Retrosternal means behind the breastbone, or sternum. Retrosternal chest pain, therefore, is a pain that occurs inside the chest.

Although it’s likely that pain behind the breastbone relates to the organs located there, such as the heart and esophagus, sometimes the pain originates elsewhere but is felt in this area.

In most cases, retrosternal chest pain falls into four primary areas:

  • gastrointestinal, or relating to the stomach and intestines
  • cardiovascular, or relating to the heart and blood vessels
  • respiratory, or relating to organs used for breathing
  • tumoral, or relating to an abnormal growth of tissue

Retrosternal chest pain can be a symptom of many conditions affecting the upper stomach and esophagus.

Acid reflux

When acid from your stomach moves up into your esophagus, it can cause a burning pain in your chest. Acid reflux is typically treated with diet and lifestyle changes combined with over-the-counter (OTC) antacids like Alka-Seltzer, Maalox, Mylanta, Rolaids, or Tums.

Gastroesophageal reflux disease (GERD)

GERD is a more severe and chronic form of acid reflux and is treated the same way. In some cases, prescription medication and even surgery are necessary treatments for GERD.

Esophagitis

Esophagitis is a potentially damaging inflammation of the esophagus. It’s typically caused by acid reflux, infections, or allergies. Treatment for esophagitis is based on the underlying cause and the amount of tissue damage already sustained.

Esophageal ulcer

An esophageal ulcer is often caused by erosion of tissue in the esophagus. Acid reflux and bacterial infection of the stomach (like Helicobacter pylori) can cause this damage.

Treatment often includes OTC medications such as Pepcid or Zantac, but your doctor might prescribe:

Retrosternal chest pain can be a symptom of a condition affecting the heart and major blood vessels such as:

Angina

Angina is chest discomfort triggered by a reduced flow of oxygen-rich blood to the heart. Angina can be treated with lifestyle changes and medication. Sometimes — if the medications are not effective — surgery such as angioplasty or bypass surgery is recommended.

Myocardial infarction

A myocardial infarction is a heart attack caused by damage to the heart muscle from a decrease or full stop of blood flow to part of the heart. Heart attacks are often treated with angioplasty or a coronary artery bypass graft (CABG) and medications such as:

Pericarditis

Pericarditis is inflammation of the pericardium, or tissue that surrounds the heart. Typical treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs). If necessary, your doctor might suggest steroids. Antibiotics could be prescribed if the pericarditis is caused by infection. If the pericarditis is chronic, colchicine (Colcrys) could be prescribed.

Pulmonary embolism

Pulmonary embolism is a blockage — such as a blood clot — in one of the pulmonary arteries in your lungs. Typical treatment for pulmonary embolism includes anticoagulation medication like:

  • warfarin (Coumadin)
  • heparin (Lovenox, Dalteparin)
  • fondaparinux (Arixtra)

Atrial fibrillation

Often referred to as AFib, atrial fibrillation is an irregular heart rate that can heighten your risk of stroke and heart disease. Treatment for AFib can include medication, nonsurgical procedures, and surgical procedures.

Retrosternal chest pain can be a symptom of a condition affecting the lungs and lower air passages.

Pleurisy

Also known as pleuritis, pleurisy is caused by inflammation of the pleura — the lining around the lungs. Pleurisy treatment is based on the underlying cause of the inflammation. If it’s caused by bacterial pneumonia, your doctor will prescribe an antibiotic. If the cause is viral, your pleurisy will often clear up on its own.

Tracheitis

Tracheitis is an inflammation of the trachea (windpipe). Treatment of tracheitis depends on the cause, which is typically allergic, viral, or bacteria-based.

Cancer

Cancer that causes retrosternal chest pain includes:

Retrosternal chest pain can be a symptom of a condition causing a benign (noncancerous) or malignant (cancerous) tumor in the area behind the sternum.

Mediastinal lymphadenopathy

Mediastinal lymphadenopathy — also referred to as mediastinal adenopathy — is the enlargement of the mediastinal lymph nodes. If a bacterial infection is suspected, antibiotics will most likely be prescribed. If cancer is suspected, your doctor will suggest a biopsy.

Thymoma

A thymoma is a growth on the thymus. Your doctor will most likely order a biopsy if a thymoma is discovered.

Substernal thyroid/goiter

Rarely, a thyroid will grow downward into the chest. If cancer is detected or the growth puts too much pressure on the trachea, lungs, or blood vessels, surgical removal is typically recommended.

Chest pain, retrosternal or otherwise, can be the result of a number of causes. And many of those causes are serious enough to warrant a trip to your doctor for an evaluation. This is one of those “better safe than sorry” situations.