Non Cardiac Chest Pain

Non-cardiac chest pain is chest pain or discomfort that is not caused by your heart. It's extremely common, and in most cases chest pain turns out not to be heart-related, though it should always be checked to make sure.

What causes non-cardiac chest pain?

Chest pain can come from many places besides your heart, including your lungs, digestive system, muscles, bones, nerves and skin, or from anxiety.

• Heartburn or acid reflux (GORD) – a burning feeling in your lower chest and upper abdomen, often after eating, lying down, or bringing up food or bitter-tasting fluid.
• A chest muscle strain or sprain – often follows an injury or exercise, feels worse when you breathe in, and eases when you rest the muscle.
• Costochondritis – inflammation where the cartilage joins your ribs to your breastbone; often has no clear cause, though it can follow an injury, heavy lifting, strenuous exercise, or even a bad bout of coughing.
• Anxiety, depression or a panic attack – can cause sharp, continuous chest pain along with a faster heartbeat, sweating or dizziness.
• A chest infection, pneumonia or pleurisy – pain that's worse when you breathe in, alongside a cough with yellow or green mucus and a high temperature.
• Pericarditis – inflammation of the sac around your heart, usually caused by a viral infection, causing sudden, sharp, stabbing pain that's worse when you breathe deeply or lie down.
• Shingles – can cause chest pain along with a tingling feeling on your skin and a rash that turns into blisters.
• A pulmonary embolus (blood clot on the lung).

Are there different types of non-cardiac chest pain?

Non-cardiac chest pain can feel quite different depending on the cause, and certain patterns make a non-heart cause more likely, though you shouldn't rely on this alone.

• Brief pain that passes quickly
• Pain triggered by eating, or that improves with antacids
• Pain that only happens with a particular movement, or when you cough or breathe deeply
• Pain you can point to with one finger, in a single, specific spot
• Pain that's tender when you press on it, suggesting a muscle or rib problem.

By contrast, heart-related pain more often feels like pressure, tightness or squeezing in the centre or left side of the chest, and may spread to your arm, neck, jaw, back or stomach. It's not always possible to tell the difference yourself, which is why new or worrying chest pain should always be checked.

How is non-cardiac chest pain diagnosed?

Because chest pain can be a sign of a heart attack or another serious problem, doctors will usually check for these first, even if a non-heart cause seems more likely.

• Blood tests
• ECG (a tracing of your heart's electrical activity)
• Chest X-ray
• Other tests, depending on what's suspected.

If these tests rule out a heart attack, a blood clot in the lung, a collapsed lung and other serious causes, you may be given a likely diagnosis based on your symptoms and sent home with advice, even if the exact cause isn't completely clear.

How is non-cardiac chest pain treated?

Treatment depends entirely on the cause.

• Heartburn or acid reflux – treated with lifestyle changes and medicines that reduce stomach acid.
• A muscle strain or costochondritis – usually settles with rest, and may take some weeks; simple painkillers such as paracetamol and topical/oral ibuprofen can help (adults can usually take up to 8 tablets, or 4 grams, in 24 hours; always check the packet).
• Anxiety or panic attacks – support for the underlying anxiety, such as talking therapies, can reduce how often chest pain happens.
• A chest infection or pneumonia – may need antibiotics.
• Pericarditis – often improves on its own within a few weeks, as it's usually caused by a virus.

When should you see a doctor?

Call 999 immediately if you have sudden chest pain or discomfort that doesn't go away, especially if it:

• Feels like squeezing or pressure, burning, or indigestion
• Spreads to your left or right arm, or your neck, jaw, stomach or back
• Comes with feeling sweaty, sick, light-headed or short of breath
• Comes with fainting or collapsing.

See a GP if:

• You have chest pain that comes and goes
• You have chest pain that goes away quickly, but you're still worried
• You have further episodes of chest pain after being told a previous episode wasn't serious, and this is worrying you.