Non-Heart Chest Pain: 2 Major Causes

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2 Major Causes of Chest Pain That Are Not From Your Heart

Like any other joint, the rib joints can get inflamed and painful. The pain can make you think you’re having a heart attack. (Always get it checked out if possible though because you might be.)

by James Hubbard, MD, MPH

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:

  1. The chest wall (ribs, spine, and muscles).
  2. The heart or blood vessels.
  3. The lungs or the lining of the lungs.
  4. 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.

1. Costochondritis

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.

Books adThe Survival Doctor’s guidebooks. They do an anxious heart good.

2. Indigestion

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?

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  • Cher

    Hello Doctor, what a frustrating day I have had and I am so relieved that I am not alone. Have just returned from the MD to follow up on my headache, chest pain, pressure in head, neck and chest. Blook work two weeks ago revealed mild anemia but not low iron. Low Potassium (3.1) and a low alkaline phosphatase at 34. My chest pain has been very severe at times each day and I am very weak and dizzy. The Doctor was concerned about the low potassium because I take Lisinopril 40mg for hypertension which can raise potassium. By the way, 39 year old female, 142 pounds, recently gained 8 pounds since quitting smoking 7 months ago. I do consume a lot of diet coke which I have been advised to stop. Was diagnosed with COPD last summer but have been breathing great since quitting smoking. Have a history of volatile blood pressure and it has been suggested by a physician several years ago that I should be tested for hyperaldosteronism. My doctor is going to revisit that in a month if I am not improved after decreasing lisinopril to 20mg, stopping the buproban which I took for smoking cessation and increasing lorazepam. So, it seems to me that he is not concerned but I am so debilitated by the pain and pressure in my head, neck and chest that I have difficulty driving and performing my daily tasks. Work at home bookkeeping for the business that we own and I have 4 boys (ages 3,9,11, and 12). Admittedly have a stressful life, always have…but I am not depressed. I recently found a hobby that I love but I haven’t felt well enough to spend time or energy on it. What bothers me the most is that I do not believe my doctor takes me seriously. At times the pain is so bad that I cry. Feels like I am being stabbed in the chest. I have 15 year old saline breast implants and I have been referred to plastic surgery to see if there could be a problem with them. I have much tenderness in my left breast and especially above and beneath my armpit. Rechecked my potassium today after taking K chloride for a week and it was normal as well as the alk phos. He had mentioned a bone condition that could explain the bone pain I have. My biggest fear is that something is being missed. I have been so sick, running low grade (intermittent) fevers and having night sweats. The pain I have in my ribs has woken me each night and has become progressively worse. I saw a physiatrist last summer and the exercises he prescribed did not help. I still do them though. My vitamin D had been low at 12 in the fall and it was thought that that could cause my pain but it has only worsened and now my level is 34. I have also had terrible terrible acne lately and two really really large boils on my back, one on my spine and another adjacent to that about 1 inch away as the first was healing thanks to antibiotics. What scares me is the low potassium, why did that occur and how could that relate to the pain…which I am having a bad bout of even as I type. I am so tired of doctors thinking I am nuts. Every time I have had a health concern, it has been a nightmare getting to the bottom of it. when I was 24, I suffered from pelvic pain for more than a year and was passed from doctor to doctor and had numerous tests before I finally got to doctor who knew immediately what was wrong. Very severe pelvic adhesions which were immediately relieved by surgery and thankfully my fertility was spared!! Sorry about the long post. I am very frustrated. I am so desperate to feel better!! Any thoughts?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Cher, it never hurts to get a second opinion from another doctor just to make sure. I’d suggest an internal medicine specialist or endocrinologist.

  • Renee

    Back on October 5, 2013 i went to a local fair and took my daughter on the merry go round. I was just sitting on a bench with her, but i got extremely dizzy, and thought I was going to pass out. It took about 10 minutes for me to feel normal again, once I was off. That was the first time I felt scared and that something might be going on with me. A week after that I was laying down for bed, when my heart had a sharp pain and made me sit up. My heart rate had increased and seemed to be beating harder. I felt light headed and my arms suddenly became heavy. I was unable to fall asleep, and stayed up until 5am wondering what was going on. Symptoms persisted for almost 2 weeks, day and night. Had TONS of blood work done and NOTHING. Went to the ER, even called 911. At one point I had 2 days where off and on I had trouble moving my fingers. I had tingling and numbness in my arms and hands and one night I couldn’t move my legs for about 5 minutes.
    Saw a Cardiologist, had an EKG and Echo. Nothing looked abnormal. Saw a Neurologist, had a CT scan on my chest and my brain. Nothing looked abnormal. I even went to a chiropractor, thinking it could be pinched nerves. Then as suddenly as it came, it went away. January 10th and 11th at night the pounding heart, lightheaded and weak feelings came back. then went away. January 22nd and 23rd those same symptoms came back. Here i am this morning, and I ‘m still having the symptoms of feeling lightheaded, weak, tingling in forearms and hands. I cut out my 1 cup of coffee on Jan 12, thinking it could be causing a problem. PLease help. What is going on.? I eat relatively healthy, I’m an active person, I quit smoking 2 years ago, I have 2 young kids and I’m so scared that I might have something seriously wrong with me.

