Definition – chest pain that is due to causes other than heart disease and often referred to as atypical chest pain.
Significant because the cardiac chest pain in women and diabetics may not be classic angina pectoris and may mimic non-cardiac chest pain
Chest wall disorders:
Costochondral – Costosternal
Exercise or movement induced chest pain.
Pain over musculoskeletal area of anterior chest, especially over the costochondral junctions that are red, swollen, warm and tender
Pain is fleeting and sharp
Intercostal or pectoral muscle strain – exercise
Herpes Zoster in the pre-eruptive stage
Post-viral or viral neuritis
Referred nerve root pain from compression or irritation of cervical or thoracic nerve roots
Pleuritic Pain (sharp or cutting secondary to coughing) is due to inflammation of the pleura
Viral pleuritis due to Coxsackie B or pleurodynia
Pneumonia with pleural inflammation (knifelike pain exacerbated by inspiration or coughing)
Pulmonary infarction in a minority of pulmonary embolism cases
Connective tissue disease – Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE) - especially in lupus
Cancer involving the pleura – heavy or dragging sensation
Gastroesophageal Reflux Disease (GERD)
Most frequent symptoms:
Pain worsened by alcohol, aspirin or some foods and by lying down.
Pain relieved by antacids.
Hard to diagnose
Mallory-Weiss tear – due to severe retching and vomiting
Peptic Ulcer Disease
Often 60 to 90 minutes after meals.
Increased appetite or anorexia
Nausea and vomiting
Bloating and belching.
Upper GI bleeding
Cholecystitis with gallstones
Occasional chest pain.
Biliary colic (prolonged periods of right upper quadrant (RUQ) pain or epigastric pain that frequently radiates to right shoulder and may be associated with nausea and vomiting
Occasional chest pain
Patient is often an alcoholic
Emotional and Psychiatric Conditions – pain is often variable (visceral tightness that lasts more than 30 minutes or is fleeting, sharp or localized),and clues as to origin are depression, prior panic attacks, somatization, agoraphobia.