How to Describe Non-Cardiac Chest Pain: Understanding Symptoms and Causes

Over half of emergency room visits for chest pain have non-cardiac causes, according to research from Michigan Medicine. When a heart condition is ruled out, a patient is diagnosed with non-cardiac chest pain (NCCP), a condition with many potential origins that can mimic a heart attack.

Quick Summary

This guide details the wide range of symptoms and possible causes of non-cardiac chest pain. It offers specific descriptions to help identify the pain, outlines common culprits like GERD and anxiety, and explains how to differentiate it from cardiac-related pain.

Key Points

• Differentiating Sensation: Non-cardiac chest pain is often sharp, stabbing, or burning, contrasting with the crushing pressure typical of heart-related pain.

• Recognizing Triggers: NCCP can be triggered by eating, stress, or specific movements, whereas cardiac pain is more often tied to physical exertion.

• Identifying Non-Cardiac Causes: Common origins include gastrointestinal issues like GERD, musculoskeletal problems such as costochondritis, and psychological factors like anxiety.

• Seeking Urgent Care: New, severe, or persistent chest pain, especially with radiating pain, sweating, or nausea, requires immediate emergency evaluation.

• Pinpointing Positional Pain: Pain that worsens with movement, deep breathing, or when pressing on the chest suggests a musculoskeletal or respiratory cause.

• Understanding Management: Treatment for NCCP varies widely based on the cause, ranging from antacids and physical therapy to stress management and psychological counseling.

What is Non-Cardiac Chest Pain (NCCP)?

Non-cardiac chest pain (NCCP) is a frequent condition defined as recurrent chest discomfort not caused by a heart problem, even though it may feel similar to a heart attack. After a thorough evaluation rules out cardiac issues, a non-cardiac source is sought. Given the proximity of organs like the heart and esophagus, and the shared nervous pathways, pain signals can be misinterpreted by the brain, leading to confusion. This can be a source of significant anxiety for patients. A proper diagnosis is crucial not only to treat the underlying cause but also to alleviate the fear and stress associated with misinterpreting the pain as a heart attack. Understanding the specific characteristics of NCCP is the first step toward effective management and peace of mind.

How to Describe Non-Cardiac Chest Pain: Key Characteristics

The way NCCP presents can vary significantly depending on its origin, but certain descriptors are common. Being able to accurately describe your pain to a healthcare provider is essential for a correct diagnosis.

Describing the sensation

• Sharp or stabbing pain: Unlike the dull, crushing pressure often associated with cardiac pain, NCCP may feel sharp or stabbing, especially in musculoskeletal cases or during a panic attack.
• Burning sensation: This is a hallmark of gastroesophageal reflux disease (GERD), where stomach acid irritates the esophagus.
• Tightness or squeezing: Some NCCP causes, such as esophageal spasms or anxiety, can lead to a sensation of tightness or squeezing in the chest.
• Aching or dull pain: A persistent ache can result from muscle strain or chronic conditions affecting the chest wall.
• Positional pain: Pain that worsens or is triggered by specific body movements, deep breaths, or coughing often points to a musculoskeletal or pulmonary cause.

Describing the timing and triggers

• Duration: NCCP can be brief, lasting only a few seconds, or it can persist for hours or days. This contrasts with cardiac pain, which typically lasts several minutes and doesn't resolve quickly.
• After meals: Pain that occurs after eating, especially large or acidic meals, is a strong indicator of a gastrointestinal cause like GERD.
• Stress or anxiety: Emotional stress, panic attacks, or anxiety can trigger or worsen chest tightness and pain.
• Exercise relation: Unlike classic angina which is reliably triggered by exertion, NCCP may not be consistently related to physical activity. In some musculoskeletal cases, however, pain may increase with strenuous movements.

