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Distinguishing Types of Chest Pain

Chest Pain

Highlights

  1. Many people with gastroesophageal reflux disease (GERD) will experience a sharp or tender pain in the chest that mimics heart-related problems.
  2. Cardiac heart pains remain unchanged as you breathe deeply, while GERD-related chest pain is more severe during deep breaths or coughing.
  3. Chest pain should be taken seriously. Talk with your doctor about your symptoms.

Chest pain can make you wonder if you’re having a heart attack. It can also be one of the many common symptoms of acid reflux. Chest discomfort that’s related to gastroesophageal reflux disease (GERD) is often referred to as non-cardiac chest pain (NCCP), according to the American College of Gastroenterology (ACG). The ACG explains that NCCP can mimic the pain of angina, which is defined as chest pain of cardiac origin. Learning ways to distinguish the different types of chest pain can put your mind at ease and help you to treat your acid reflux more effectively.

Symptoms

Symptoms

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 spread throughout your body. These places include your:

  • arms, especially the upper part of your left arm
  • back
  • shoulders
  • neck

Chest pain stemming from GERD may affect your upper body in some cases, but it’s most often centered either behind your sternum or just underneath it in an area known as the epigastrium.

NCCP is usually accompanied by a burning behind your breastbone and may not be as present in the left arm. Esophageal spasms are the constriction of the muscles around the food tube. They occur when acid reflux or other medical issues cause damage within the esophagus. In turn, these spasms 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
  • tight like a vice
  • heavy like an elephant sitting on the chest
  • deep

NCCP, on the other hand, may feel sharp and tender. People with GERD may have 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’s 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-related chest pain tend to feel better when you move 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 can make GERD symptoms and discomfort worse, particularly right after eating.

Cardiac chest pain continues to hurt, regardless your body position. However, it can also come and go throughout the day, depending on the severity of angina. NCCP 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
  • nauseated
  • short of breath
  • numb 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
  • a burning sensation in your throat, chest, or stomach
  • a sour taste in your mouth caused by regurgitation of acid 

Other Types of Chest Pain

 Type 1

GERD isn’t the only cause of NCCP. Other causes can include:

  • a blood clot lodged 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
  • a chronic pain syndrome, such as fibromyalgia
  • high blood pressure
  • anxiety or panic attacks
  • shingles

Diagnosis

Diagnosis

You should take chest pain seriously. Speak with your doctor about your symptoms. Your doctor may perform an EKG or stress test. They may also 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 help your doctor find 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 inhibitors (PPIs). A PPI is a type of medication that reduces acid production in your stomach. Your doctor also may recommend cutting out certain types of food that can trigger symptoms, such as fried foods, spicy foods, and citrus fruits. A prolonged trial of PPI drugs can help relieve symptoms so that chest pain will no longer be a part of your life.

You asked, we answered

  • What types of chest pain are the most dangerous and should be addressed as an emergency?
  • Whether it’s cardiac or non-cardiac cardiac chest pain, it can be difficult to determine an emergency situation since the symptoms vary. If the onset of the pain is sudden, unexplained, and worrisome, you should call your doctor or seek emergency care immediately.

    - Dr. Mark LaFlamme

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