5 Causes of Chest Pain Unrelated to the Heart

Chest pain is a common symptom that can cause significant anxiety and concern, as it is often associated with heart problems. Non-cardiac chest pain, or NCCP, is a type of pain that originates from the chest but is not related to the heart. Various factors, including musculoskeletal issues, pulmonary disorders, oesophagal disorders, gastrointestinal problems, and psychological factors can cause this condition.

A proper diagnosis can help alleviate anxiety and provide relief to patients who may be experiencing debilitating chest pain. In some cases, treatment for patients with NCCP may be as simple as making simple lifestyle changes or taking medication.

In contrast, further testing or referral to a specialist may be necessary in other cases. As such, healthcare professionals must thoroughly evaluate NCCP patients to ensure proper diagnosis and management. This article explores various conditions, including those that can be mistaken for angina or feel like a heart attack but are not. 

Non-cardiac chest pain is a medical term used to describe chest pains that are not caused by heart disease. One of the most common causes is muscular-type pains, but what are the other causes?

Non-cardiac Chest Pain

Understanding what non-cardiac chest pain is is crucial. Non-cardiac chest pain is defined as discomfort or pain in the chest unrelated to the heart, highlighting the importance of assessing the severity of chest pain. This type of pain can mimic the pain associated with a heart attack or other heart conditions, but it originates from other bodily systems. The common causes of non-cardiac chest pain in patients are varied and can include:

• Gastrointestinal Causes
• Musculoskeletal Issues
• Respiratory Problems
• Psychological Factors

5 Causes of Non-cardiac Chest Pains

Multiple conditions can cause non-cardiac chest pains, indicating that chest pain is a chronic issue for many individuals. Often, these non-cardiac causes may include gastrointestinal disorders (stomach-related), oesophagal disorders (oesophagus-related), musculoskeletal disorders (muscle-related), pulmonary disorders (lung-related), or psychological disorders such as anxiety and stress.

Gastrointestinal Causes of Non-Cardiac Chest Pain

Gastrointestinal disorders are a potential cause of non-cardiac chest pain that cannot be ignored. However, evaluating the gastrointestinal system to rule out any abnormalities causing the pain is essential.

Conditions such as gastroesophageal reflux disease (GERD) and acid reflux disorders are common causes of non-cardiac chest pain, although they predominantly arise in the upper gastrointestinal tract. Thus, medical professionals should emphasise the importance of gastrointestinal assessments during chest pain evaluations. Identifying such conditions ensures early diagnosis and timely treatment, improving the patient's quality of life.

Gastrointestinal Reflux Disease (GERD)

GERD is a common cause of pain in the upper chest. GERD occurs when the stomach's acid flows back up the oesophagal pipe (food pipe connecting the mouth to the stomach). When this happens, the acid irritates the lining of the oesophagal pipe, leading to GERD. Heartburn, a GERD symptom, causes sharp pain behind the breast bones, which leads to chest pain. Studies reveal that GERD is the main cause of non-cardiac chest pain.

Symptoms of GERD include chest pains, belching, heart pain, and regurgitation of food. Patients with this disease also find it difficult to sleep. Smoking, late-night eating, eating fried foods, or drinking alcohol and coffee can cause GERD. Reducing or eliminating these habits can reduce the risk of getting symptoms.

Peptic Ulcer

Peptic ulcers are open sores that develop in the stomach lining or the first part of the small intestine (duodenum). Additionally, can an ulcer cause chest pain and shortness of breath? Yes, in some cases, these symptoms can occur together, further complicating the diagnosis.

Gastritis

Gastritis refers to inflammation of the stomach lining. It can be caused by factors such as infection, certain medications, or excessive alcohol consumption. Gastritis can cause chest pain and discomfort.

Gallbladder Disorders

Conditions affecting the gallbladder, such as gallstones or cholecystitis (gallbladder inflammation), can cause unexplained chest pain radiating to the upper abdomen. This pain may be mistaken for cardiac-related pain.

