Non-Cardiac Chest Pain: Causes, Symptoms, Treatment
What Is Non-Cardiac Chest Pain?
Non-Cardiac Chest Pain is the medical terminology used for chest pains which are not related to any specific heart condition, but are quite similar to pains experienced due to pain from a cardiac condition. Non-Cardiac Chest Pain is usually felt underneath the sternum and is squeezing and pressure-like in quality. This pain tends to radiate to the neck, left arm and the back. Non-Cardiac Chest Pain usually occurs after having food and the duration of the pain is variable. There may also be associated symptoms of heartburn or fluid regurgitation. Since Non-Cardiac Chest Pain is very similar to anginal chest pain, hence more often than not this pain is attributed to a cardiac cause and multiple tests and studies are conducted like EKG, stress test, and the like. Once these tests show negative results then an individual is given a diagnosis of Non-Cardiac Chest Pain and other causes of chest pain are investigated.
What Are The Causes Of Non-Cardiac Chest Pain?
Non-Cardiac Chest Pain are basically caused due to esophageal and non-esophageal factors. Studies have estimated that about 50% of cases of Non-Cardiac Chest Pain are due to acid reflux disease.
Some of the esophageal sources of Non-Cardiac Chest Pain are:
Gastroesophageal Reflux Disease: GERD is the most common cause of Non-Cardiac Chest Pain. Studies have shown that about 50% of cases of Non-Cardiac Chest Pain are caused due to this disease. There may also be associated symptoms of heartburn and regurgitation along with chest pain.
Esophageal Contraction Disorders: Some of the other esophageal causes of Non-Cardiac Chest Pain are disorders of esophageal muscles like esophageal spasms, nutcracker esophagus, and at times achalasia.
Esophageal Hypersensitivity: This condition is also one of the causes of Non-Cardiac Chest Pain. In this disease even a little bit of exposure to acid content may cause excruciating pain.
Nonesophageal Causes of Non-Cardiac Chest Pain
Some of the nonesophageal causes of Non-Cardiac Chest Pain are musculoskeletal conditions affecting the chest wall or the spine, lung disorders, pericardial conditions and digestive abnormalities like ulcers, gallbladder, or pancreatic diseases.
Stress: Stress also plays an important role in bringing out Non-Cardiac Chest Pain. Stress leads to disorders like anxiety and panic attacks which causes chest pains.
What Are The Risk Factors For Non-Cardiac Chest Pain?
Non-Cardiac Chest Pain may occur in children and adults alike, although some studies have shown that Non-Cardiac Chest Pain occurs more in females than males even though the reason for this is not clearly understood. Studies have shown that about 20% of people in the United States suffer from Non-Cardiac Chest Pain. There are no specific risk factors thus far for Non-Cardiac Chest Pain.
What Are The Diagnostic Studies Conducted For Non-Cardiac Chest Pain?
To begin with anyone having chest pain needs to be evaluated to rule out cardiac causes of chest pain to include EKG, laboratory studies, and stress test. Once a cardiac cause of chest pain has been ruled out, then the physician will start looking for other causes of chest pain. Since most of the Non-Cardiac Chest Pains are caused due to esophageal disorders hence the individual may be referred to a gastroenterologist for further consultations to identify the cause of the pain. To begin with, the individual will be given a trial course of proton pump inhibitors which act as acid suppressants for a couple of weeks to see if the symptoms improve. If the symptoms improve, then the most likely cause of Non-Cardiac Chest Pain is acid reflux. If the pain does not improve, then further studies are done to include a test to determine the amount of acid present in the stomach and if there is any reflux present. This can be followed by endoscopy to evaluate the internal structures of the stomach. An ultrasound of the abdomen may also be performed to rule out gallstones as a cause for the pain.
What Are The Treatments For Non-Cardiac Chest Pain?
To begin with, the individual will be given a trial of a proton Pump Inhibitor for a minimum of two weeks. If the symptoms start to improve then it is confirmed that acid reflux is the cause of the individual's pain and the course of PPI is extended for about eight weeks but at a reduced dose. The common medications used for Non-Cardiac Chest Pain are omeprazole, lansoprazole, and pantoprazole.
In case the individual does not respond to standard course of PPIs, then it is believed that reflux is not the cause of the individual's pain. In such cases, other medications are tried. These medications work by reducing transmission of pain from the esophagus to brain thus reducing the pain. The medications generally used for this purpose are tricyclic antidepressants in the form of amitriptyline, nortriptyline, desipramine, and Trazodone of which imipramine and Trazodone are the most common. Some of the side effects with these medications are drowsiness, dry mouth, diplopia, and urinary retention. In some cases another class of antidepressants called SSRIs are also used for controlling pain. Some of these medications are paroxetine, fluoxetine, and citalopram. Some studies have shown venlafaxine to be equally effective in control of Non-Cardiac Chest Pain. If an individual does not respond to any of the above mentioned treatments then other potential causes of Non-Cardiac Chest Pain are explored such as achalasia and if identified the individual is treated for it. As of now, research is still going on in trying to find a more potent medication for treatment of Non-Cardiac Chest Pain.
Stress Management: In case If an individual is found to have Non-Cardiac Chest Pain due to anxiety or stress, then that individual needs to be referred to a psychiatrist to formulate an appropriate treatment program in the form of medications or techniques like cognitive behavioral therapy, Biofeedback and the like.
What Impact Does Non-Cardiac Chest Pain Have On An Individual's Life?
It is very rare that individual with Non-Cardiac Chest Pain are not able to be consistently employed. On an average, an individual with Non-Cardiac Chest Pain tends to lose about 10 days of work in a year which is quite common for people who suffer other gastrointestinal diseases like irritable bowel syndrome and the like. Hence it is quite unusual for an individual to be not able to work due to Non-Cardiac Chest Pain.