Non-cardiac chest pain, also referred to as non-cardiac chest discomfort, is the term used to describe chest pain that is not caused by heart-related conditions or a heart attack. In most individuals, non-cardiac chest pain is associated with an esophageal issue, such as gastroesophageal reflux disease (GERD). Other causes may include musculoskeletal problems, lung conditions or diseases, stomach issues, stress, anxiety, and depression.
What is non-cardiac chest pain?
Non-cardiac chest pain refers to pain in the chest that is not caused by heart disease or a heart attack.
What causes non-cardiac chest pain?
Non-cardiac chest pain is often described as feeling like angina, the chest pain caused by heart conditions. Patients may experience a sensation of pressure or heaviness behind the breastbone. Some people also report that the pain spreads to the neck, left arm, or back. The pain can last from a few minutes to several hours.
Who experiences non-cardiac chest pain?
An episode of non-cardiac chest pain occurs in up to 25% of adults in the United States. There are no specific risk factors that make a person more likely to experience non-cardiac chest pain.
What causes non-cardiac chest pain?
In most individuals, non-cardiac chest pain is related to a problem with the esophagus, the tube that connects the mouth to the stomach. Several different esophageal issues can cause non-cardiac chest pain.
Gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain. Also known as acid reflux, this condition is responsible for 22% to 66% of non-cardiac chest pain cases.
Other, less common esophageal issues that can cause chest pain include:
- Muscle problems, also known as esophageal motility disorders. In these conditions, abnormal muscle activity in the esophagus prevents food from moving normally through the esophagus. Esophageal muscle problems include uncoordinated muscle contractions (esophageal spasm), high-pressure contractions or squeezing of the esophagus (nutcracker esophagus), and weak contractions caused by nerve loss (achalasia).
- Esophageal hypersensitivity. People with this condition experience significant pain from even small changes in pressure in the esophagus or minimal amounts of stomach acid entering the esophagus. Individuals with a normal esophagus would not feel any discomfort from these pressure changes or acid presence. The reason why some people develop this heightened sensitivity (hypersensitivity) to pressure or acid remains unclear.
What Other Issues Can Cause Non-Cardiac Chest Pain?
Some less common problems that may cause non-cardiac chest pain include:
- Muscle or bone problems in the chest, chest wall, or spine.
- Lung diseases or conditions, including those affecting the pleura, the tissue covering the lungs.
- Stomach issues, such as ulcers.
- Stress, anxiety, or depression.
Do People with Non-Cardiac Chest Pain Have Other Symptoms?
Patients with non-cardiac chest pain may also experience heartburn or a bitter taste in the mouth due to stomach acid. In some patients, non-cardiac chest pain occurs after eating. For others, the pain is linked to anxiety or depression.
How is Non-Cardiac Chest Pain Diagnosed?
An individual experiencing chest pain cannot immediately tell if it is heart-related or non-cardiac. Anyone with unexplained chest pain should seek emergency medical care.
At the emergency room, a doctor will perform a complete physical exam, which includes checking temperature, blood pressure, and heart rate. They will then assess the patient for heart disease or a heart attack through tests like an electrocardiogram (ECG) and blood tests. The heart releases certain proteins during a heart attack, which will show up in a blood test.
If these tests confirm the heart is healthy and there is no heart attack, the chest pain is classified as non-cardiac.
Which Doctor Treats Non-Cardiac Chest Pain?
The first time someone experiences non-cardiac chest pain, they often go to the emergency room, fearing it might be a heart attack. The emergency doctor will ensure the pain is not heart-related.
If it turns out to be non-cardiac chest pain, the emergency doctor will usually refer the patient to a gastroenterologist, a specialist in digestive system disorders, for further evaluation and treatment.
Some individuals who have experienced multiple episodes of non-cardiac chest pain may visit their primary care doctor or a cardiologist instead of the emergency room. The doctor will follow the same steps to rule out heart issues before referring the patient to a gastroenterologist.
How is Non-Cardiac Chest Pain Treated?
Although non-cardiac chest pain can be frightening due to its similarity to heart pain, it can often be successfully treated once the underlying cause is identified. With proper treatment, most patients experience symptom relief.
The most common treatment for non-cardiac chest pain caused by GERD is proton pump inhibitors (PPIs). Treatment typically begins with a high dose of a PPI. Once GERD symptoms improve, the PPI dosage is reduced to the lowest amount necessary to control symptoms. It may take two or more months of medication for symptoms to be fully managed.
What Treatments Are Available for Non-Cardiac Chest Pain Not Caused by GERD?
For other conditions that cause non-cardiac chest pain, pain-blocking medications are the most common and effective treatment. Tricyclic antidepressants (TCAs), used in low doses, are frequently prescribed. If the patient experiences side effects from TCAs, low doses of other types of antidepressants may be used.
When muscle issues are the source of non-cardiac chest pain, simple treatments such as heating pads, stretching exercises, or pain relievers can help alleviate the discomfort.
Non-cardiac chest pain caused by anxiety or depression can benefit from the help of a psychologist. Talk therapy, which teaches patients how to change or eliminate thought patterns that lead to anxiety, may reduce the frequency of chest pain episodes.
What is the Prognosis for People with Non-Cardiac Chest Pain?
Most non-cardiac chest pain is caused by GERD. Individuals who follow their doctor’s recommendations for managing GERD generally do not experience further problems with non-cardiac chest pain.