Pancreatitis

Pancreatitis is inflammation of the pancreas. When the pancreas becomes inflamed, it can cause abdominal pain that may radiate to the chest area.

Irritable Bowel Syndrome (IBS)

IBS is a gastrointestinal disorder characterised by abdominal pain, bloating, and changes in bowel habits. Some individuals with IBS may experience chest pain in the middle of the chest and after eating, but not heartburn. It's vital to consider these possibilities when diagnosing non-cardiac chest pain.

Functional Dyspepsia

Functional dyspepsia is characterised by recurring or chronic indigestion symptoms, including upper abdominal discomfort or pain, bloating, and early satiety. Chest pain can be a manifestation of this condition.

Esophagal Causes of Non-Cardiac Chest Pain

Esophagal causes can contribute to non-cardiac chest pain. Here are some potential esophageal causes to consider:

Esophageal Spasm

Esophageal spasms are abnormal contractions of the muscles in the esophagus, leading to chest pain. The pain is typically described as squeezing or pressure-like and may be triggered by swallowing.

Esophageal Motility Disorders

When we eat, food passes through our food pipe to the stomach. A disorder in food movement from the mouth to the stomach causes oesophagal motility disorders. Symptoms include chest pains or burning sensations in the heart. Oesophagal motility disorders cause swallowing difficulty, also known as achalasia, when food passes through the food pipe. Swallowing with difficulty causes sharp pain. Since the heart and the oesophagus share a standard nerve supply, the pain is felt in the chest region, leading to chest pain.

Esophagitis

Esophagitis is inflammation of the oesophagus, often caused by stomach acid irritating the oesophagal lining. This condition can cause chest pain, difficulty swallowing, and a sensation of food getting stuck.

Esophageal Hypersensitivity

Esophageal hypersensitivity occurs when a slight change in pressure in the esophagus causes pain. Pressure change occurs when small amounts of stomach acid enter the food pipe (oesophagus). The symptoms of this disease are similar to GERD. People with this disease experience intense chest pains and heartburn. Other symptoms include difficulty in swallowing food. Esophageal pain is often much more common in women as they have a higher risk factor as compared to men.

Esophageal Stricture

An oesophagal stricture is a narrowing of the oesophagus, often caused by scar tissue formation. This can result in chest pain, swallowing difficulties, and a feeling of food sticking in the chest.

Esophageal Tumors

Although less common, certain tumours in the oesophagus can cause non-cardiac chest pain. These may include benign or malignant growths.

Hiatal Hernia

A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity, potentially leading to symptoms of reflux and non-cardiac chest pain. This can cause chest pain and reflux symptoms similar to GERD and other gastric disorders.

Musculoskeletal Causes of Non-Cardiac Chest Pain

Musculoskeletal issues associated with chest pain can lead to severe discomfort, which may be mistaken for cardiac-related pain. While musculoskeletal causes can be painful, they are generally not life-threatening. However, cardiac causes of chest pain can be fatal if left untreated. Therefore, patients who experience any chest pain should seek medical attention immediately to determine the underlying cause and receive appropriate treatment. This type of pain is a classic example of what feels like a heart attack but is not and is an essential differential in diagnosing chest pain. Common conditions causing musculoskeletal chest pain include costochondritis, muscle strains, and rib fractures.

Costochondritis

Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone and can be mistaken for a heart attack.

Muscle Strains

Muscle strains can cause chest pain, especially among those who have been sedentary or have overexerted themselves.

Rib Fractures

Rib fractures are also associated with acute chest pain, especially when breathing or coughing. It is crucial to receive a proper evaluation to rule out cardiac causes of chest pain, as it is vital to determine its exact cause.

