You already know that clogged coronary arteries, heart rhythm disorders and muscle strains can cause substernal chest pain, but there are causes you have no idea about.

Maybe you also already know that the following can cause substernal chest pain:

• Pneumonia and bronchitis
• Pulmonary embolism (blood clot in lung)
• Costochondritis (inflamed cartilage of the ribs)
• Heartburn, acid reflux, GERD (gastroesophageal reflux disease)
• Panic or anxiety attack

Here are lesser known causes
of substernal (behind the breastbone) chest pain.

Aortic Aneurysm

An aortic aneurysm is when the aorta (the body’s largest blood vessel) has a bulge.

Occasionally this can result in chest pain, says Dr. John A. Elefteriades, MD, William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.


  • Bone
  • Esophageal
  • Leukemia (acute promyelocytic)
  • Lung
  • Lymphoma (non-Hodgkin)
  • Pancreatic

Coronary Artery Spasm (Prinzmetal Angina)

“There is a syndrome called Prinzmetal’s angina (also called vasospasm),” explains Monica Reynolds, MD; cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.

“It is not very common and often hard to document,” continues Dr. Reynolds. “It is caused by vasospasm (contraction and narrowing) of the coronary arteries rather than atherosclerosis.  It occurs more in younger women.”

Esophageal Hypersensitivity

Esophageal Spasm

“Esophageal spasms can vary in duration,” says Steven Fleisher, MD, a gastroenterologist at MedStar Franklin Square Medical Center, Baltimore.

“Clinically important contractions need to persist for more than 6 seconds,” adds Dr. Fleisher.

Esophageal Ulcer 


“Esophagitis, inflammation of the esophagus, can cause severe chest pain,” notes gastroenterologist Larry Good, MD in practice for 41 years with a private practice in Lynbrook, NY. He is affiliated with Concierge Choice Physicians, a leading provider of personalized care in the U.S.

Hiatal Hernia 

Medications: Side Effects

Did you know that the insert for Rogaine (minoxidil), the hair regrowth drug, lists chest pain as a possible side effect?! Read the inserts of any medications (prescribed or OTC) to see if chest pain is listed as a potential side effect.

Obstructive Sleep Apnea

A paper in Mayo Clinic Proceedings (Loui et al, 1994) reports the case of three people with obstructive sleep apnea who had presented with angina type chest pain. The sleep apnea was the cause of this chest pain.

Sleep apnea is a condition in which breathing temporarily stops during sleep. It is highly treatable with a CPAP device.

If left untreated, sleep apnea can lead to heart disease (which of course often causes substernal chest pain), congestive heart failure, cardiac arrhythmia and high blood pressure.

Pancreatitis substernal

Sources substernal substernal