More than once I’ve had a patient complain of severe chest pain and we just can’t figure out what it is. There are no other signs or symptoms. A few days later a rash develops in the area of the pain, and we have a diagnosis—shingles.
Other times the patient just knows it’s a bad case of indigestion. Antacids even help it. It’s not until we get an EKG (heart tracing) that we find out he/she’s having a big ol’ heart attack.
One of the more difficult diagnostic dilemmas in medicine is to completely rule out heart trouble as your cause for chest pain. So if you’re having pain, don’t assume. Get it checked out. My last post has tips for what to do until you can. In this post, though, I’m going to go over some causes and treatments for non-heart chest pain.
Chest pain almost always comes from one of four places:
- The chest wall (ribs, spine, and muscles).
- The heart or blood vessels.
- The lungs or the lining of the lungs.
- The esophagus.
Shingles and anxiety are two exceptions.
As you might imagine, there are many potential causes of non-heart chest pain. But in my experience, the two most common are costochondritis (rib pain, for short) and indigestion.
This chest-wall pain is so easy to miss and yet so easy (most of the time) to diagnose.
A rib is not just one long, curved bone going around half the chest. It has joints. Yes, joints. Why? They move just enough to help expand your chest to take in air and contract it to blow the air out.
In the back of the chest, joints connect the ribs to the spine. In the front, some of your rib bones connect to the sternum (breastbone) by way of cartilages. The place where the rib attaches to the cartilage is a joint. So is the place where the cartilage attaches to the sternum. And, like other joints, these can get stressed and inflamed.
Try feeling them now. It’ll help you know where to feel later if they become a source of pain. The costochondral joints (rib to cartilage connections) are located approximately along the nipple line running vertically. In my experience this joint causes the most trouble. The sternochondral joints (cartilage to sternum connections) run along the edge of the breastbone.
Common causes for pain in these joints are repetitive pushing and pulling, a chronic cough, or large breasts.
Costochondritis symptoms: Chest pain in those areas. It can be worse with deep breaths or arm movements.
Signs: Tenderness. Touching the joint area makes the pain worse, and it’s the same type of pain you’re already having.
Treatment: Anti-inflammatories, like ibuprofen (Advil) or naproxen (Aleve), can help, as can a heating pad on moderate temperature or warm towels for about twenty minutes every two to four hours. And, of course, don’t do the activity that you think has caused the pain. If you have large breasts, wear a good support bra. If the pain is severe, doctors can inject the joint with numbing medicine for temporary relief. Sometimes, a steroid is added for longer-lasting relief.
The problem with indigestion is sometimes, a heart attack can feel like a bad case of it. So get to a hospital if your “indigestion” discomfort is prolonged, worse, or different than usual; if there’s associated sweating or shortness of breath; or if it just won’t go away.
Indigestion symptoms: A burning or cramping in the chest. Sour fluid can come back up in your throat.
Signs: This is primarily a symptom diagnosis. Sometimes, your mid-upper abdomen can be tender. But if it’s more than a little tender, you should be thinking of other possible causes, such as pancreatitis (inflammation of the pancreas) or an ulcer. Both the pancreas and the stomach are located in that area. Both problems can be serious and need to be checked out by a doctor ASAP.
Treatment: Antacids such as Tums, Rolaids, or Maalox. A half-teaspoon of baking soda mixed in a glass of water can be a quick fix, but taking too much (say, the dose mentioned several times a day for over a week or two) can mess with your body’s acid-base balance and be very unhealthy. Over-the-counter meds, like Tagamet, Pepcid, and Prilosec, help but tend to take longer to work.
Prevention: The above, and avoid heavy meals or food that brings the indigestion on. Avoid excessive caffeine. Stop smoking. Other risk factors are being overweight and lack of exercise.
You really shouldn’t self-diagnose chest pain unless you absolutely can’t get medical help. It’s too risky. Even heart doctors need to get tests, and still the diagnosis may be iffy.
Next post, I go over a few more non-heart causes of chest pain.
Have any of you ever had chest pain? What did it turn out to be? How did you treat it?
Illustration by Mikael Häggström. Labels added.