What is Non-Cardiac Chest Pain

What is non-cardiac chest pain?
Many people, both young and old, have intermittent chest pain. Chest pain can be alarming, as it might indicate severe heart disease or even a heart attack. However, many people (and most young people) have chest pain that is not caused by the heart – this is called non-cardiac chest pain.

What causes non-cardiac chest pain?
The most common cause of non-cardiac chest pain arises from a nearby organ, the esophagus. Esophageal causes of non-cardiac chest pain include gastroesophageal reflux disease (GERD) and esophageal spasm. GERD results from stomach acid backing up into the esophagus, which produces heartburn and chest pain. Esophageal spasm is caused by chaotic muscle contractions of the lower esophagus aggravated by acid reflux, stress or unknown factors.
Another common cause of non-cardiac chest pain is musculoskeletal problems, especially fibromyositis (muscle inflammation). Finally, anxiety and panic attacks can produce chest pain that resembles the pain experienced during a heart attack.

Who is affected by non-cardiac chest pain?
Both men and women are affected by non-cardiac chest pain. However, the syndrome is twice as common in women, especially young and middle-aged women.

What are the symptoms?
Non-cardiac chest pain may resemble cardiac pain, therefore, you need to see a physician for this problem. The chest pain is usually in the middle of the chest and is characterized by a dull, burning or pressure sensation. The pain usually does not radiate into the neck, shoulders or arms.
Non-cardiac chest pain secondary to esophageal causes is made worse during or after meals, when lying on the back (supine position), exercising or when experiencing anxiety. Associated symptoms are often found including heartburn, acid regurgitation or difficulty swallowing and a feeling of food sticking in the middle of the chest (dysphagia).
Non-cardiac chest pain secondary to musculoskeletal disorders can be located anywhere on the chest wall (multiple painful sites are common). Patients may also complain of muscle and joint aches, fatigue and difficulty sleeping.
The chest pain associated with anxiety and panic attacks is accompanied by a feeling of impeding doom, shortness of breath, heart palpitations, sweating and insomnia.

How do you find out if you have non-cardiac chest pain?
You must see your physician so he or she can exclude heart disease. This may require further testing including an exercise stress test, cardiac ultrasound or a cardiac angiogram.
After heart disease is confidently excluded, your medical history and physical exam should give your doctor the appropriate clues to the non-cardiac causes of your chest pain.
These causes may be GERD, esophageal spasm, musculoskeletal problems or anxiety/panic attacks.
Further testing for esophageal problems may be necessary. These tests may include fiberoptic endoscopy to visualize and exam the esophagus for injury from acid, manometry to identify abnormal esophageal contractions, and pH testing to identify excessive acid reflux into the esophagus.

What is the treatment for non-cardiac chest pain?
Most patients can have complete relief of their symptoms if the appropriate cause of non-cardiac chest pain is identified.

For the following conditions, treatment may include:
• GERD
• Lifestyle changes
• Drugs to control acid reflux such as antacids, H2 blockers, cisapride, proton pump inhibitors
• Esophageal spasms
• Treat associated GERD/anxiety
• Medications such as anticholinergics, calcium channel blockers
• Musculoskeletal disorders
• Heat
• Stretching exercises
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Anxiety/Panic attacks
• Anxiolytics
• Imipramine
• Alprazolam
Surgery is rarely required to treat any of the above causes of non-cardiac chest pain.
For more information call Dr. V. Fishbein

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