Common Causes of Non-Cardiac Chest Pain

Gastrointestinal (GI) Causes

• Gastroesophageal Reflux Disease (GERD): The most common cause of NCCP. Acid reflux irritates the esophageal lining, causing heartburn that can feel like chest pain.
• Esophageal Spasms: Abnormal contractions of the esophagus muscles can cause severe, squeezing chest pain that is often described as pressure.
• Esophagitis: Inflammation of the esophagus from various causes can lead to chest pain and difficulty swallowing.
• Hiatal Hernia: When part of the stomach pushes into the chest cavity, it can cause GERD-like symptoms and chest pain.
• Peptic Ulcers: Sores in the stomach lining can cause upper abdominal pain that radiates to the chest.

Musculoskeletal (MSK) Causes

• Costochondritis: This is an inflammation of the cartilage connecting the ribs to the breastbone. The pain is often sharp, localized, and worsens when you press on the affected area or take a deep breath.
• Muscle Strains: Overuse or injury from lifting, exercise, or severe coughing can strain chest wall muscles, causing persistent pain.
• Rib Fractures or Bruises: Trauma to the ribs can lead to sharp, localized pain that is exacerbated by movement or breathing.
• Slipping Rib Syndrome: The ligaments of the lower ribs can become weak, allowing the rib tips to move and cause pain.

Psychological Factors

• Anxiety and Panic Attacks: During high stress or a panic attack, the body's 'fight or flight' response can cause muscle tension, increased heart rate, and hyperventilation, leading to chest tightness or sharp pains.

Respiratory Causes

• Pleurisy: Inflammation of the lung lining, called the pleura, causes sharp chest pain that worsens with deep breathing or coughing.
• Pneumonia: This lung infection can lead to sharp chest pain alongside other symptoms like fever and a cough.
• Pulmonary Embolism: A life-threatening blood clot in the lung artery can cause sudden chest pain, shortness of breath, and rapid heart rate.

Comparing Non-Cardiac vs. Cardiac Chest Pain

Because many symptoms can overlap, it is crucial to understand the subtle differences in how cardiac (angina) and non-cardiac chest pain are typically described. If there is any doubt, or if the pain is severe and sudden, always seek immediate medical attention.

Feature	Non-Cardiac Chest Pain (NCCP)	Cardiac Chest Pain (Angina)
Sensation	Often sharp, stabbing, burning, or a dull ache. May feel localized.	Described as crushing pressure, squeezing, or tightness. May feel like a heavy weight on the chest.
Location	Can be anywhere in the chest, but often behind the breastbone. Some types, like costochondritis, are localized to specific points.	Typically radiates to the left arm, shoulder, neck, or jaw. Can also be in the back.
Duration	Can last for seconds, hours, or even days.	Usually lasts for several minutes, often 1 to 5 minutes, but not for seconds.
Triggers	Often triggered by eating, stress, anxiety, specific body movements, coughing, or deep breathing.	Typically triggered by physical exertion or emotional stress. It usually improves with rest.
Associated Symptoms	May include heartburn, regurgitation, difficulty swallowing, or shortness of breath related to anxiety.	Often accompanied by shortness of breath, cold sweats, nausea, or lightheadedness.
Relief	May improve with antacids, rest (if musculoskeletal), or stress reduction techniques. Does not improve with nitroglycerin.	Often relieved by rest or nitroglycerin medication.

When to Seek Medical Attention

While this guide provides details on how to describe non-cardiac chest pain, it is not a substitute for professional medical advice. A number of the conditions causing NCCP, such as a pulmonary embolism, can be life-threatening. Therefore, any new, severe, or persistent chest pain should be evaluated by a healthcare professional immediately to rule out cardiac or other serious causes.

Call 911 or go to the emergency room immediately if you experience:

• Sudden, severe chest pain, especially if it feels like crushing pressure.
• Chest pain accompanied by shortness of breath, sweating, nausea, or dizziness.
• Pain that radiates to your arm, neck, jaw, or back.
• Chest pain that lasts longer than a few minutes and does not go away with rest.

