World Heart Day: Difference between cardiac and non-cardiac pain

–        Dr. Yogesh Harwani, Gastroenterologist, Noble Gastro Hospital

Cardiac chest pain also known as Anginal Pectoris, occurs due to inadequate blood supply and oxygen to the heart. It is like crushing of squeezing pain in the chest that may radiates to the left arm shoulder.

Non-cardiac chest pain is sharp or burning pain in chest which is not related to the heart and may be caused by infections, trauma, GERD, acid peptic disease or muscularache or any disorder of esophagus, etc. It is typically behind your breast bone and closer to your heart.

How to differentiate whether it is related to heart or not?

There are few features of heart disease related pain:

• Sensation of pain or of pressure, tightness, squeezing or burning
• Gradual onset of pain over the course of a few minutes
• Pain in different areas including constant pain in middle of chest extends to the left arm, neck, jaw or back
• Accompanied by other signs like difficulty in breathing, a cold sweat or sudden nausea
• Usually appears during or after physical exertion or emotional stress.

Non-cardiac chest pain is more like

• Pain which increases by breathing or coughing that only stays for few seconds and that is not continuous
• Only to one side of body and localised to one small spot.
• May last for many hours or days without any other symptoms,
• May be associated with burning behind breast bone, nausea, vomiting, eructation, fever, coughing etc.

The most common non-cardiac chest pain causes are GERD, anxiety, muscular pain, costochondritis, Pneumonia, Hiatus hernia and panic attacks.

How to differentiate by tests:

There are certain tests for chest pain due to cardiac disease:

ECG, Troponin-1, 2D-Echo, CT – Coronary Angiography and conventional Angiography.

For non-cardiac chest pain:

X-ray, USG-chest, UGI Endoscopy, Manometry, CT-Scan, etc.

Do’s and Don’ts in Chest pain:

Do’s

First of all, never ignore the chest pain or taken for granted and assume that it is because of gas/acidity as it could be serious, consult your primary physician and do the test which are necessary, to diagnose the cause of chest pain. Then if it is cardiac, then do the further investigations and treatment of that disease because that may be harmful of it may endanger your life, do the consultation to your Cardiologist, take medicines, do regular checkup, do exercise, yoga, etc. to get good cardiac health.

For other causes, control infections, do some mindful-meditation or yoga for anxiety and sometime psychiatric medicines, do regular exercises, weight reduction, avoid certain foods, proper sleep, if possible, do consultation with your gastroenterologist and endoscopy if needed…

Don’ts

• Don’t make assumptions and don’t assume heart disease based on the age and fitness.
• Don’t wait for more time before it may cause for late
• Don’t apply pressure on chest
• Don’t drive yourself
• Don’t do more vigorous exercise if you are experiencing pain
• Avoid certain type of foods
• Don’t take medication without consultation to your primary care physician.

In many cases, causes of chest pain other than the Cardiac issues are mainly related to esophagus or stomach for example Esophagitis, GERD, APD, & Esophageal or Gastric ulcers, motility disorders of esophagus, fungal infection of esophagus, Laxity of G-E junctions, Gastritis etc., so in this cases first consultation and proper diagnosis is necessary then certain dietary measures, avoidance of certain type of foods, endoscopic examination, regular exercise, meditations may usually resolves the problem because of stress full life, food habits. These problems arise in day-to-day life and call it as pathological. One should call it as lifestyle disorders.

Most important measures are diatory modification, weight loss, prevention from certain infection, quit smoking, tobacco, regular exercise, and mental health play vital role in prevention of these type disorders.

Number of disorders leading to chest pain other than heart issue:

• Muscular-muscleache acidity disorders (30-35%),
• Acidity (5 – 30%),
• Psychiatric disorders (5 to 11%),
• Lung diseases (3 to 6%)
• Cardiac disorders (26 to 28%)