Patients complaining of “instantaneous stabbing pain in the heart” are more likely to consider cardiac neurosis, which requires psychosomatic treatment. Less often, it is coronary artery disease or neuralgia, which can be treated with medication or surgery. Cardiac neurosis is a cardiac-related symptom mainly caused by psychosomatic. It is often characterized by pinprick chest pain, fixed location, variable duration, often accompanied by breathlessness and chest tightness. It occurs more often in women, and is more common in menopausal women, with clinical manifestations of cardiac symptoms but no organic cardiac disease on clinical examination. After the exclusion of organic heart disease, the disease is mostly treated with psychotherapy, psychological guidance, behavior modification, biofeedback and other treatments. Coronary artery disease is mostly characterized by pressure pain in the precordial region or behind the sternum, and less often by stabbing pain, mostly caused by activities. In mild cases, oral medication can be taken to control the symptoms (e.g., nitrates), and in severe cases, interventional stenting is required. Neuralgia is mostly caused by herpes zoster or costochondritis, the pain can be pinprick-like, the pain site along the intercostal region, when the attack needs to use nutritive drugs (such as aspalathin) to relieve the symptoms. If the patient complains of “instant stabbing pain in the heart”, it is necessary to consult a hospital to clarify the cause of the disease and listen to the doctor’s instructions for treatment.