For non-emergency situations, such as recurrent but mild pain after a cardiac workup has been completed, a discussion with your doctor can help formulate a plan for diagnosis and management. You may be referred to a gastroenterologist, a physical therapist, or a mental health professional depending on the suspected cause.

Management and Treatment Options

Treatment for NCCP is dependent on the underlying cause. A doctor will typically start by addressing the most likely culprits and may use medication, lifestyle changes, and other therapies.

For GERD and esophageal issues

• Proton Pump Inhibitors (PPIs): Medications like omeprazole can effectively reduce stomach acid production and treat GERD-related pain.
• Lifestyle modifications: Avoiding trigger foods, eating smaller meals, not eating before bedtime, and elevating the head of the bed can help manage reflux.
• Other medications: H2 blockers and, in severe cases, muscle relaxants or other therapies may be used.

For musculoskeletal causes

• Pain Relievers: Over-the-counter NSAIDs, such as ibuprofen, can help reduce inflammation and pain.
• Rest and Activity Modification: Avoiding activities that worsen the pain is crucial for healing.
• Physical Therapy: Can help with muscle strains and conditions like costochondritis by strengthening muscles and improving posture.

For psychological factors

• Stress Management: Techniques like deep breathing, meditation, and exercise are very effective at reducing stress and anxiety.
• Therapy: Cognitive Behavioral Therapy (CBT) can help patients reframe negative thought patterns that contribute to anxiety and chronic pain.
• Medication: In some cases, antidepressants or anti-anxiety medications may be prescribed, especially when anxiety disorder is a significant factor.

Conclusion

When faced with chest pain, it's natural to fear the worst. However, a significant portion of chest pain is not caused by heart problems. Non-cardiac chest pain can be described using various characteristics related to its sensation, duration, and triggers. By paying close attention to these details and communicating them clearly to a healthcare provider, individuals can help pinpoint the correct underlying cause, which could be anything from GERD to anxiety or a muscle strain. Always prioritize immediate medical evaluation for severe or new chest pain to rule out a heart attack. With a proper diagnosis, a targeted treatment plan can be implemented to manage the pain and reduce the associated anxiety, ultimately improving quality of life. For more in-depth information on managing non-cardiac chest pain, explore resources from reputable medical institutions, such as the Cleveland Clinic.

Frequently Asked Questions

What is the most common non-cardiac cause of chest pain?

The most common non-cardiac cause of chest pain is gastroesophageal reflux disease (GERD), also known as acid reflux. It can cause a burning sensation or pressure in the chest that mimics a heart issue.

Can anxiety and panic attacks cause chest pain?

Yes, anxiety and panic attacks are a significant cause of non-cardiac chest pain. The body's stress response can lead to physical symptoms like muscle tension and an increased heart rate, resulting in chest tightness or pain.

How can I tell if my chest pain is musculoskeletal?

Musculoskeletal chest pain often worsens when you press on a specific area of your chest, move your arms or torso, or breathe deeply. It may feel like a sharp, localized pain.

What kind of chest pain is a sign of a heart attack?

A heart attack typically presents as a crushing or squeezing pressure in the center or left side of the chest that may radiate to the arm, jaw, or back. It is often accompanied by sweating, shortness of breath, or nausea.

How long does non-cardiac chest pain usually last?

The duration of non-cardiac chest pain is highly variable. It can last for only a few seconds, for several hours, or even persist for days, depending on the underlying cause.

What should I do if I experience new or severe chest pain?

If you experience new, severe, or persistent chest pain, especially if it is accompanied by other symptoms like shortness of breath, radiating pain, or dizziness, you should seek emergency medical attention immediately by calling 911.

Can diet and lifestyle changes help manage non-cardiac chest pain?

Yes, for many causes of NCCP, such as GERD, lifestyle modifications are very effective. This includes avoiding trigger foods, eating smaller meals, and managing stress through exercise and relaxation techniques.