Substernal chest pain

Substernal chest pain is characterized as intense pain beneath the sternal bone. There are various contributing factors where some are serious such as myocardial infarction, pulmonary embolism and atrial fibrillation.

What are the possible causes?

  • Stable and unstable angina pectoris
  • Myocardial infarction
  • Acute coronary syndrome
  • Atrial fibrillation
  • Aortic dissection
  • Pulmonary embolism
    Substernal chest pain

    Pain is aggravated by coughing or breathing.

Characteristics of substernal chest pain

Remember that it might be difficult to differentiate between chest pain from a heart condition and one from another cause. Some of the associated symptoms that can be used to determine that the chest pain is not likely due to a heart issue include the following:

  • Sour taste in the mouth or feeling of regurgitation in which swallowed food reenters the mouth
  • Difficulty with swallowing
  • Quality of pain changes if the position is altered, either better or worse.
  • Pain is aggravated by coughing or breathing
  • Chest tenderness during deep palpation
  • Indications of heartburn accompanied by a burning feeling at the back of the breastbone


The care for substernal chest pain is based on the underlying reason. The pain is usually managed using medications.

  • Artery relaxing medications – these are given in cases where the arteries become constricted. They allow the arteries to relax and function normally. One example is nitroglycerin which is given sublingually.
  • Blood thinners – these medications are given if there is an identified clot in the artery that disrupts with the blood flow.
  • Cardiac-related medications – if the chest pain is due to a heart issue, aspirin is usually prescribed by the doctor.
  • Clot-dissolving medications – these medications are given if the individual is experiencing a heart attack or if there is a blood clot.
  • Acid-suppressing medications – these are given if there is substernal chest pain due to surplus formation of stomach acid. The medication works by lowering the production of stomach acid as well as help relieve the pain.
  • Antidepressants – in cases where there is no heart-related cause or other conditions, the substernal chest pain might be due to anxiety or panic attack. These medications are given to relieve the symptoms.

More Information / Disclaimer

The information posted on this page on substernal chest pain is for learning purposes only. Learn to recognize and manage circulatory conditions by taking a standard first aid course with Kelowna First Aid.