Distinguishing Types of Chest Pain

Written by Erica Roth and R. Sam Barclay | Published on March 19, 2015
Medically Reviewed by Healthline Medical Team on March 19, 2015

Overview

Chest pain can be scary. It can make you wonder if you’re having a heart attack. It can also be one of the many common symptoms of acid reflux. Gastroesophageal reflux disease (GERD) related chest discomfort is often referred to as non-cardiac chest pain (NCCP), according to the American College of Gastroenterology (ACG).

The ACG explains that non-cardiac chest pain can mimic the pain of angina, which is defined as chest pain of cardiac origin.  Learning to distinguish the different types of chest pain can put your mind at ease and help you to treat your acid reflux more effectively.

Location

Cardiac chest pain and NCCP can both appear behind your breastbone, making it hard to distinguish between the two types of pain. Cardiac chest pain is more likely than reflux-related pain to radiate to your arms (especially left upper arm), back, shoulders, and neck. Chest pain stemming from GERD may affect your upper body in some cases, but is most often centered either behind your sternum, or just underneath it in a region known as the epigastrium.

NCCP is usually accompanied by a burning behind your breastbone and may not be as present in the left arm as cardiac pain is. Esophageal spasms (constriction of the muscles around the food tube) due to damage within the esophagus (either from acid reflux or other medical issues) can cause pain in your throat and the upper area of your chest as well.

Sensation

You may be able to tell what type of chest pain it is by assessing the type of pain you’re feeling. Common ways that patients describe pain associated with heart disease include:

  • crushing
  • searing
  • tightness, like a vice
  • heavy (like an ‘elephant sitting’ on the chest)
  • deep

On the other hand, non-cardiac chest pain may feel sharp and tender.

People diagnosed with GERD may experience temporary, severe chest pain when taking a deep breath or coughing. This difference is key: The intensity level of cardiac pain remains unchanged when you breathe deeply. Reflux-related chest discomfort is less likely to feel like it’s originating from deep within your chest. It may seem like it’s closer to the surface of your skin, and it is more often described as ‘burning’ or ‘sharp’.

Body Position

Ask yourself if your chest pain changes in intensity or goes away completely when you change your body position to determine the cause of the discomfort. Muscle strains and GERD-based chest pain tend to feel better upon moving your body. The symptoms of acid reflux, including chest pain and heartburn, may ease considerably as you straighten your body to a sitting or standing position. Bending and lying down — particularly right after eating — can make GERD symptoms and discomfort worse.

Cardiac chest pain continues to hurt, regardless of the position of your body. However, it can also come and go throughout the day, depending on the severity of angina. Non-cardiac chest pain associated with indigestion or a pulled muscle, for example, tends to be uncomfortable for an extended period of time before going away.

Associated Symptoms

Assessing other symptoms that occur with chest pain can help you distinguish one form of pain from another. Pain caused by a cardiac issue can make you feel:

  • lightheaded
  • dizzy
  • sweaty (or ‘diaphoretic’)
  • nauseated
  • short of breath
  • numbness in the left arm or shoulder

Non-cardiac, gastrointestinal causes of chest pain can include a variety of other symptoms, including:

  • trouble swallowing
  • frequent burping or belching
  • burning in your throat, chest, or stomach
  • sour taste in your mouth caused by regurgitation of acid 

Other Types of Chest Pain

GERD isn’t the only cause of non-cardiac chest pain. Other causes can include:

  • blood clot lodging in the lungs
  • inflammation of the pancreas
  • gallstone disease
  • asthma
  • inflammation of the cartilage that holds the ribs to the breastbone
  • injured, bruised, or broken ribs
  • chronic pain syndromes, including fibromyalgia
  • high blood pressure
  • anxiety or panic attacks
  • shingles

Diagnosis and Treatment

Chest pain should be taken seriously. Speak with your doctor about your symptoms. Your healthcare provider may perform an EKG or stress test, or draw cardiac blood tests, to rule out heart disease as the underlying cause if you don’t have a prior history of GERD. Usually, a full medical history and testing can uncover the reason for your chest pain and put you on the road to recovery.

Chest pain that accompanies frequent heartburn can be treated with proton pump inhibitor (PPI) medications, a type of drug that reduces acid production in your stomach. Your doctor also may recommend cutting out certain types of food, such as fried foods, spicy foods, and citrus, all which can trigger symptoms. A prolonged trial of PPI drugs can help relieve symptoms so that chest pain will no longer be a part of your life.

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  • Q: How can one distinguish cardiac chest pain from non-cardiac chest pain? - Exercising with Health Challenges - Fitness Q & A - American Council On Exercise(ACE) . (n.d.). Become an ACE-certified personal trainer and maintain your personal training certification with the American Council on Exercise. Also offering, Group Fitness Instructor, Lifestyle and Weight Management Coach and Advanced Health and Fitness Specialist fitness certifications. . Retrieved April 9, 2012, from http://www.acefitness.org/fitnessqanda/fitnessqanda_display.aspx?itemid=258

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