a few days by a blistering rash.
• Costochondritis: tenderness where the ribs join the breastbone. Pressing on the spot reproduces the pain.
• Muscle strain after coughing, lifting or exercise.

Anxiety and panic

A panic attack can cause burning or tight chest pain with a racing heart, trembling, tingling and fast breathing. It peaks within about 10 minutes. Panic is a diagnosis made after heart causes are excluded, not before.

What a warm burning feeling in the chest may be

A warm or hot sensation rather than true pain is usually reflux, a hot drink or food, anxiety (a surge of adrenaline causes a flush of warmth) or hot flashes in perimenopause. Warmth that spreads across the chest with palpitations or breathlessness should still be checked, particularly if it is new.

How doctors find the cause

In an ER or urgent setting the first step is to exclude a heart attack:

• ECG within 10 minutes of arrival
• Troponin blood tests, often repeated over a few hours
• Chest X-ray and sometimes a CT scan

If the heart is not the cause, or symptoms are long-standing:

• A trial of acid-suppressing medicine for classic reflux symptoms
• Upper endoscopy for alarm features: difficulty swallowing, weight loss, vomiting, bleeding, anemia, age over 60 with new symptoms, or no response to treatment
• pH monitoring to measure acid exposure when the diagnosis is unclear
• Stress testing or coronary CT when angina is possible

Treatment and home care

Treatment depends on the cause. For heartburn:

• Eat smaller meals and stop eating 2 to 3 hours before bed.
• Raise the head of the bed by 15 to 20 cm (6 to 8 in).
• Cut down on alcohol, coffee, chocolate, fatty food and peppermint if they trigger symptoms.
• Stop smoking and lose weight if overweight; both reduce reflux.
• Antacids give fast relief. H2 blockers (famotidine) and proton pump inhibitors (omeprazole, esomeprazole) reduce acid for longer. Follow the label dose and see a doctor if you need them for more than 2 weeks.

Heart causes need medical treatment. Shingles responds best to antiviral medicine started within 72 hours of the rash. Chest wall pain eases with rest, heat and simple pain relief.

Frequently asked questions

Can a burning chest pain be a heart attack?

Yes. Heart attacks can feel like burning or indigestion, especially in women, older adults and people with diabetes. Burning that comes with exertion, lasts more than a few minutes, or comes with sweating, breathlessness, nausea or pain in the arm or jaw needs emergency care. Call 911 or your local emergency number.

What does a warm burning feeling in the chest mean?

Most often it is acid reflux, especially after eating or lying down. Anxiety, hot flashes and hot drinks can also cause warmth in the chest. A new warm or burning sensation with palpitations, breathlessness or exertion should be checked by a doctor.

How do I know if chest burning is heartburn?

Heartburn usually follows meals or lying down, rises toward the throat, causes a sour taste and eases with antacids or sitting up. If burning comes on with exercise, spreads to the arm or jaw, or comes with sweating or breathlessness, treat it as possible heart pain.

Why does my chest burn when I cough?

Coughing irritates an inflamed windpipe and bronchi, causing a raw, burning feeling behind the breastbone. This is common with colds, flu and bronchitis. See a doctor if you have a high fever, breathlessness, blood in your sputum, or symptoms lasting more than 3 weeks.

Can anxiety cause burning in the chest?

Yes. Anxiety and panic attacks can cause burning or tightness in the chest, along with a racing heart, fast breathing and tingling. Anxiety can also worsen reflux. Because these symptoms overlap with heart problems, new chest pain should be checked before it is attributed to anxiety.