Back pain with chest pain can come from a strained muscle, the spine, reflux or the gallbladder, but it is also a classic sign of three emergencies: heart attack, aortic dissection and a blood clot in the lungs. Sudden, severe, tearing or pressure-like pain in the chest and back, especially with breathlessness or sweating, needs 911.
Medically reviewed by
Board-certified cardiologist · Katy & Sugar Land, TX
Fellowship-trained in cardiovascular disease, interventional cardiology, echocardiography and advanced heart failure and transplant cardiology. Former Assistant Professor of Cardiology at McGovern Medical School.
Why does my back hurt with chest pain?
The chest and upper back share many of the same nerves. Pain from the heart, the aorta, the lungs, the esophagus and the upper abdomen can all be felt between the shoulder blades, and pain from the spine or rib joints can wrap around to the front of the chest. That makes the combination of chest and back pain one of the trickiest symptoms to sort out without testing.
| Possible cause | Typical features | Urgency |
|---|---|---|
| Heart attack | Pressure or squeezing in the chest that spreads to the back, arm, jaw or neck; sweating, nausea, breathlessness | Emergency: call 911 |
| Aortic dissection | Sudden, severe tearing or ripping pain in the chest that shoots to the back between the shoulder blades | Emergency: call 911 |
| Pulmonary embolism | Sharp pain worse with breathing, sudden breathlessness, fast heartbeat, sometimes a swollen leg | Emergency: call 911 |
| Pericarditis | Sharp chest pain that may reach the shoulder or upper back, worse lying flat, better leaning forward | Same-day medical care |
| Gallbladder or pancreas | Upper abdominal pain spreading to the back or right shoulder blade, often after fatty meals; nausea | Urgent care or ER if severe |
| Acid reflux or esophageal spasm | Burning or squeezing behind the breastbone, sometimes felt in the back | See a doctor |
| Muscle strain or spine | Aching or sharp pain worse with certain movements, posture or pressing on the area | See a doctor if it persists |
| Shingles | Burning, band-like pain on one side, followed by a rash | See a doctor promptly |
- Sudden, severe, tearing or ripping pain in the chest or back
- Chest pressure or squeezing lasting more than a few minutes
- Shortness of breath, cold sweat, nausea or lightheadedness
- Fainting, weakness or numbness on one side, or trouble speaking
- Coughing up blood or a racing heartbeat with sharp breathing pain
Heart attack and back pain
Back pain is a well-recognized heart attack symptom. The National Heart, Lung, and Blood Institute lists pain or discomfort in the back, along with the jaw, neck, arms, shoulders and upper stomach, among heart attack warning signs. Women are more likely than men to notice upper back pain, shortness of breath, nausea and unusual fatigue, sometimes with only mild chest discomfort. Read more about heart attack symptoms in women.
Back or chest discomfort that appears with walking or stairs and settles with rest can also be angina, an early warning that coronary arteries are narrowed.
Aortic dissection: tearing pain between the shoulder blades
The aorta is the large artery that carries blood from the heart to the body. In an aortic dissection, the inner layer tears and blood forces its way between the layers of the wall. People often describe a sudden, severe, sharp, tearing or ripping pain in the chest that moves to the back between the shoulder blades. It may come with fainting, weakness on one side, or a big difference in blood pressure between the arms.
Dissection is uncommon but life-threatening, and it is treated very differently from a heart attack. Long-standing high blood pressure is the most important risk factor. Others include a known aortic aneurysm, certain inherited connective tissue disorders, a bicuspid aortic valve and stimulant drug use. Keeping blood pressure controlled with help from a blood pressure specialist lowers the risk.
Upper back pain and chest pain from other causes
Lungs. A blood clot in the lungs, pneumonia or inflammation of the lung lining (pleurisy) can cause sharp pain in the chest and back that worsens with breathing or coughing.
Pericarditis. Inflammation of the sac around the heart causes sharp chest pain that may reach the shoulders or upper back. It typically improves when sitting up and leaning forward. An echocardiogram checks for fluid around the heart.
Digestive organs. Gallbladder pain often spreads to the right shoulder blade, while pancreatitis can bore straight through to the back. Reflux and esophageal spasm can be felt behind the breastbone and in the back.
