Chest pain is often a cause for concern especially if you are over 40, obese, smoke and have a history of high blood pressure or high cholesterol. Naturally you are inclined to think that it may be a heart attack, but this is not always so. In fact many people who report to emergency rooms believing that they are having a heart attack are actually experiencing heartburn due to acid reflux. Similarly, some people who think they may just be experiencing a bout of reflux may in fact be having a heart attack and do not even known it.
Therefore it is important to be able to differentiate between cardiac and non-cardiac pain, especially if you are within a high risk group for cardiovascular conditions like coronary artery disease.
What is cardiac pain?
Cardiac pain, also referred to as heart pain, is any pain that arises from the heart. With common conditions like coronary artery disease, the pain usually arises from the myocardium – the thick middle muscular layer of the heart which comprises most of the heart wall. However, cardiac pain can refer to pain from any part of the heart, including the heart valves, coronary arteries that supply blood to the heart and even the lining around the heart known as the pericardium.
What is non-cardiac pain?
Non-cardiac pain simply means that the pain is not arising from the heart. It can therefore refer to any pain but is a term usually used to indicate chest pain that does originate from the heart or major blood vessels. With regards to the chest, non-cardiac pain can include chest wall pain, lung pain and esophageal pain. However, neighboring organs like the stomach, pancreas, gallbladder and bowels may be responsible for what is perceived as chest pain. Similarly pain arising from problems in the back can cause chest pain.
Common Problems in Cardiac and Non-Cardiac Pain
The main conditions that give rise to chest pain which may be difficult to differentiate as cardiac or non-cardiac includes angina pectoris, myocardial infarction (heart attack) and gastroesophageal reflux disease (GERD).
- Angina pectoris is a condition where the heart is injured due a lack of oxygen as the coronary arteries are narrowed. It is usually a temporary occurrence and passes with rest or nitrates (drugs that widen the arteries).
- Myocardial infarction, also known as a heart attack, is where a portion of the heart muscle dies as a result of an interruption to the blood supply to the heart.
- Gastroesophageal reflux disease (GERD), also known as acid reflux, is a condition where the stomach acid flows backwards into the esophagus due to a malfunctioning lower esophageal sphincter (LES).
Therefore it is important to differentiate between angina pectoris or a heart attack and gastroesophageal reflux disease (acid reflux). However, there may be other conditions that may also cause chest pain or lead to referred or radiated pain to the chest. This includes:
- Esophageal ulcers
- Peptic ulcer disease
- Inflammatory bowel disease
- Cancer of the esophagus, stomach or lungs.
- Fractured rib
There are various other conditions that may also be responsible for chest pain, or pain in the area of the heart. It is therefore important to seek medical attention for chest pain, even if it is mild and you are not within a high risk group for a cardiovascular disease. Early diagnosis and prompt treatment can save lives. Always speak to a doctor as soon as possible
Differences between Cardiac and Non-Cardiac Pain
There is a large degree of overlap with cardiac and non-cardiac pain including the nature of the pain and accompanying symptoms. Sometimes it is extremely difficult to differentiate and diagnostic investigations may be necessary in order to conclusively identify the cause. It is also possible that there may be no symptoms, not even pain, as is seen in a silent heart attack or with silent acid reflux. However, the following differences may be useful.
Nature of the Pain
Cardiac pain is usually crushing, congestive, aching, squeezing or heavy in nature. Non-cardiac pain due to acid reflux is usually burning in nature, hence the term heartburn. Sometimes cardiac pain can be burning in nature, while acid reflux pain may be similar in nature to typical cardiac chest pain.
Location of the Pain
Cardiac pain is usually centrally located in the chest and may be slightly to the left of the midline. It tends to radiate outwards to the jaw, neck, arm and upper abdomen. It most often occurs on the left side and may also radiate to the back. Non-cardiac pain is usually localized to the affected area and may occur either on the right or left side depending the area that is inflamed.
Triggers and Exacerbating Factors
Cardiac pain is often triggered and worsened with strenuous physical activity as well as with psychological stress. Acid reflux pain is triggered or worsened by overeating, caffeinated or alcoholic beverages, spicy and greasy foods, lying flat or bending over. However, cardiac pain can sometimes be triggered by eating or certain foods. Non-cardiac pain and specifically acid reflux can be triggered or worsened by physical activity and stress in some instances.
Cardiac pain may be relieved or eased by resting or using nitrates and related drugs. However, in some instances these factors may not help with cardiac and emergency medical attention is required. Acid reflux pain is often relieved by antacids within minutes and acid-suppressing drugs like proton pump inhibitors over a longer period. Rest can also help to relieve acid reflux pain if it is triggered or worsened by activity.
There are a host of signs and symptoms that may accompany both cardiac and non-cardiac pain. Nausea is one of the few symptoms that accompany both cardiac and non-cardiac pain. Difficulty breathing, dizziness, excessive sweating and fainting are more likely due to cardiac pain but some of these symptoms may occur as a result of lung problems. Excessive belching, vomiting and changes in appetite are more likely to occur with non-cardiac pain and specifically digestive pain.