Chest Pain When it is not Your Heart

What causes Chest Pain When it is not Your Heart?

Often, chest pain is unrelated to heart problems. However, even if your chest pain has nothing to do with your cardiovascular system, the problem may still be important. Your chest pain could be nothing serious, but you will not know that until you have been evaluated by a physician (which is why you should not self diagnose or ignore chest pain). Diagnosis can be a tricky business since many types of chest pain may at first seem like pain from the heart. Diagnosis usually requires a medical history and a physical exam.

 

Gastroesophageal disorders

Approximately 60% of people with noncardiac chest pain have an esophageal or swallowing problem to blame for their chest pain. These include:

 

Gastroesophageal Reflux Disease (GERD) – Heartburn is the most common cause of gastroesophageal-related chest pain. It occurs when acid from the stomach moves up into the esophagus, producing a painful burning sensation in your chest. You may also have a sour taste in your mouth and a sensation of food or liquid coming back. Heartburn usually follows meals and may last for hours. Symptoms occur more frequently when you bend at the waist or lay down. They are usually relieved by belching and antacids. If your symptoms suggest heartburn, you will likely be given an over-the-counter prescription strength acid blocker and then sent home.

Most episodes of heartburn are isolated events caused by eating too much of the wrong thing. However, if you experience frequent heartburn, at least one episode per week, you may be referred from the Emergency Room to your own doctor or a gastroenterologist for more tests. Left untreated, chronic, or very frequent heartburn, can occasionally lead to scarring and narrowing of your esophagus. Tests used to diagnose gastroesophageal problems include a barium swallow and an endoscopy (a common procedure in which a thin, flexible instrument attached to a camera is passed down your throat). This allows your doctor to view your esophagus and your stomach. This is a painless procedure and requires intravenous anesthesia.

 

Esophageal motility disorders - These affect the muscles of your esophagus making swallowing difficult and even painful. One type of motility disorder is esophageal spasm, a condition that effects a small percent of people with chest pain. When they swallow the muscles that normally move food down their esophagus are uncoordinated resulting in a painful spasm. Because the esophageal spasm can be calmed with Nitroglycerin, which also relieves some heart-related pain, this condition is sometimes mistaken for a heart problem. Achalasia (ak-uh-la-zhuh) affects another small percent of people with chest pain. With this condition, the valve of the lower esophagus does not open properly to allow food to enter the stomach. Instead, food backs up into the esophagus causing pain. Motility disorders can usually be treated with minor surgery, medication, or endoscopic techniques.

 

Anxiety disorders - Many people who come to the Emergency Room with unexplained chest pain are experiencing some form of anxiety. Stress-related causes of chest pain include general anxiety and panic attacks.

 

Costochondritis - which is inflammation of the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breast bone or sternum. This pain may occur suddenly and be intense, which may cause some people to assume that it is a heart attack. However, with costochondritis it hurts when you push in your sternum or the ribs near the sternum. Heart attack pain is usually more wide spread and the chest wall usually is not tender. This is treated with rest, heat, and nonsteroidal anti-inflammatory drugs such as ibuprofen.

 

Miscellaneous Causes

Chest wall pain can also come from chest muscles rather sore from excessive coughing, rib injuries, and bruised muscles. Muscle-related pains tend to hurt when you twist side-to-side or raise your arms.

 

Lung conditions - Lung conditions which are less common but an important cause of chest pain. These conditions are usually diagnosed with a chest x-ray and CAT scan and include: Pulmonary embolism - which occurs when a blood clot becomes lodged in a lung artery blocking blood flow to the lung tissue. This is a life-threatening cause of chest pain and your doctor needs to check for this right away. Symptoms include sudden, sharp chest pain that begins or worsens with deep breaths or a cough. Other symptoms include shortness-of-breath, rapid heartbeat, anxiety, or faintness. Pulmonary embolism is treated with emergency blood thinning medications and, rarely, surgery.

 

Pleurisy – inflammation of the pleura of the membrane that lines your chest cavity and covers your lungs. The pain that is sharp and localized and is made worse when you inhale or cough. Pleursy can result from a wide variety of underlying conditions such as a viral infection, bacterial infections (such as pneumonia), and autoimmune conditions (such as lupus). It can also occur from pulmonary embolism, tumors involving the surface of the lung, and even rib fractures.

 

Other Lung Conditions: Collapsed lung (pneumothorax), high-blood pressure and arteries serving the lungs (pulmonary hypertension), and severe asthma can also produce chest pain.

 

Other Causes of noncardiac chest pain

Other Causes of noncardiac chest pain can include pinched nerves or shingles (an infection of the nerve caused by chicken pox virus). Chronic pain syndrome such as fibromyalgia can also cause chest pain. In addition, inflammation of the gallbladder (cholecystitis) or pancreas can cause acute upper abdominal pain that radiates to the chest.

 

Diagnosis May Bring Relief

Chest pain can be among the most difficult symptoms to interpret. But a few hours in the Emergency Room having your chest pain evaluated can bring peace of mind. You may feel the most relief from your symptoms by simply finding out the cause and you will probably save a lot of money in the future.

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