Non-cardiac causes of chest pain

While heart-related issues often cause chest pain, there are several non-cardiac conditions that can cause chest pain as well. Here’s what you need to know about non-cardiac chest pain and some common conditions that can cause pain.

Pneumothorax

A pneumothorax, commonly referred to as a “collapsed lung” is one cause of non-heart-related chest pain. It occurs when air gets in the space between the lung and the chest wall. The air puts pressure on the lung, which causes it to collapse. In some cases, only part of the lung collapses. In more severe cases, the entire lung collapses. 

A collapsed lung can be caused by chest trauma, certain medical procedures, or underlying medical conditions like emphysema, lung cancer, and asthma. A pneumothorax can also be spontaneous, where there’s no known cause.

Symptoms of a pneumothorax include chest pain, shortness of breath, tachycardia, and low oxygen saturation. 

If a pneumothorax is small, it will often resolve on its own. The treatment for a larger pneumothorax is to insert a chest tube, which removes excess air and allows the lung to re-expand.

Costochondritis

Costochondritis, a cause of non-cardiac chest pain, is inflammation of the cartilage tissue that connects the ribs to the sternum (the breastbone). Costochondritis usually occurs on the left side of the sternum, which is why it’s often mistaken for a heart attack. The pain is usually worse when pressure is applied to the area or when the patient coughs or takes a deep breath. 

In most cases of costochondritis, there’s no known cause. Once more serious causes of chest pain have been ruled out, costochondritis often improves with oral anti-inflammatory medications and warm compresses.  

Pulmonary Embolism

A pulmonary embolism (PE) is a blood clot that gets lodged in an artery in the lung, blocking blood flow to the lung tissue supplied by that artery. Symptoms of PE include chest pain that’s usually worse with inspiration, shortness of breath, tachycardia, low oxygen saturation, a fast respiratory rate, and a cough.

Risk factors for PE include surgery, recent trauma, prolonged immobilization, pregnancy, cigarette smoking, cancer, obesity, and hormonal contraceptives or hormone replacement therapy. 

A blood test called a D-dimer is often ordered on patients with symptoms of PE. If the D-dimer is elevated, a chest scan is then performed to look for a clot. 

Since PEs can be fatal if not detected and treated quickly, it’s important for anyone with symptoms of PE to seek immediate medical attention.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD), commonly referred to as acid reflux or heartburn, is another common cause of non-heart-related chest pain. In addition to chest pain, GERD often causes a sour or acidic taste in the mouth, regurgitation of food, trouble swallowing, upper abdominal pain, wheezing, and a cough. These symptoms are usually worse when lying flat. 

Risk factors for GERD include obesity, pregnancy, connective tissue disorders, and having a hiatal hernia, where the stomach pushes up into the chest cavity.

GERD is often exacerbated by cigarette smoking, going to bed right after eating, eating large meals, taking anti-inflammatory medications, drinking acidic beverages like coffee and alcohol, and eating foods that are greasy, acidic, or spicy. 

Several types of acid-reducing medications as well as lifestyle modifications often improve the symptoms of GERD.

Additional non-cardiac causes 

While the most common causes of chest pain are discussed above, other conditions can also cause chest pain that is not a heart attack. These include: 

Esophageal spasms and disorders

An esophageal spasm is an abnormal contraction of the esophageal muscle, the tube that helps food move from your mouth to your stomach. These spasms can be mild or severe, making it difficult to swallow and causing non-cardiac chest pain. 

Exercise, stress, GERD, or certain foods can trigger spasms. Treatment usually involves taking medications that relax the muscles or nerves in the area. 

Musculoskeletal issues

Just like other muscles in the body, muscles in the chest can be strained causing chest pain that is not heart-related. Pain caused by muscle strain can be dull or sharp and may come on suddenly, which is why it can be concerning.

Typically chest pain caused by muscle strain will resolve on its own with rest and medications to manage the pain, but certain causes may require specific treatment. 

Psychological factors

Psychological factors, particularly extreme stress, anxiety, or depression, can also present as chest pain. Non-cardiac chest pain is a common symptom, reported in 28.5% of people with panic attacks. Stress, anxiety, and other mental health concerns can also make the symptoms of other chest-related conditions, such as GERD or esophageal spasms worse. 

Stress management, taking deep breaths, regular exercise, getting enough sleep, and seeking treatment for mental health concerns are ways to help prevent chest pain caused by psychological factors.

Infections and inflammation

Viral and bacterial respiratory infections such as bronchitis or pneumonia can cause non-cardiac chest pain. These types of infections typically have other symptoms as well such as a high fever, muscle aches, coughing, and fatigue. 

Treatment for chest pain caused by infections will depend on the underlying cause of the infection and may require antibiotics or other medications. 

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References: 

1. https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367
2. https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175
3. https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647
4. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts
5. https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353840/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442249/