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 a 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.


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

Coronary Artery Spasm (Prinzmetal Angina)

Esophageal Issues

Hiatal Hernia 

Side Effects of Medications

“All these problems are potential common causes of chest (substernal) pain,” says Morton Tavel, MD, Clinical Professor Emeritus of Medicine, Indiana University School of Medicine, and author of “Health Tips, Myths and Tricks: A Physician’s Advice.”

Dr. Tavel explains, “Each tends to have typical features that allows the physician to proceed with appropriate testing and treatment options.

“To review each of these would require a lengthy discussion, far beyond the scope of a brief Q and A session.”

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.

Dr. Tavel’s medical research includes over 125 publications, editorials and book reviews in peer-reviewed national medical journals. He was formerly director of the cardiac rehabilitation program at St. Vincent Hospital in Indiana.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.


Top image: Shutterstock/Seksan 99