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Cardiac vs. Non-cardiac Chest Pain

The term “chest pain” is commonly associated with heart attacks or other types of cardiac conditions, such as angina. In fact, roughly half of the chest pain cases seen by doctors are of cardiac origin. The remaining 50% is referred to as non-cardiac chest pain (NCCP). So where is the pain coming from? What most may not realize is there are multiple sites in our bodies that, when injured or diseased, can cause pain in our chest.

While most individuals who suffer from chest pain quickly seek medical attention, others may attribute it to a musculoskeletal cause. In this case, they may seek help from a Physical Therapist. Fortunately, we are qualified to recognize the difference between true cardiac chest pain (CCP) and chest pain of which the primary source stems from elsewhere in the body. Although there is no definitive way for the average person to differentiate the two, here are a few distinctions between cardiac and NCCP:

Cardiac chest pain often presents itself as a burning, squeezing, crushing or heavy feeling. This type of pain is more diffuse, meaning it fans out from its central point. CCP can also cause pain that travels down the arms, jaw, neck and back. Individuals with CCP are often relieved by rest and nitrates, medicines designed to relieve chest pain due to cardiac disease.

Non-cardiac chest pain can vary from sensations such as stabbing, sharp and burning. Also, the exact location of NCCP can usually be pinpointed. NCCP does not radiate to other parts of the body, but is considered to be a secondary site of pain. The most common primary site is the esophagus, given its close proximity to the heart, but the lungs, stomach, diaphragm, and gallbladder can be responsible as well. As Physical Therapists, the cause for which we can provide treatment is musculoskeletal in nature. In fact, a study conducted by Spalding et al. showed that, of 250 patients hospitalized with chest pain, 23% of patients with NCCP were felt to have a musculoskeletal cause. This type of pain involves the ribs, spine or muscles of the chest wall, and symptoms include limited movement of the spine and pain on palpation of the chest area.

If you ever suffer from chest pain, it is important you seek immediate medical attention. Provided the cause is diagnosed as being musculoskeletal, do not hesitate to consult a Physical Therapist, as they will be able to offer you treatments which will help alleviate your pain.

References:

Lenfant, C. (2010). Chest Pain of Cardiac and Noncardiac Origin. Metabolism. 59 Suppl 1:S41-6

Spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. J R Soc Med 2003; 96:122.