Pulmonary Causes Of Non-Cardiac Chest Pain

Pulmonary causes can also contribute to non-cardiac chest pain. Here are some potential pulmonary causes to consider:

Pulmonary Embolism (PE)

A pulmonary embolism occurs when one of the arteries in the lungs gets blocked. The clot blocks the blood returning to the lungs, which can lead to loss of life. Symptoms of pulmonary embolism include a short, sharp pain in the chest, shortness of breath, or fever. You feel chest pain when you breathe inwardly or when you cough.

Pneumonia

Inflammation or infection of the lung tissue can lead to pneumococcal diseases such as pneumonia that may cause chest pain, along with symptoms such as fever, cough, and difficulty breathing, may be present.

Pleurisy

Pleurisy refers to the inflammation of the lining around the lungs (pleura). This condition can cause sharp chest pain that worsens with deep breathing or coughing.

Pneumothorax

A pneumothorax occurs when air collects in the space between the lungs and the chest wall, causing the lung to collapse partially or entirely. This can result in sudden, sharp chest pain, specifically anterior chest wall pain and difficulty breathing.

Asthma

Asthma is a chronic respiratory condition characterised by inflammation and narrowing of the airways. Chest tightness, wheezing, and shortness of breath can accompany asthma, leading to chest pain in some cases.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a group of lung diseases, such as chronic bronchitis and emphysema, which can cause chest discomfort and difficulty breathing.

Pulmonary Hypertension

Pulmonary hypertension is a condition characterized by high blood pressure in the arteries of the lungs. Chest pain, along with symptoms such as shortness of breath and fatigue, may be experienced.

Psychological Causes Of Non-Cardiac Chest Pain

Sometimes, the tight pain you feel in your chest isn't a result of heart conditions. It could be a result of either stress, panic attacks, or anxiety. When you're anxious, you experience shortness of breath. Then, the body's system produces hormones that increase blood pressure. The pressure leads to an increase in the force of the heartbeat in the chest region. Combined with the tight muscles of your chest, it can lead to sharp pains in the chest, which is another non-cardiac cause of chest pain.

Studies reveal that one out of four people experiences chest pains due to panic attacks. Symptoms of anxiety-related chest pains differ in individuals. While some may experience sharp pains, others experience tight chest pains. Other symptoms include constant chest aches or tightness around the chest region.

Understanding the Differences

What can be mistaken for angina and what constitutes non-cardiac chest pain are critical questions in medical diagnostics. Understanding the distinction between cardiac and non-cardiac chest pain and recognising symptoms inconsistent with cardiac-related chest pain is critical to effective treatment.

Frequently Asked Questions About Non-cardiac Chest Pain

Non-cardiac chest pain (NCCP) refers to chest pain that is not caused by a heart problem and it is a very common condition that can be caused by a variety of factors. Here are some of the most common and frequently asked questions about chest pain unrelated to the heart:

How is Non-cardiac Chest Pain Different From Cardiac Chest Pain?

Cardiac chest pain is caused by a problem with the heart, such as coronary artery disease or ischemic heart disease. It often feels like a crushing or squeezing pain in the chest that may radiate to the left arm or jaw. Non-cardiac chest pain, on the other hand, may feel like a sharp or burning pain in the chest that is not related to the heart.

What Causes Chest Pain Besides a Heart Attack?

There are many causes of chest pain besides a heart attack. Some of the most common include gastroesophageal reflux disease (GERD), anxiety, muscle strain, costochondritis, pleurisy, pneumonia, hiatal hernia, and panic attacks among others.

What Are the Symptoms of Non-cardiac Chest Pain?

The symptoms of non-cardiac chest pain can vary depending on the underlying cause. However, some common symptoms include:

• Pain in the chest that is sharp, dull, or aching
• Pain that is worse with exertion or stress
• Pain that is relieved with rest or medication
• Pain that is accompanied by other symptoms, such as shortness of breath, nausea, or vomiting

What Are the Pain Characteristics in Patients With Non-specific Chest Pain?

