Do you feel a dull ache or a sharp stab in and around your chest area? In all possibilities, you might instinctively conclude that this radiating discomfort is an impending heart attack! However, before you likely jump to a disparaging scenario, be aware and consider the fact that there can be other thoracic causes of chest pain. 

While it’s absolutely vital to rule out a heart attack or cardiac arrest first, many people are surprised to learn that chest pain often comes from other sources, like muscles, bones, lungs, or even digestive issues.

Dr. Dinesh Mittal, a well-known Cardiothoracic and Vascular Surgeon, believes that chest pain does not always suggest a heart attack. He says, “Not all chest pain causes are heart-related. In Fact, chest pain, many times, occurs due to thoracic conditions emanating from the lungs, bones, tissues and digestive problems not related to the heart.”

Let’s investigate all these non-cardiac chest pain causes and understand the signs that your body manifests.

Understanding The Thoracic Cavity: A Peek Into Thoracic Anatomy

It’s commonplace to pinpoint an impending heart attack when you feel a shooting pain or a dull ache in your chest. The heart is the most vital organ in our thoracic cavity, but our thoracic cavity is also home to many other crucial organs. Recognising this complexity of the thoracic cavity is the foremost step in understanding why not every chest pain does not culminates in a heart attack.

The thoracic cavity’s anatomy includes a bony structure consisting of ribs, breastbone, and the thoracic spine located at the back. The base of the thorax is lined by the diaphragm, a muscle that acts as a barrier between the stomach and the chest and is primarily involved in breathing. 

Besides the heart and its corresponding aorta artery and the vena cava vein, lie several other crucial organs within the thoracic cavity, namely:

• Lungs: The two lungs on either side of the heart play a key role in the exchange of oxygen. Sometimes, individuals feel a distinct discomfort in the chest when the pleura or the outer lining of the lungs is affected. Moreover, an inflamed windpipe or trachea and its corresponding air-carrying bronchi can cause chest pain.
• Oesophagus: This is the food pipe that carries food from your mouth all the way to your stomach and is located just behind the heart in the thoracic cavity. Any muscle spasms or GERD/ acid reflux problems can be mistaken for cardiac pain.
• Musculoskeletal system: The ribs and the breastbone, along with the spinal bones, together comprise the chest wall. The intercostal muscles, which play an essential role in breathing, connect the ribs and the cartilage to the breastbone or the sternum. Any strain or injury to any of these skeletal, bony structures and muscles can cause non-cardiac chest pain.

Therefore, even though heart problems can cause chest pain, there are several thoracic causes of chest pain other than the heart. Any infection, inflammation, or dysfunction of the lungs, oesophagus, bones, muscles, or nerves can cause discomfort that the brain perceives as chest pain. 

Dr. Dinesh highlights that “Understanding this complexity helps to make people recognise the necessity of a thorough evaluation when chest pain happens, as the root cause and diagnosis might be related to thoracic organs other than the heart.”

Non-Cardiac/Thoracic Causes of Chest Pain

What causes chest pain besides a heart attack? In the preceding paragraphs, we have elucidated that chest pain can originate from organs other than the heart. Problems with the lungs, muscles, bones, and digestive system can also cause chest pain. Let’s delve into these thoracic causes of chest pain in more detail. 

Lung-related causes of chest pain

• Pneumonia: This lung-related infection can cause chest pain along with fever, cough and difficulty in breathing.
• Pleuritis: The chest cavity and the lung lining become inflamed, leading to a sharp pain in the chest that is exacerbated by coughing or breathing.
• Pulmonary Embolism: The lung artery experiences a blood clot, and subsequently, individuals experience shooting pain accompanied by shortness of breath. This condition is a medical emergency warranting immediate hospitalisation.

Musculoskeletal Causes of Chest Pain

• Costochondritis: Sometimes, the cartilage that connects the ribs to the breastbone becomes inflamed, causing pain and tenderness when you touch or feel the chest area.
• Muscle injury or strain: Chest pain can emanate if muscles of the chest wall experience trauma or are overexerted.
• Rib injury: Fractured ribs or any rib bruising can cause localised chest pain, which worsens upon breathing or movement.