Muscles, ribs and spine. Poor posture, lifting, a twisted rib joint or a pinched nerve in the upper spine can cause pain that wraps from the back to the chest. This pain usually changes with movement or position and can be tender to touch.
How doctors diagnose chest and back pain
The first priority is ruling out emergencies. Depending on your symptoms, testing may include:
- An EKG and troponin blood tests for heart muscle injury.
- Blood pressure in both arms and a chest X-ray.
- CT angiography of the chest when aortic dissection or a lung clot is a concern.
- An echocardiogram to check heart function, valves, the aorta’s root and the heart lining.
- Stress testing if pain appears with exertion.
- Abdominal ultrasound, spine imaging or other tests when the heart and aorta look normal.
Treatment depends on the cause
Heart attacks are treated with medications and, often, angioplasty and stenting to reopen the blocked artery. Aortic dissection may need emergency surgery or strict blood pressure control. Pericarditis usually responds to anti-inflammatory medicines. Muscle and spine pain often improves with rest, heat, gentle stretching, posture changes and physical therapy. Treating the right cause starts with the right diagnosis.
Chest and back pain evaluation in Katy and Sugar Land
Once emergencies have been ruled out, Advanced Cardiology can help find the cause of recurring chest and back pain. Dr. Khalid evaluates the heart and aorta, blood pressure and risk factors, with EKG and echocardiogram testing available in the office. Learn more about our chest pain care.
Katy office: 410 W Grand Pkwy S, Suite 4D, Katy, TX 77494
Sugar Land office: 7102 Tarrington Ave, Suite 505, Sugar Land, TX 77479
Phone: (713) 258-6111
We also see patients from Fulshear, Richmond, Rosenberg, Stafford, Missouri City and west Houston.
Recurring chest and back pain? Get your heart checked
If symptoms have settled but keep coming back, request a visit with a cardiologist in Katy or Sugar Land.
Having symptoms right now? Call 911. Do not wait for an appointment.
Frequently asked questions
Is back pain with chest pain a sign of a heart attack?
It can be. Heart attack pain often spreads from the chest to the back, arms, jaw or neck, especially in women. Chest and back pain with pressure, sweating, nausea or breathlessness needs 911.
What does it mean when your chest and back hurt at the same time?
Causes range from muscle strain and reflux to heart attack, aortic dissection, pulmonary embolism, pericarditis and gallbladder disease. Sudden or severe pain should be treated as an emergency until a doctor rules out serious causes.
What does aortic dissection pain feel like?
It is usually sudden and severe, often described as tearing or ripping, starting in the chest and moving to the back between the shoulder blades. It is a medical emergency.
Can a pulled muscle cause chest and back pain?
Yes. Muscle strain, rib joint irritation and upper spine problems can cause pain in both areas. This pain usually changes with movement, posture or pressure on the spot. Pain without a clear injury, or with other symptoms, should be checked.
Can acid reflux cause chest and back pain?
Reflux and esophageal spasm can cause burning or squeezing pain behind the breastbone that some people also feel in the upper back. Heart causes should be ruled out first if the pain is new.
What is pain between the shoulder blades a sign of?
It is most often muscular, but it can also signal a heart attack, aortic dissection, gallbladder disease or lung problems. Sudden, severe pain or pain with chest symptoms needs urgent care.
When should I see a cardiologist for chest and back pain?
See a cardiologist if chest and back pain comes with exertion, you have high blood pressure or other heart risk factors, or ER tests were normal but symptoms continue.
Trusted health resources
- Heart Attack: Symptoms, National Heart, Lung, and Blood Institute (NIH)
- Aortic dissection, MedlinePlus Medical Encyclopedia
- Venous Thromboembolism, National Heart, Lung, and Blood Institute (NIH)
- Pericarditis, MedlinePlus Medical Encyclopedia
- Gallstones, MedlinePlus, U.S. National Library of Medicine
Medical disclaimer: This article is for general education and is not a diagnosis or a substitute for care from your own doctor. If you think you may be having a heart attack, stroke or another emergency, call 911 right away.