The pain experienced by patients with non-specific chest pain can vary in severity and duration. It may feel like a burning, sharp, or stabbing pain in the chest that can sometimes be intense enough to mimic a heart attack. The pain may also be diffuse, meaning it is spread out over a large area of the chest rather than being localized in one spot.

What is the Prevalence of Non-cardiac Chest Pain?

Non-cardiac chest pain is a very common condition among patients with chest pain. In fact, it is estimated that up to one-third of patients who seek medical attention for chest pain do not have a cardiac cause for their symptoms.

How is Non-cardiac Chest Pain Diagnosed?

Diagnosing non-cardiac chest pain can be challenging because it is a non-specific symptom that can be caused by a variety of factors. An evaluation may include a medical history, physical exam, esophageal manometry, electrocardiogram, chest x-ray, blood tests, echocardiogram, upper endoscopy, and other tests to rule out cardiac and other potential causes of chest pain. A rapid-access chest pain clinic such as The Harley Street Heart and Vascular Centre Singapore may be helpful for patients who require urgent evaluation.

Can Non-cardiac Chest Pain Be Caused by Anxiety or Panic Attacks?

Yes, anxiety or panic attacks can be a cause of non-cardiac chest pain. These conditions can cause physical symptoms, including chest pain, that can be mistaken for a heart problem. It is important for patients to seek medical evaluation to rule out any potentially serious causes of chest pain before assuming it is related to anxiety or panic attacks.

Can Gastroesophageal Reflux Disease (GERD) Cause Non-cardiac Chest Pain?

Yes, GERD can cause non-cardiac chest pain. This is because the acid in the stomach can irritate the lining of the esophagus, leading to pain or discomfort in the chest. Treatment for GERD may include proton pump inhibitors or other medications to reduce stomach acid production.

Can Non-cardiac Chest Pain Be Caused by a Problem With the Esophagus?

Yes, non-cardiac chest pain can be caused by problems with the esophagus, such as esophageal spasms or inflammation. These conditions can cause pain that is referred to the chest. Treating the underlying esophageal problem can often relieve chest pain symptoms.

Are There Any Specific Tests That Can Be Done to Diagnose Non-cardiac Chest Pain?

There is no single test that can definitively diagnose non-cardiac chest pain. However, tests such as esophageal manometry, upper endoscopy, and ambulatory pH monitoring can help determine if the pain is related to an esophageal problem. Other tests, such as an electrocardiogram, may be performed to rule out a cardiac problem.

How is Non-cardiac Chest Pain Treated?

The treatment for non-cardiac chest pain depends on the underlying cause. Some common treatments for non-cardiac chest pain include:

• Medications, such as proton pump inhibitors (PPIs) for GERD or anxiety medications for anxiety
• Lifestyle changes, such as losing weight, eating a healthy diet, and exercising regularly
• Surgery, in some cases, such as for a hiatal hernia

What Are the Risks of Non-cardiac Chest Pain?

The risks of non-cardiac chest pain depend on the underlying cause. However, some common risks of non-cardiac chest pain include:

• Anxiety
• Depression
• Sleep problems
• Reduced quality of life

What Should I Do if I Have Non-cardiac Chest Pain?

If you have non-cardiac chest pain, it is important to see a doctor to get a diagnosis and treatment. Do not ignore chest pain, even if you think it is not caused by a heart problem. Untreated non-cardiac chest pain can lead to serious complications, such as anxiety and depression.

Conclusion

If you have chest pain, it is best to seek a reputable and experienced heart doctor in Singapore such as The Harley Street Heart and Vascular Centre. In fact, our job as cardiologists is to work out what the cause of your chest pain is. The frightening symptoms of chest pains might not mean the presence of heart disease. Once your cardiologist confirms the absence of heart disease, he/she may direct you to a primary care physician or to a gastroenterology or respiratory specialist for their expert opinion.

---