A patient of Dr Dinesh Mittal shares, “I was experiencing chest pain for the past few weeks. The pain worsened if I tried to touch and feel the chest area. I was frightened and assumed the worst. I then booked an appointment with Dr. Dinesh Mittal, a well-regarded cardiothoracic surgeon. Dr. Dinesh, after examining me, diagnosed me with costochondritis and explained to me that the cause of my chest pain was simply an inflamed cartilage that connects my ribs to the breastbone. This diagnosis was a relief to me as I was worried that something was not right with my heart.” 

Gastrointestinal Causes of Chest Pain

• Acid Reflux/Gastroesophageal Reflux Disease (GERD): Stomach acid moves up towards the chest, causing chest pain and a burning sensation. This condition worsens particularly after having a heavy, fatty meal.
• Gallbladder problems: The Gallbladder can become inflamed, and gallstones can develop, causing pain that can radiate towards the chest.
• Esophageal contractions: Muscle spasms in the food pipe or oesophagus can cause discomfort when swallowing and squeezing, as well as pain in the chest area.

Neurological/Psychological Causes of Chest Pain

• Nerve problems: Nerve pain in Shingles causes a characteristic burning sensation and pain that travels along the nerve path in the chest area.
• Anxiety or Panic Attacks: Psychological conditions such as anxiety and panic attacks can cause heart palpitations, difficulty in breathing and feelings of tightness in the chest.

Another patient of Dr Dinesh shared, “I was once admitted to the ER of Fortis Hospital, New Delhi, as I suddenly experienced shortness of breath, rapid heart rate and severe tightness in the chest. Dr. Dinesh examined me and ran some cardiac tests on me. However, after examining my reports, he concluded that I actually had a panic attack and needed to consult a psychologist and therapist. His calm and positive demeanour helped quell my fears of having a cardiac arrest.”

When should I worry about chest pain if it’s not my heart?

Many times, chest pain is caused by conditions not related to the heart. However, you should never ignore symptoms such as sudden, severe pain that appears to be squeezing or crushing. Also, pain that radiates towards the neck, jaw, back or shoulder should be taken seriously. Moreover, symptoms like nausea, dizziness, sweating and vomiting that accompany chest pain should be thoroughly evaluated.

Dr Dinesh Mittal says, “It’s important to understand that one should never self-diagnose and seek immediate medical attention if any of these symptoms occur along with chest pain.”

Your Takeaway 

It’s important to understand that not all chest pain will cause a heart attack. But, it’s also vital to note that individuals should prioritise health and safety and even non-cardiac chest pain should be thoroughly medically evaluated.

FAQs

1. Can lung problems cause chest pain?

Yes, lung conditions like pneumonia, pleurisy and pulmonary embolism can cause chest pain. Such pain is usually felt as a stabbing pain that aggravates with coughing or breathing. 

2. How to address non-cardiac chest pain?

The treatment for non-cardiac chest pain lies in first identifying the underlying reason for chest pain, which can include musculoskeletal problems, digestive issues such as acid reflux or GERD and even psychological problems. Treatment usually comprises acid-inhibiting medications, OTC painkillers, pain-management techniques and psychological and behavioural therapies.

3. Which conditions can imitate heart attack symptoms?

An oesophageal muscle spasm can cause chest pain similar to the pain of a cardiac arrest. This pain in the gallbladder can cause nausea and intense pain in the upper areas of right abdomen. 

4. How do you describe a non-cardiac chest pain?

Non-cardiac chest pain can manifest as tightness or squeezing pain or even as a dull ache or heaviness, especially behind the breastbone. Sometimes, the pain can also radiate to the left arm, neck or back area. Also, the pain can exacerbate after eating and may be accompanied by heartburn.

5. When should I worry about chest pain if it’s not my heart?

A doctor should investigate chest pain even if it’s not cardiac-related. An intense shooting or stabbing pain in the chest area accompanied by shortness of breath, dizziness, and nausea lasting more than five minutes needs to be investigated immediately. 

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