Chest pain causes that aren’t heart related

There are so many different causes for chest pain, both cardiac and non-cardiac. Some are serious, but most cases aren’t. Sometimes, a specific cause may not be identified. Here’s what you should know about chest pain.

What besides heart issues can cause chest pain?

There are a lot of other causes for chest pain outside of heart-related issues. The heart is only one organ in the chest. Other body parts located in the chest area include muscles, bones, connective tissues, nerves, skin, the lungs, the aorta (a major artery), the esophagus and the stomach. These can all cause chest pain.

Musculoskeletal pain can often occur from inflammation or injury to the muscles or bones of the chest wall. This can be due to trauma, arthritis or other conditions such as fibromyalgia. Certain rashes like herpes zoster will cause chest pain localized to the skin. Some lung-related causes include pneumonia, pleurisy (inflammation of the lining of the lungs) or pulmonary embolism (blood clots to lungs). Common gastrointestinal-related causes include acid reflux or esophageal pain.

Additionally, chest pain can result from pain referred from areas outside of the chest, such as the gallbladder, pancreas or the spine. Anxiety or panic attacks may also cause chest pain.

Which causes are the most common?

By far, the most common cause of chest pain is musculoskeletal. Studies looking at causes of chest pain in the primary care setting have shown that about one-third to one-half of all patients presenting to their doctor with chest pain had pain related to musculoskeletal conditions or chest wall pain. Gastrointestinal-related pain accounted for 10-20% of all causes. About 10% was attributed to anxiety or panic. Respiratory conditions accounted for 5% of patients. Cardiac causes accounted for about 15%.

Are any of these causes life-threatening?

Outside of certain cardiac causes of chest pain, there are definitely non-cardiac causes of chest pain that can be life-threatening. Pulmonary embolism is a condition in which a blood clot blocks blood flow to the lungs. This is usually associated with acute chest pain and shortness of breath. Aortic dissection occurs when the lining of the aorta suddenly rips or tears and is associated with acute, severe chest pain that often radiates to the back. Pneumothorax, or collapsed lung, is another life-threatening condition associated with acute chest pain and shortness of breath. Certain emergent gastrointestinal causes include tears in the esophagus or stomach. Depending on how severe, blunt trauma or injury to the chest wall can also be life-threatening.

What are the treatments for these chest pains?

The treatment for chest pain differs individually depending on the cause. Most musculoskeletal pain can be treated conservatively with rest and over-the-counter pain relievers like acetaminophen, ibuprofen or naproxen. Acid reflux can usually be relieved with changes in diet and antacids. More serious or life-threatening causes of chest pain require immediate medical attention and treatment in a hospital.

At what point should you seek medical attention for a chest pain?

Since chest pain is one of those symptoms that can be associated with emergent, life-threatening conditions, it’s never wrong to seek medical attention for chest pain.

In general, I recommend a low threshold for seeking medical attention for chest pain. Usually, the more serious or life-threatening causes of chest pain tend to occur abruptly and not improve on their own. If the chest pain is occurring at rest, becoming more severe or lasting longer, it’s best to seek immediate medical attention. If there are other associated symptoms, such as shortness of breath, fainting, weakness, dizziness, fever and coughing blood, these would also be signs to seek attention. Some chest pain may not be constant and can reoccur intermittently over a long period of time.

If this is the case, outpatient medical evaluation may also be warranted.

Bottom line: If there’s ever doubt about the cause of chest pain or if there are concerns for serious causes, talk to your doctor or seek immediate medical attention.

Jim Liu is a cardiologist with The Ohio State University Wexner Medical Center.