    • javagirl22

      did they check you for low iron levels?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Renee, Sounds like you’ve been checked pretty well. Is it possible the first bout (which possibly could have been triggered by watching the merry-go-round) scared you so much that you could be having anxiety? That you’re hyperventilating at times, which can sometimes cause temporary tingling, even temporary cramping and loss of muscle strength? If you think it’s possible, there is treatment. Here’s some my post on non-prescription therapies. http://www.thesurvivaldoctor.com/2012/12/04/anxiety-relievers/ I’m certainly not saying that’s definitely what it is. But it is one of the things to consider in the list of possibilities.

  • Coryy

    21 year old male, chest pain above the nipple line on the left side of my chest, sometimes i can feel my heart pounding, My Doc had me do a lay down ECG and a blood test, both came out normal, and was told she believed it to be anxiety….. kinda hard for someone to believe it could just be in their head lol

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Coryy. If you have concerns with the doctor’s diagnosis, get a second opinion. Also be sure to read the above post about costochondritis.

  • NewDay3

    Many years ago I had 2nd degree hear block from Lyme disease. They had to put an Iv port directly onto my chest and the tube went straight into the large vein leading to my heart (cant think of what its called). I now have chest pains every day for the last 2 years. The pain is right below my left breast tissue near my sternum. Is it possible there is swelling scar tissue from the Iv port causing this? It feels like the pain is in my heart, but ive been checked and my heart is healthy plus it would have killed me by now Ha

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      That would be impossible for me to say. Generally, veins don’t cause pain unless it is an acute injury.

  • Nikki

    I have had some serious health issues lately… So I had a baby 6 months ago, found out I had hyper and now have hypothyroid, low vitamin D , an enlarged spleen, and enlarged lymph nodes in my chest and neck, my gallbladder taken out 4 weeks ago, and an emergency appendectomy 3 weeks ago! I have had multiple d dimers done (not since this last surgery tho), MRI of my head, chest CT and X-rays, and blood work… Everything came back okay… 3 days ago I woke up with a horrible left arm ache that was so bad I could barely use my arm. I also have chest pains… They are not 100% consistent but I do have a slight dull ache almost all day and some sharp stabbing pains only in the left side! Right now I feel okay the pain isn’t so bad and no stabbing feeling… I get myself all worked up about blood clots because of all the surgery I have had so close together… Everything I read says a PE or any blood clotting will hurt terribly bad and I don’t feel like that’s what’s wrong but I’m really starting to worry about this pain… My arm pain by the way feels a lot better today but I still have the chest pains, I also feel as though sometimes I get dizzy and have shortness of breath but it’s not consistent in any way? Could this be anxiety??

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I definitely could be anxiety, but you should talk to, or see, your doctor to rule out other problems.

  • Travis

    Hi
    I have a question… When I was younger I had Rheumatic fever . I am now 27. The last year and a half I have been having bad chest pains, numbness, dizziness and tightness. I have been to the emergency room and was told it was just anxiety. I do no have any insurance and my money is really tight so I just kind of went with that and having been living with the pain unable to even afford anxiety medications plus I don’t have a doctor to talk to. I have been reading about this Rheumatic fever and read that it can cause heart valve disease liter in life. I’m really broke and really cannot afford another bill but should I go to a free clinic or something and ask a doctor there? I’m super afraid of this being something’s serious but if it ends up being anxiety, money is so tight that I could be kicked out of my home. What should I do? Thanks

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If there’s a free clinic, definitely start there.

  • Amanda

    For about the last 3 years I have been dealing with sharp, stabbing, almost electrical type pain on the left side of my chest around my left breast. I am 35 pretty active, and have felt a fluttery type heartbeat at times. I have not gone to the dr.’s yet I guess out of fear, however I am really starting to get worried because it will no go away and is happening more often.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Delaying going to the doctor is only prolonging your fear. You’ll probably get good news, but you should go ahead and make an appointment tomorrow.

  • gary

    simple asertion in the cold will have tightness in chest can work for hours in heated area

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I don’t quite follow. If you’re saying breathing in cold air can cause chest pain for several hours, I agree. Thanks.

  • Lashauna Holley

    I have really bad pain in the middle of my back the pain is also felt in the middle of my chest. It feels like a sharp stabbing pain going straight through. It hurts to move, breathe, cough, laugh, anything. I am currently 24 weeks pregnant. Ive been having this pain straight for like the last hour and a half im so ready to just leave work because this pain is unbearable. What could be going on?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Anything from a pinched nerve to a pulled muscle to something in your lung. If I were you I’d call my doctor right away and see what he/she suggests.

      • Lashauna Holley

        I went in to the ER it was costalchondritis. I can only take extra strength Tylenol for it but it does not help at all.

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          You should call ask your OB doctor’s advice. Heat or ice might help. But, I’d ask the OB before even taken an herb or supplement.

  • Sheri

    Hi. Heres my story. I’ve journaled my pains for over 2 years. 52 year old female in menopause. I’ve had the palpitations, worn the 24 hr heart monitor (occasional extra heartbeat), had a few panic attacks with the shakes, out of breath easily and i have pains shortly after laying on my left side. I could go a month with no chest pains at all. But then they start again. I call them “the four corners” surrounding my left boob. Occasionally the pain will be what feels like directly under, but mostly they are on the side of my left boob. And sometimes the pain is only like as if I touched an old bruise, so not intense pain, and sometimes it’s sharper. But today I’ve had the pains, off and on, for over 4 hours. About every 5 min I get the “bruise” feeling. It lasts about 30 seconds. One ? I have is – would a chest X-ray show anything?