Non-Cardiac Chest Pain
What is non-cardiac chest pain?
Non-cardiac chest pain is the term that is used to describe pain in the chest that is not caused by heart disease or a heart attack.
What does non-cardiac chest pain feel like?
Non-cardiac chest pain is often described as feeling like angina, the chest pain caused by heart disease. The patient feels a pressure or squeezing pain behind the breast bone. Some people also report the pain spreads to the neck, left arm, or back. The pain can last for a few minutes or for hours.
Who gets non-cardiac chest pain?
An episode of non-cardiac chest pain has occurred in as many as 25 percent of adults in the United States. No risk factors have been identified that make a person more likely to get non-cardiac chest pain.
Symptoms and Causes
What causes non-cardiac chest pain?
In most people, non-cardiac chest is related to a problem with the esophagus, the tube that connects the mouth with the stomach. There are several different esophagus problems that can cause non-cardiac chest pain.
Gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain. Also called acid reflux, this condition causes 22 to 66 percent of non-cardiac chest pain.
Other, less common esophagus problems that can cause chest pain include:
- Muscle problems, also called esophageal motility disorders. In people with these problems, abnormal muscle activity in the esophagus prevents food from moving through the esophagus normally. Esophagus muscle problems include uncoordinated muscle contractions (esophageal spasm), high-pressure contractions or squeezing of the esophagus (nutcracker esophagus), and missing contractions caused by nerve loss (achalasia).
- Visceral or esophageal hypersensitivity. People with this condition have a lot of pain when there is a very small pressure change in the esophagus or a small amount of stomach acid comes up into the esophagus. People with a normal esophagus would not feel anything from the pressure change or the presence of acid. The reason why some people have this extra sensitivity (hypersensitivity) to pressure or acid is not known.
What other problems can cause non-cardiac chest pain?
Some less-common problems that can cause non-cardiac chest pain include:
- Muscle or bone problems in the chest, chest wall, or spine (back)
- Lung conditions or diseases, including diseases of the pleura, the tissue that covers the lungs
- Stomach problems, such as ulcers
- Stress, anxiety, or depression
Do people with non-cardiac chest pain have other symptoms?
Patients with non-cardiac chest pain also may have heartburn or a bitter taste in the mouth due to stomach fluid “coming up.” In some patients, non-cardiac chest pain occurs after eating. For some patients, non-cardiac chest pain is associated with stress, anxiety, or depression.
Diagnosis and Tests
How is non-cardiac chest pain diagnosed?
The person having chest pain cannot know whether it is heart related or is non-cardiac chest pain. A person having unexplained chest pain should go to the emergency room.
The emergency room doctor first will give the patient a complete physical exam that includes temperature, blood pressure, and heart rate. Next the doctor will test the patient for heart disease or heart attack. These tests include an electrocardiogram (a noninvasive test that records the heart’s electrical activity) and blood tests. The heart releases certain proteins when a heart attack occurs that will show up in a blood test.
If these tests show that the heart is fine and the pain is not from a heart attack, the pain is called non-cardiac chest pain.
Management and Treatment
What kind of doctor treats non-cardiac chest pain?
The first time a person has non-cardiac chest pain, he or she usually goes to the emergency room, thinking he or she is having a heart attack. The first thing the emergency room doctor will do is make sure the pain is not a heart attack or due to heart disease.
If it truly is non-cardiac chest pain, the emergency room doctor usually refers the patient to a gastroenterologist, a doctor who specializes in digestive system disorders, for more testing and treatment.
Some people who have had several episodes of non-cardiac chest pain go to their primary care physician or a heart doctor (cardiologist) instead of the emergency room. The doctor will follow the same steps to make sure the pain is not heart-related, then refer the person to a gastroenterologist.
How is non-cardiac chest pain treated?
Although non-cardiac chest pain can be a scary event because it feels like heart pain, it usually can be treated successfully once the doctor identifies the cause of the pain. With the right treatment, the symptoms go away for most patients.
Proton-pump inhibitors (PPI) are the most common treatment for non-cardiac chest pain caused by GERD. Several different PPIs are available. Treatment usually begins with a high dose of a PPI. After GERD symptoms lessen, the dose of the PPI is reduced to the lowest amount that control symptoms. Two or more months of drug treatment may be needed to control symptoms.
What treatments are available for non-cardiac chest pain that is not caused by GERD?
The most common and effective treatment for other health problems that cause non-cardiac chest pain is a medicine that blocks the pain signals. Tricyclic antidepressants (TCAs), used in a low dose, are the most commonly used medicines. A low dose of other types of anti-depression medicine can be used if the patient has side effects from the TCAs.
When non-cardiac chest pain is caused by a muscle problem, simple treatments, such as a heating pad, stretching exercises, or over-the-counter pain relievers like ibuprofen, can relieve the pain.
Non-cardiac chest pain can be due to stress, anxiety, or depression. A psychologist can help patients with these problems work through them so they do not cause chest pain. Talk therapy that teaches the patient how to change or eliminate thought patterns that cause stress can reduce the frequency of chest pain episodes.
Outlook / Prognosis
What is the prognosis (long-term outlook) for people with non-cardiac chest pain?
Most non-cardiac chest pain is caused by GERD. People who follow their doctor’s instructions for managing GERD usually do not have further problems with non-cardiac chest pain.