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Patient guide

Non-cardiac chest pain

Chest pain is common and frightening. Once serious heart causes have been assessed, many people are told their pain is ‘non-cardiac’. This guide explains what can cause it and how we investigate respiratory and other causes.

When to call 999

Call 999 for sudden chest pain or discomfort that does not go away, pain spreading to an arm, neck, jaw, back or stomach, or chest pain with sweating, nausea, light-headedness or breathlessness. Do not wait for a private appointment. New sharp pain when breathing or coughing needs prompt advice from your GP or NHS 111.

Heart causes come first

Chest pain can arise from the heart, lungs, chest wall, oesophagus (food pipe) or stomach. The pattern of pain alone cannot safely establish the cause. Suspected heart-related pain needs assessment first – for example an ECG, blood troponin tests in hospital, or tests such as a CT coronary angiogram, following NICE guidance. A normal ECG alone does not rule out a heart problem. We see patients with chest pain once urgent and heart causes have been assessed, or alongside cardiology when the cause is unclear.

Common causes of non-cardiac chest pain

  • Chest wall pain – strain of muscles or joints, or inflammation where the ribs join the breastbone (costochondritis). It is often tender to touch and worse with movement.
  • Reflux and oesophageal problems – acid reflux (GORD) or spasm of the food pipe can cause burning or squeezing pain that can feel like heart pain.
  • Pleural and lung causes – pleurisy, chest infection, a blood clot in the lung (pulmonary embolism) or a collapsed lung typically cause sharp pain on breathing in. Some of these need urgent treatment.
  • Breathing-pattern disorder and anxiety – an altered breathing pattern, panic and anxiety can cause chest tightness, pain and breathlessness. These symptoms are real and treatable.
  • Other causes – shingles before the rash appears, and occasionally problems in the upper abdomen.

How we assess it

Your consultant asks about how the pain started, where it is, what brings it on and eases it, associated symptoms and risk factors, and reviews previous heart tests. Depending on the likely cause, tests may include a chest X-ray, blood tests, spirometry or full lung function tests, a CT scan, or tests for blood clots. We may involve cardiology or gastroenterology colleagues where needed.

Treatment

Treatment follows the diagnosis. Chest wall pain often settles with simple pain relief, activity modification and physiotherapy. Reflux is treated with lifestyle measures and acid-reducing medicines, with referral for further tests if symptoms persist. Pleurisy may need pain relief and treatment of its cause. Breathing-pattern disorder responds well to specialist breathing retraining, and psychological support can help when anxiety plays a part. Understanding the cause, and knowing what has been ruled out, is itself an important part of treatment.

Preparing for your appointment

  • Bring letters and results from previous heart tests, including ECGs and scans.
  • Keep a note of when the pain occurs, how long it lasts and what helps.
  • Bring a list of your medicines.

Sources and further information

This guide gives general information for adults and does not replace individual medical advice.