A long-term (chronic) pain that feels like angina, but it is not, is called noncardiac chest pain (NCCP). While angina is caused by heart problems, noncardiac chest pain may be related to the esophagus (the tube that carries food and drinks from the mouth to the stomach). Usually, people experience this condition due to GERD (gastroesophageal reflux disease), but it may also occur due to other esophageal disorders.
In most cases, doctors diagnose NCCP by excluding other conditions that cause similar symptoms, but it is often caused by esophageal disorders. The esophagus runs from the mouth and goes to the stomach right alongside the heart. As a result, the same sensory nerves send pain signals to the brain from both organs (the heart and esophagus). That’s why it is difficult to say exactly what causes this pain.
Most of the time, people who experience chest pain do not have heart disease, but it is quite difficult to determine what exactly causes chest pain, heartburn, or a heart attack. Only doctors can determine what causes chest pain.
Symptoms
Commonly, the symptoms of NCCP resemble the symptoms of angina. For example:
- Squeezing, clenching, or tightness
- A heavy weight or pressure in the chest
- Heartburn or indigestion
- Intense panic, dread, or stress
- The symptoms may spread to the neck, back, or arms
Both cardiac and noncardiac chest pain may appear after a stressful situation or after a large meal. The symptoms often last several minutes but may last longer, which means you should visit a doctor. Moreover, it is less likely to experience excessive sweating, shortness of breath (dyspnea), and feel better with Nitroglycerin if you have NCCP.
Causes and Risk Factors
One of the most common causes of NCCP is GERD. It occurs when the gastric acid flows back from the stomach into the esophagus. This acid burns it on the inside, causing pain. However, it may also occur due to other causes. Check some of them below:
- Esophagitis – This condition is an inflammation of the esophagus that may also occur due to GERD. However, it may also happen due to certain infections and medicines, eosinophilic esophagitis, and other conditions.
- Esophageal muscle problems – These conditions are known as motility disorders, and they negatively affect the muscles in the esophagus. Sometimes, people develop esophageal muscle spasms that cause pain and swallowing problems (dysphagia).
- Hypersensitivity – When the esophageal nerves become hypersensitive, it may cause discomfort even with very small changes in pressure or acid. It is also known as functional chest pain.
- Chest wall pain – In general, musculoskeletal chest pain feels different from cardiac chest pain, but there are some inflammatory disorders that may feel similar. For example, costochondritis, slipping rib syndrome, and others.
- Certain psychological disorders – In some people, depression, panic, and anxiety may cause chest pain. However, it often occurs in people with hypersensitivity disorders.
- Digestive problems – Some people may experience chest pain when gas and bloating in the stomach do not flow into the intestines, but go back into the esophagus.
- Lung diseases – Chronic chest pain may also occur due to some lung conditions. Some of them are pleurisy and pleural effusion, in which fluid begins to build up around the lungs. Moreover, pneumothorax or pneumomediastinum may also cause noncardiac chest pain.
While NCCP may affect anyone, there are some factors that could increase your risk even more. These include another functional disorder (such as functional dyspepsia), persistent and significant stress, sleep disorders, regular use of tobacco and alcohol, and others.
What Are the Long-term Effects of Noncardiac Chest Pain?
Not everyone who develops NCCP will experience the following complications. They often happen in people with severe symptoms or who do not get treatment. Check some complications below:
- Respiratory problems (that are often caused by pneumothorax or pulmonary embolism)
- Gastrointestinal damage (that can lead to esophageal ulcers, inflammation, or even Barrett’s esophagus)
- Severe muscle strain
- Infections (such as shingles or pneumonia, pleurisy, or osteomyelitis)
- Panic disorder
- Depression
- Reduced quality of life
This article does not contain a complete list of NCCP complications. However, you can talk with your physician about ways to reduce the risk of developing them.
Diagnosis
In most cases, NCCP is diagnosed after excluding cardiac causes. People who experience symptoms that resemble cardiac chest pain (also known as angina) often go to the emergency room (ER), where doctors ask questions about their symptoms and may perform some tests to rule out a heart attack or heart disease. Check the most common tests below:
- Blood tests
- Electrocardiogram (ECG or EKG)
- Exercise stress test
- Heart CT (computerized tomography) scans
When all cardiac causes are excluded, doctors may refer you to a gastroenterologist for further testing. This doctor can diagnose and treat disorders related to the esophagus. Check below some tests often performed to diagnose esophageal diseases:
- Esophageal manometry
- Upper endoscopy
- Ultrasound
- Esophageal pH test
In some cases, physicians may prescribe medicines for GERD before testing for it. For instance, if you administer proton pump inhibitors (PPIs) and your symptoms improve, doctors diagnose GERD. When not, you may need additional testing.
Treatment
In most cases, the treatments for people with NCCP are different because they depend on the exact cause. Check below for the most common treatments used to treat people with NCCP:
- Acid reflux medicines – The most commonly used and effective medications to relieve inflammation in people with NCCP are proton pump inhibitors.
- Esophageal motility treatments – Some people with NCCP may need additional treatments to ease muscle spasms or constriction in the esophagus. These often include medicines to relax the muscles.
- Pain modulators – In most cases, doctors recommend a low dose of antidepressants to ease pain and psychological conditions. They often prescribe tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs).
- Psychological therapies – In general, there are multiple options, but physicians usually recommend psychotherapy (also known as talk therapy).
Frequently Asked Questions
What can I expect if I have noncardiac chest pain?
While most people develop a mild form of NCCP that is treated with antidepressants and proton pump inhibitors, sometimes, people need more extensive treatment or a combination of treatments.
Why do I have chest pain but no angina?
One of the most common causes of NCCP is gastroesophageal reflux disease (GERD), but it may also occur due to esophageal dysmotility and esophageal hypersensitivity.
When to go to the ER for chest pain?
Typically, you should call 911 or visit the nearest emergency room (ER) when any of the following symptoms occur. For example:
- Severe chest pain
- Shortness of breath (dyspnea)
- Nausea
- Vomiting
- Dizziness
- Excessive sweating
If you have additional questions, ask your healthcare provider.
