Chest pain is a common reason for patients to visit their doctor. Many a time they worry what might be the cause of the pain, and in particular worry whether it may be a heart attack.
This worry and anxiety is natural. It may be reassuring to know that not all chest pain is due to the heart, and there are a number of other causes as well. This sort of pain is called non cardiac chest pain. However, if you do suffer from chest pain, rather than think it could be due to these other causes, we STRONGLY RECOMMEND you see your doctor straight away for further advice.
Right, so lets see what the other causes for chest pain are. We will not be talking about heart attacks or heart related pain here.
1. Gastro-Esophageal Reflux Disease (GERD)
Gastro-esophageal reflux disease (gastro = stomach, esophagus = food pipe), also called GERD, heartburn or acid reflux disease is the most common cause of non cardiac chest pain seen in clinical practice. Millions of people all over India and in the South Asian countries suffer from this condition. This is well recognised as one of the commonest causes of non-cardiac chest pain.
Patients with GERD often complain of chest pain behind the breast bone. The pain is typically ‘burning’ in nature, and patients state that they experience increased episodes of burping and ‘acid in the mouth’. Patients also tend to salivate more. The symptoms are worse after a heavy meal and when lying down flat. This history is fairly classic of this condition.
Examination is usually normal, though some patients may have pain in the upper abdomen due to gastritis. In patients who have severe cases of GERD, or in those whom the symptoms are no better with treatment, a special test called an upper gastrointestinal endoscopy may need to be performed. An ECG will be normal (which is not the situation in most cases of cardiac chest pain).
GERD is treated with antacids and drugs called proton pump inhibitors. These block the production of acid and help relieve the reflux pain. In rare cases, surgery is offered but the symptoms have to be very severe for that option to be explored.
2. Esophageal spasm
This condition is closed related to GERD but is due to other causes. Here, there may be abnormality in the cells and nerves lining the esophagus, in addition to thickening of the smooth muscle that lines it. These abnormalities cause it to contract tightly. Other causes can include diabetes and a condition called scleroderma (rare). In essence, the pain experienced from esophageal spasms is similar to that of a muscle cramp.
In addition to just chest pain, patients with esophageal spasm may also have difficulty swallowing food. Patients may also experience heartburn.
This condition is diagnosed through specialised tests such as barium swallow and esophageal manometry (assesses pressure within the esophagus) that assess the structure and function of the food pipe.
Treatment is similar to GERD and involves antacids. In some cases, patients may be prescribed drugs such as nitrates and calcium channel blockers. These drugs relax the muscles in the lining of the food pipe, thus relieving the pain and difficulty swallowing. Advanced treatments include surgery and enlargement of the cavity of the esophagus using dilators. In some cases, botox injections (comprised of botulinum toxin) may be administered to help relax the muscles.
3. Biliary Colic
Biliary colic refers to pain that occurs due to inflammation of the gall bladder. The gall bladder is located just below the ribs on the right side of the body, and as such any inflammation of this organ can cause chest pain and abdominal pain. Without delving into too much detail regarding the causes of biliary colic, it is well worth knowing that this is a condition that cause chest pain and needs immediate attention. It is often caused by gall stones or inflammation of the gall bladder (called cholecystitis). It requires urgent attention and in some cases requires hospitalisation.
This condition consists of inflammation of the cartilage that attaches the ribs to the breast bone. In most cases, the pain is rather sharp in nature, and is worse when the patient presses on the chest. Patients also experience pain when they lay on their chest in bed, and perform any movements of the shoulder or torso. The condition often affects the 4th, 5th and 6th ribs.
Costochondritis is often incorrectly called Tietze’s syndrome. However, the latter refers to swelling of the cartilage rather than inflammation. Symptoms are however similar, and treatment involves the use of painkillers such as non-steroidal anti-inflammatory drugs. In some cases, patients may need steroid injections.
5. Lung causes
While discussing the lung causes of chest pain in too much detail is not appropriate for this article, we thought we should briefly mention them anyway. The common lung causes for chest pain include –
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- Chest infections and pneumonia – This can cause inflammation of the lining of the lung, thus causeing chest pain.
- Pulmonary Embolism – This refers to a blood clot in the lungs.
- Lung Cancer – This can be fairly painful in some patients, depending on the location of the cancer. Pain may be due to involvement of the pleura, or spread of cancer to the ribs and other bones.
- Pleurisy – This is inflammation of the lining of the lungs
- Pneumothorax – Refers to accumulation of air in between the 2 layers of pleura that line the lungs. It can compress the lungs and cause breathlessness and pain.
The chest pain when it is due to lung disease is often worse when the patient takes a deep breath in. This is not the case when the pain is coming from the heart. Treatment is variable for each condition.
6. Other causes
Some other causes of chest pain include skin diseases such as Herpes Zoster (Shingles), nerve compression and depression.
It is clear that not all chest pain is from the heart, and a number of different causes need to be considered when making a diagnosis and offering any form of treatment.
It is imperative that you see your doctor if you are suffering from any kind of chest pain. At Baliga Diagnostics Pvt. Ltd., we offer comprehensive assessments for all our patients who come to see us with chest pain. You can book an appointment to see us any time!
For research articles by Dr Vivek, click here.