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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  • Patsy

    I developed terrible sharp pains in my back. It felt like I was being stabbed. It radiated around my ribs to chest and jaw. GP sent me to a Gastro guy who could find nothing wrong, did multiple tests, sent me to a Neurologist who asked me why I was there. By now, I can only keep down one Activia and a couple ounces of water a day. I’d vomit up a lot of foam each time I ate. I could swallow or breathe. If I ate something, hiccups started and vomiting followed. FINALLY, dear friends who are Cardio-Thoracic surgeons were called by my husband who told him to get me to the hospital asap. Diagnosis? Achalesia. Only 1 in 100,000 people have develop it. The Esophagus does not function correctly. Surgery corrected the problem to the stomach. I was eating regular food in 6 days.

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

      Thanks for sharing. I’ll bet you’ll feel a lot better after treatment.

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  • D R

    Well, my son had chest pains that were debilitating. At age 21, we found all his pains were from thyroid. He has graves disease. The difficult thing was catching his thyroid counts just right.

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

      Thanks for sharing.

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  • Please Help

    Hey just seeing if I can get a quick reply. I just did a round of antibiotics and steroids for what the nurse practitioner believed to be walking pneumonia (tightness in my chest, fatigue, cough that had lasted for over a month etc.). I’ve been finished with the pills for four days or so but I’ve been experiencing extreme fatigue, shortness of breath and tonight very acute chest pain in my middle to left side. It’s late and going to the ER, while an option, may just get me a listen of my heart and a new round of antibiotics. Two questions: would you reccomend I go? And what should I ask them to do if I do decide to go.

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

      I can’t tell you what to do. That’s a judgement call for you to make. If you’re extremely short of breath or the pain is keeping you awake, you might consider it. Whenever you go, all you need to do is explain like you did in the comment, they’ll check you and should know what to do from there.

  • Kalman

    I have
    experienced similar chest pain for over a month. It began with a sharp pain on
    the left side of chest here my heart is, so I thought I had a heart attack. I went to the hospital to get
    it checked out. After heart monitoring and ultrasound tests of the heart
    and lungs my doctor said there was nothing to worry about and it was because of
    stress. A few days later I started to have left abdominal pain(rarely) and tingling
    on the right side of my chest as well as on the left side. Also noticed that chest wall
    is tender to the touch. I don’t know if there is something serious.

  • Kalman

    I have
    experienced similar chest pain for over a month. It began with a sharp pain on
    the left side of chest where my heart is, so I thought I had a heart attack. I went to the hospital to get
    it checked out. After heart monitoring and ultrasound tests of the heart
    and lungs my doctor said there was nothing to worry about and it was because of
    stress. A few days later I started to have left abdominal pain(rarely) and tingling
    on the right side of my chest as well as on the left side. Also noticed that chest wall
    is tender to the touch. I don’t know if there is something serious.

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

      Sounds like you should follow up with your regular doctor. If you don’t have one, you should find one.

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

      Sounds like you should follow up with your regular doctor. If you don’t have one, sounds like you should get one.

  • http://batman-news.com Joe

    My chest pain actually feels as if I need to stretch…I sit for a living and unfortunately get trapped gas more often than I’d like to discuss…I know this is trapped gas b/c a year or so ago I started doing Yoga and what was interesting was that the more I did the workout the more I burped…not a little but a lot and loud….I also yawned quite a few times…I’ve stopped working out and really need to return as the pressure on my upper stomach and chest area sometimes feels like a burp is on top of ever it (just burped) and the pressure is lighter….good grief

  • gloria

    hello i am writing this in hopes to get some type of answer, I have been feeling these heat spots on my head and bad shoulder and neck pain also lately i have felt this pulsating more like throbbing pain on the left back side of my head, it comes ang goes . I also have been feeling pain in my chest more under my ribs, the pain on my neck ive had for a year and i feel like sometimes my nerves ae the cause because i feel a pain on the left side from my head all the way to my feet and sometimes its hits my lest side of my hip bad i cant move or walk on that leg. i have went to the d and they wanted to send me to get a wave test done because on my hot spot on my head and sometimes my eyes feel weird i have also a lot of twitching in my face sometime i research the symptoms i have and a lot of times i freak out because i have read several possible diagnosis like aneurysm , or optical neuralgial or somethings like that please help

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

      Gloria, sorry but I can’t make a specific diagnosis without a direct exam. My suggestion is you follow your doctors recommendations. He/she has seen you and can make informed suggestions and tests customized for you that you’re not going to find anywhere on the internet.