What is non-cardiac chest pain?
Non-cardiac chest pain is chest discomfort that does not arise from a cardiovascular (heart-related) source. A thorough cardiac evaluation by a cardiologist should be performed to be sure that the pain is not heart related. Chest discomfort can be described in a number of ways including pressure or fullness, burning, aching or pain, squeezing, sharp, or dull. Symptoms may be associated with physical movement, exertion, swallowing, or breathing and be of variable duration and severity depending on the cause.
What causes non-cardiac chest pain?
Causes of non-cardiac chest pain can include esophageal motility (movement) disorders, gastroesophageal reflux disease (GERD), anxiety, pulmonary (lung-related) or musculoskeletal (chest wall) systems. Esophageal chest pain may result from acid or alkaline (bile) reflux into the esophagus, esophageal dysmotility (abnormal esophagus or upper and lower esophageal sphincter movements) or esophageal hypersensitivity (discomfort experienced with normal esophageal processes due to an increased awareness or heightened nerve sensitivities).
How is non-cardiac chest pain diagnosed?
Diagnosis is based on the results of a number of tests that evaluate for esophageal motility disorders, gastroesophageal reflux disease (GERD), or other sources of pain such as from the lungs or musculoskeletal (chest wall) systems. Tests also aid in planning the best treatment options.
- Chest x-ray or chest CT scan to evaluate for lung and some musculoskeletal related issues.
- Barium swallow studies (thick barium contrast solution is swallowed to see esophagus structures and movements by x-ray).
- Upper endoscopy (EGD is a camera scope placed in the esophagus for direct visualization of the upper GI tract).
- Esophageal manometry and pH (measures esophageal pressures, swallowing ability, and acid levels).
- Bravo pH study (measures acid levels either on or off acid-reducing medicine).
What are examples of treatments for non-cardiac chest pain?
- Depending on the cause, diet modification and changes in eating habits can be helpful for some sources of esophageal chest pain. Recommended changes include eating low acid foods (no citrus or tomato-based foods), avoidance of extreme temperatures with foods and beverages, limiting alcohol, caffeine and carbonated beverages. Also, eating smaller but more frequent meals and eating slowly.
- Medications to reduce acid or bile levels can be helpful for GERD associated symptoms.
- Esophageal dysmotility and hypersensitivity can be responsive to changes in eating habits and diet along with medications that help to relax muscle contractions or reduce nerve sensitivities.
- Chest pain that has been evaluated by a doctor can be relieved by the use of anti-inflammatory medications, direct heat or nerve blocking medications at your providers instruction. If your chest pain has not been evaluated or becomes more severe than usual, it is important to consult with a physician to exclude heart-related causes of chest pain.
- Stress avoidance or measures to reduce stress levels may be helpful for anxiety-related pain along with anti-anxiety medications.
When to seek medical advice for non-cardiac chest pain?
If chest pain should change location, duration, character (type of pain) or becomes more severe, seek medical advice as soon as possible as this could indicate a new or more serious problem.