Are there other causes for chest pain other than cardiac causes?

There are many causes of chest pain. The one that doctors worry about the most is cardiac because it has the potential to be life-threatening. Non-invasive tests to diagnose coronary artery disease are not all perfect in picking up reduced blood flow to the heart in all people; especially in those with increased body mass index or special populations. Therefore, if you have symptoms of coronary disease but have been told they are not cardiac in nature, you may want to get a second opinion at a center with experience in diagnostic testing. Once coronary disease is truly ruled out the work-up can proceed at a more leisurely pace.

*Please note: If you have chest pain that lasts longer than 5 minutes and is not relieved by rest or medication, please seek emergency assistance (call 911).*

Cardiac causes of chest pain are:

  • Ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm)
  • Pericarditis (inflammation of the sack around the heart)
  • Myocarditis (inflammation of the heart)
  • Cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections

Gastrointestinal causes of chest pain include:

  • Heartburn
  • Reflux (acid from the stomach washing back into the esophagus)
  • Gallstones
  • Esophageal spasm
  • Esophageal rupture
  • Varicose veins of the esophagus
  • Strictures of the esophagus
  • Tumors of the esophagus and other less common GI problems

Pulmonary (lung) causes include:

  • Pneumonia
  • Pulmonary embolus
  • Pneumothorax
  • Chronic obstructive pulmonary disease (COPD)
  • Pleuritis and bleb rupture

Other potential causes are:

  • Aortic dissection
  • Back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.)

Psychological causes of chest pain are common and include:

  • Panic attacks
  • Anxiety
  • Stress and mental duress

As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.

A good internal medicine doctor or cardiologist can work through the potential causes of your symptoms.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2019.

References

  • McSweeney J, Cody M, O'Sullivan P, Elberson K, Moser D, Garvin B. Women's Early Warning Symptoms of Acute Myocardial Infarction. Circulation. 2003; 108(21):2619-2623
  • ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction._ Circulation. _2007;116:e148-e304, June 27, 2017.
  • ACC/AHA 2014 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction._ Circulation. _2014;130:e344-e426., September 23, 2014.

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