Chest pain, but not a heart problem? Let's talk about (Noncardiac Chest Pain)

Imagine that you suddenly feel a pain in your chest, like a heavy weight being placed on it. Doesn't it make you panic? Our mind races with fear, "Is this a heart attack?" That fear is actually reasonable. But did you know, not all chest pain is caused by a heart problem. Sometimes the cause of this pain can be something that has nothing to do with the heart. Today, in this article, we will talk about this chest pain that scares many people, but is not related to the heart, which is medically known as (Noncardiac Chest Pain - NCCP) .

Simply put, what is this really about?

Noncardiac Chest Pain (NCCP) is simply a pain in the chest that occurs without any problem with your heart. It can feel exactly like the pain that comes from a heart attack (angina). That's why it often confuses us and scares us.

Now you might be thinking, "If it's not the heart, why does it hurt in the chest?" That's a good question. Our esophagus is located very close to where our heart is inside our chest, which is where the food goes to the stomach when we eat. The pain signals from both organs are carried to the brain by the same nervous system. So sometimes the brain can't tell whether the pain is coming from the heart or the esophagus. It's like feeling a problem next door as if it's a problem at home.

What many of us call "heartburn" is not actually a heart problem, but rather an inflammation caused by stomach acid rising up into the esophagus. Despite the name, it has nothing to do with the heart. This is a prime example of NCCP.

How does this pain feel? What are the symptoms?

As mentioned earlier, this pain is very similar to the pain experienced during a heart attack. So it can be a little difficult to distinguish between the two. Let's take a look at what these symptoms are.

This pain can sometimes start after a large meal or when you feel stressed. It can last from a few seconds to a few hours. If the pain lasts for more than a few minutes, it is wise to seek medical advice immediately.

Why is this happening? What are the main reasons?

Okay, now let's see what other things could be causing this pain, if not the heart.

1. Esophageal Problems

This is the most common reason for NCCP.

• GERD (Gastroesophageal Reflux Disease): Simply put, this is a condition that occurs when gastritis becomes severe. The acid in the stomach comes up and travels up the esophagus into the throat. This acid burns the walls of the esophagus, causing inflammation and pain. This is what we called "heartburn" as we talked about earlier.
• Esophagitis: In addition to GERD, other infections, certain medications, or allergies can cause the lining of the esophagus to swell. This swelling can also cause chest pain.
• Esophageal muscle problems: Our esophagus is a tube made of muscles. If these muscles do not work properly, they can suddenly spasm or tighten. This can cause severe chest pain and difficulty swallowing.
• Esophageal Hypersensitivity: Some people have very sensitive nerves in their esophagus. Even a small change in pressure, or even a small amount of acid, that a normal person would not notice, can be felt as a great pain to them.

2. Musculoskeletal Pain

Sometimes the pain doesn't come from inside the chest, but from the chest wall.

• Chest pain can also be caused by conditions such as a torn rib, a bruised rib, or inflammation of the cartilage that connects the ribs (costochondritis) .
• A simple way to identify this is to press your finger directly on the area where you are experiencing pain and if the pain increases, it is likely to be a muscle or bone-related pain like this.

3. Psychological Conditions

This is a surprising fact to many, but it is very important.

• Things we feel inside, such as stress, anxiety, and depression, can manifest as physical pain, especially chest pain.
• Imagine that you suddenly feel very scared and anxious (panic attack), have difficulty breathing, your chest tightens, your heart beats faster, and you feel like you are having a heart attack. Although this is a mental state, the pain you feel is 100% real pain.

4. Lung Conditions

Although rare, chest pain can also be caused by certain lung conditions, such as pleural effusion or pneumothorax .

How do doctors find this?

When you go to a hospital, especially an Emergency Department (ETU) with chest pain, the first thing the doctors do is check if you have a life-threatening heart condition. That's the priority.

1. Making sure there are no heart diseases:

• Blood tests: These check for enzymes that accumulate in the blood during a heart attack.
• ECG (Electrocardiogram): The electrical activity of the heart is checked to see if there are any abnormal patterns.
• Exercise stress test: An ECG is taken while you exercise to see how your heart responds to stress.
• Heart CT scan: This test can be done to see if there are any blockages in the blood vessels of the heart.

Only after doing all these tests and being 100% certain that the cause of your chest pain is not your heart will the doctor come to the conclusion that you have NCCP.

2. Next, find the cause:

• You may then be referred to a gastroenterologist .
• There, tests such as an upper endoscopy (examination of the esophagus and stomach with a tube with a camera), esophageal manometry, or esophageal pH test are performed to try to find the exact cause of the pain.
• Sometimes your doctor will first try some medications for GERD (such as Proton Pump Inhibitors - PPIs). If those medications reduce your chest pain, it can be confirmed that GERD is the cause.

What are the treatments?

Treatment depends on the cause of your pain.

• If the cause is GERD: Medications such as proton pump inhibitors (PPIs) that reduce stomach acid production are given. These are the most commonly used and most effective treatments.
• If the cause is a problem with the muscles in the urethra: There are medications or other treatments to relax those muscles or restore their function.
• If the cause is stress or anxiety: Psychological therapy and stress management are very important. Also, sometimes antidepressants , such as tricyclic antidepressants or SSRIs , are given in very low doses. These medications are not only used to treat depression, but they are also used to control long-term nerve pain. So if your doctor prescribes a medication, don't think, "I'm not crazy, why am I giving this medication?"

Noncardiac Chest Pain is not usually life-threatening. However, it can have a significant impact on your quality of life. It's not easy to live with the constant fear of chest pain. Also, if the underlying cause (e.g. GERD) is not treated, it can lead to other complications over time.