Jan had never had any heart problems, but when she started feeling chest pains one evening after dinner she called 911. “I’m having a heart attack!” she exclaimed in fright. Fortunately, Jan’s distress was caused by heartburn—not heart disease—but she did a smart thing by calling for help.
Of the 5 million emergency room patients who complain of chest pain each year, only a small percentage have had a heart attack. What’s going on with the others? Here’s a look at some common causes of noncardiac chest pain, some of which may also require immediate medical attention.
An injury to the bones, muscles or organs in the chest can cause pain within the chest wall. A fall or sports-related injury could break a blood vessel, collapse a lung (pneumothorax) or break a rib, resulting in chest discomfort. In that case, breathing, coughing or sneezing can make the pain worse. If injury or inflammation is the cause, the chest wall usually is tender to the touch.
An inflammatory condition, such as pain and swelling in the chest wall cartilage, called costochondritis, or inflammation of the membranes that surround the lung, called pleurisy, also can cause chest pain. Lung conditions including a blood clot (pulmonary embolism) and pneumothorax can be fatal if not treated immediately. Pneumonia and asthma also may cause chest discomfort.
If the pain is made better or worse by eating, it could be the result of an ulcer, gallbladder disease or GERD (gastroesophageal reflux disorder, also known as heartburn). In these cases, the pain often starts at the bottom of the breastbone and produces a burning or aching sensation. Pain that occurs after a meal or when you lie down or that spreads from the stomach up is most likely heartburn. These uncomfortable episodes occur when stomach acids move up into the esophagus.
Over-the-counter antacids can relieve occasional heartburn. But people who experience heartburn regularly should talk to their doctors. They may benefit from highly effective prescription drugs. Chronic, untreated heartburn can lead to a scarred and narrow esophagus.
Many emergency room chest-pain patients have panic disorders. A panic attack causes heart attack-like symptoms such as chest pain and shortness of breath. If no physical symptoms are present, the doctor may prescribe stress-reducing strategies.