Atypical Chest Pain
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This article will review the symptoms, causes, and management of atypical chest pain. Atypical chest pain differs from chest pain indicative of a heart attack. Symptoms include sharp or tearing pain, shortness of breath, and back pain.
What is atypical chest pain?
Atypical chest pain is defined as chest pain that does NOT have all three characteristics of chest pain that is typical of a heart attack. These typical indicators include: 1) chest pain or discomfort in the center of the chest behind the breastbone, 2) gets worse with exertion or stress, and 3) gets better with rest or a medication called nitroglycerin.
Instead, atypical chest pain will be sharp, stabbing, or tearing, in a specific area of the chest, and may last for hours or days. You may also experience a cough or shortness of breath as well as difficulty swallowing.
Atypical chest pain may be treated through monitoring, medications, or procedures. If the pain is severe or you experience shortness of breath, or you have a history of heart disease, you should seek immediate medical attention.
It looks like your chest pain is atypical, however further testing might be needed. Therefor, you should schedule an appointment within two days with your primary care physician who can coordinate these further tests. These will likely include a stress EKG (electrocardiogram), which is a readout of the hearts' electrical activity during exercise.
Atypical chest pain symptoms
As covered in the synopsis, atypical chest pain does not have all three characteristics of chest pain indicative of a heart attack. Therefore, atypical chest pain may instead have the following characteristics:
- Quality: Unlike typical chest pain, which is usually a dull pain or pressure sensation, atypical chest pain may be sharp, stabbing, or tearing. Atypical chest pain may get worse when breathing in, may get better with leaning forward, and may be worse when you push on the chest. The pain may be worse with eating, which suggests a gastrointestinal cause.
- Location: Atypical chest pain may be located in a specific area of the chest, unlike typical chest pain, which is usually felt throughout the chest. Atypical chest pain may also spread to the back. Pain that spreads to the arms or neck is more characteristic of typical chest pain.
- Onset and timing: Atypical chest pain may come on suddenly, which is unusual for typical chest pain. Atypical chest pain may also last for hours or days, while typical chest pain usually does not last for more than 20 to 30 minutes.
Other symptoms of atypical chest pain will likely include the following.
- Cough or shortness of breath: Atypical chest pain may be associated with cough or shortness of breath, especially if it is due to a lung-related cause. Gastroesophageal reflux disease (GERD) can also cause a long-standing cough.
- Painful or difficulty swallowing: Atypical chest pain may be associated with pain or difficulty swallowing if it is due to a gastrointestinal cause such as gastroesophageal reflux disease.
Atypical chest pain causes
Atypical chest pain refers to chest pain that is not “typical” of the kind caused by a heart attack. The definition of atypical chest pain is not clear, and different people may mean different things by atypical chest pain. Many things can cause atypical chest pain and a few are described below.
Atypical chest pain may still be due to a heart attack, even without all of the “typical” symptoms. In particular, women, older people, and people with diabetes who are having a heart attack are more likely to present with symptoms other than typical chest pain, such as shortness of breath, nausea or vomiting, or passing out.
Heart-related causes other than heart attack
Other than a heart attack, other heart-related causes can cause atypical chest pain. A few of these include:
- Inflammation of the heart: This may be of the lining of the heart (pericarditis) or of the heart muscle (myocarditis).
- Diseases of the heart valves
- Failure of the heart to pump normally
- Aortic dissection: This is a tear in the large blood vessel that delivers blood from the heart.
Because the lungs are also located in the chest, lung disorders can also cause atypical chest pain. A few include the following:
- Pulmonary embolism (PE): A blood clot in the lungs
- Pneumothorax: A collapsed lung
- Pneumonia: An infection of the lungs
- Chronic obstructive pulmonary disorder (COPD)
- Lung cancer
The esophagus and stomach are both located in or near the chest, and disorders of these organs can cause atypical chest pain, such as the following.
- Gastroesophageal reflux disease (GERD): A common cause of atypical chest pain, this occurs when acid from the stomach refluxes back into the esophagus, causing irritation.
- Gastritis: This is inflammation of the stomach lining.
- Inflammation of the esophagus
- A tear in the lining of the esophagus
Musculoskeletal chest pain
Injury to the muscles or bones in the chest is another common cause of atypical chest pain. Musculoskeletal chest pain can be due to direct injury to the chest, which can lead to tissue damage and broken ribs, as well as injury to the chest from overuse.
Anxiety and panic attacks can cause symptoms that may feel like a heart attack. During a panic attack, you may experience sudden-onset chest pain or tightness, shortness of breath, dizziness, and intense fear. However, if you are younger than 40 years old, are otherwise healthy, and do not have a previous heart condition, it is more likely to be a panic attack.
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Treatment options and prevention for atypical chest pain
The treatment for atypical chest pain will vary depending on the cause of chest pain. Treatment may include clinical monitoring, medications, procedures, and/or surgery. Some examples of treatments for various causes of atypical chest pain are described below.
Some causes of atypical chest pain may not require treatment and may be clinically monitored by both you and your physician. For example, mild musculoskeletal pain that does not bother you can be monitored.
Some causes of atypical chest pain may be treated with medications.
- For inflammation of the lining of the heart: This is usually treated with a combination of aspirin, ibuprofen (Advil, Motrin), or indomethacin (Indocin) with colchicine (Colcrys).
- For a blood clot in the lungs (pulmonary embolism): People with a blood clot in the lungs may need to be treated with blood thinners such as heparin or warfarin (Coumadin).
- For pneumonia: People with pneumonia may need to be treated with a course of antibiotics.
- For gastroesophageal reflux disease (GERD): People with gastroesophageal reflux disease may benefit from a course of medications to decrease acid levels in the stomach such as omeprazole (Prilosec) or pantoprazole (Protonix).
Procedures or surgery
Some causes of atypical chest pain may require treatment with procedures and/or surgery.
- For a heart attack: You will need to be treated with a procedure to open up the blocked blood vessel on the heart, or with open heart surgery to bypass the blocked blood vessel.
- For a collapsed lung (pneumothorax): People with a collapsed lung may need to have a needle or tube inserted into their chest to help re-inflate the lung.
- For an esophageal tear: People with a tear in their esophagus may need surgery to repair the tear.
When to seek further consultation for atypical chest pain
If you develop any symptoms of atypical chest pain such as the following, you should seek care right away:
- A sharp chest pain that gets worse with breathing in or position changes
- Back pain
- Shortness of breath
If you have a history of heart disease, you should consider going straight to the emergency department or calling an ambulance. Even heart attacks can cause atypical chest pain, so it is important to be promptly evaluated by a doctor and treated.
Questions your doctor may ask to determine atypical chest pain
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Do your symptoms occur after an emotional time or recent stress?
- Any fever today or during the last week?
- Do you have a cough?
- Where is your chest pain exactly?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He graduated Phi Beta Kappa from Swarthmore College with a BA in biology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness. In his free time, he enjoys running, biking, and spending time with his friends and family.
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