Tightness in chest? It could be related to fibromyalgia, heartburn, or even a rib-cage injury but should always be checked out for the possibility of a heart issue.

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It may be a classic heart-attack symptom, but pressure or discomfort or tightness in your chest doesn’t always accompany a heart attack. For some people, particularly women, pain in other places may be their main symptoms. For others, chest discomfort comes and goes—the result of a condition called angina, which indicates an elevated risk for heart attack. And in still other cases, tightness in chest may develop but have nothing to do with the heart.

Chest Pain Related to Heart Attack

When chest pain or pressure is related to the heart, it’s often caused by a condition known as atherosclerosis or a hardening of the arteries. Atherosclerosis usually develops when the arteries become narrowed by plaque buildup along the artery walls. Plaque is made up of waxy LDL cholesterol, cellular waste, fatty substances in your bloodstream, calcium, and fibrin, a substance that helps your blood clot.

Plaque can build up so much that it narrows the path for blood to flow through the artery. Circulation may actually stop altogether in that blood vessel or it may slow to a trickle, leaving tissue and organs downstream of that artery starved for oxygen-rich blood.

Plaque may also break off and form a blood clot that can block blood flow. When this happens in the brain, the result can be a stroke. When it happens in an artery within the heart, a heart attack can occur. An artery of the heart is called a coronary artery. So a person with atherosclerosis affecting a heart artery is said to have coronary artery disease (CAD). Sometimes, the term “coronary heart disease” is used interchangeably with CAD.

Understanding Angina Symptoms

When the heart muscle doesn’t get enough blood, it reacts much the same way as any muscle that stops getting blood. It hurts. The heart is a little more complicated than a leg or arm muscle, so the feelings can be tightness in your chest, or pressure, or a stabbing pain.

If reduced blood flow in a coronary artery causes pain when you exercise but subsides with rest, you may have stable angina. Usually, stable angina symptoms are the same each episode, and can be predicted based on your level of exertion.

A more dangerous type of angina is called unstable angina. Its symptoms may appear after exercise or at rest. Unstable angina episodes are difficult to predict and tend to last longer than those associated with stable angina. If you have unstable angina, you’re at a higher risk for a heart attack.

Some people have angina symptoms beyond just chest pressure. Other angina symptoms may include nausea, shortness of breath, sweating and pain or pressure in other parts of the body, such as the jaw, neck and back.

“Most people with chest pain due to heart disease will have pain accompanied by other problems like breathing difficulties, sweating, feeling sick to the stomach, etc.,” says Phillip A. Horwitz, MD, executive director of the University of Iowa Heart and Vascular Center.

Women and Heart Disease

Women in particular are more likely to have angina symptoms that include more than tightness in chest. Some of these same signs can also indicate a heart attack, so talk with your doctor about how you might distinguish between an episode of angina and an actual heart attack.

“Often, women don’t have the classic symptoms, such as pressure-like chest pain,” says Gary Schaer, MD, professor of cardiovascular medicine at Rush University Medical Center. “They more frequently experience dizziness, nausea or fatigue, and they may have chest pain that radiates to both arms instead of just the left arm, as is common in men.”

If you have been diagnosed with angina, you may have been prescribed nitrates, which are medications that help open up your arteries. They are typically taken when tightness in chest starts. If you have angina symptoms that don’t go away after several minutes, even after taking a nitrate or other angina medication, you may be having a heart attack. You or someone close to you should call 911, even if you’re unsure about whether a heart attack is actually occurring.

Other treatments for angina include stenting, a procedure in which thin, flexible mesh tubes are placed in narrowed arteries to help improve circulation.

When Tightness in Your Chest Isn’t a Heart Attack

Feelings of tightness in chest muscles or anywhere in the upper body may be caused by health issues unrelated to the heart. Heartburn, which occurs when stomach acid moves up into the esophagus, can cause great discomfort right in the middle of your chest. A swallowing problem related to Parkinson’s disease or some other cause, can also cause pain in the chest.

Muscle-related conditions such as fibromyalgia may trigger chest pain. Rib-cage injuries or strained pectoral muscles may also trigger tightness in chest.

Of course, respiratory problems can also cause tightness or discomfort in your lungs. A blood clot in your lung can be a painful and life-threatening condition.

And, if you’re prone to panic attacks and serious anxiety problems, chest discomfort and difficulty breathing can be common symptoms.

Take Tightness in Chest Seriously

The bottom line is that pain or tightness in chest feelings aren’t normal. They can be signs of serious health problems that you simply can’t ignore.

If you experience chest pain, even if you feel it’s just from exertion or “overdoing it a little,” you should tell your doctor. Be ready to describe the feelings as accurately as you can (sharp, achy, pressure, etc.) as well as what seems to bring on those feelings, how long they last and what, if anything, helps them go away.

The diagnosis may be a very manageable condition. But you won’t know until you get your tightness in chest checked out.

Originally published in 2016 and updated.