Understanding chest pain: Cardiac and non-cardiac causes

Chest pain, often an immediate cause for concern, can arise from various sources, both cardiac and non-cardiac. In her latest online article, Dr Anne Griguer delves into the distinctive features, diagnostic approaches, and treatments for conditions like pericarditis, myocarditis, angina, heart attacks, as well as non-cardiac issues such as musculoskeletal, lung-related, and stomach-related causes. Recognising these differences is crucial for prompt and accurate medical intervention, ensuring tailored management based on the specific underlying cause of chest discomfort.

Cardiac chest pain:

Heart inflammation (pericarditis and myocarditis)

Chest pain related to heart inflammation, known as pericarditis or myocarditis, is often triggered by viral infections like the cold or flu. Typically affecting young adults, this condition manifests as a tight or burning sensation on the left side or across the chest. The discomfort is exacerbated by lying down and relieved by bending forward. Patients may also experience viral symptoms such as low-grade fever, cough, diarrhoea, or vomiting.

Diagnosis involves cardiac tests such as blood tests (inflammation markers and a cardiac marker called troponin), electrocardiograms (ECG), and echocardiograms. In cases of suspected myocarditis, a cardiac MRI may be recommended.

Treatment is generally rest and anti-inflammatory medications like aspirin, ibuprofen, or colchicine. In more severe cases, additional treatments such as beta-blockers or steroids may be necessary if the inflammation damages the heart muscle.

Angina and heart attack (Myocardial infarction)

Chest pain caused by blockages in the heart arteries due to cholesterol deposits (atheroma) is known as angina. This condition can progress to a heart attack (myocardial infarction) when there is an acute complete (or almost complete) blockage of an artery. Common in individuals over 60 with cardiovascular risk factors (high cholesterol, high blood pressure, smoking), angina is characterised by tightness or pressure in the chest occurring on exertion, often radiating to the left arm or jaw. A heart attack would cause similar symptoms but would generally occur at rest and be more sudden, severe and prolonged.

Diagnostic tests include blood tests and ECG, followed by exercise tests, cardiac CT scans, or invasive coronary angiograms to localise the blockage and determine if an intervention is needed.

Lifestyle changes (healthy diet, regular exercise), preventive medications (Aspirin, Statins), anti-anginal medication (like beta-blockers or nitrates), and, if necessary, interventions like stents or cardiac bypass surgery form the pillars of treatment.

Other cardiovascular causes

Additional cardiovascular causes of chest pain include: Pulmonary embolism, arising from a clot in the lung arteries, often in the elderly, after surgery or in the context of a condition increasing the risk of blood clots (cancer, thrombophilia); Aortic dissection, a rare condition involving the tearing of the aorta, is associated with hypertension and aortic dilatation (aneurysm) and causes acute severe pain in the chest and back. Both conditions demand urgent medical attention and specific diagnostic measures including blood tests (D dimers) and chest CT scan.

Non-cardiac chest pain

When individuals encounter chest pain, their immediate concern often revolves around the heart. However, a significant proportion of chest pains falls under the category of 'musculoskeletal,' stemming from issues with the ribs, nerves, muscles, or joints between the ribs and sternum. In such instances, the pain is typically sharp, localised, and can be replicated by applying pressure to a specific chest point or moving the rib cage.

Chest pain may also be associated with lung-related issues, particularly during a chest infection. In these cases, the pain intensifies with deep breaths or coughing and may coincide with respiratory symptoms like shortness of breath, wheezing, coughing, or general viral symptoms.

Another non-cardiac source of chest pain is the stomach, often linked to gastric reflux or gastric ulcers. This type of pain is often characterised by a burning sensation ascending in the chest, exacerbated by heavy or spicy meals and worsened when lying down.

If you are experiencing chest pain, it is advisable to consult your general practitioner or a cardiologist for a comprehensive clinical examination and simple tests to rule out any cardiac-related causes. However, emergency services should be contacted if the pain is severe and/or prolonged, feels constricting across the chest and left arm, especially for individuals with cardiac risk factors or a history of cardiac problems.

Dr Anne Griguer is an esteemed consultant general and imaging consultant. You can schedule an appointment with Dr Griguer on her Top Doctors profile.