Chest Pain isn’t always from the heart

Causes of chest pain

Frequently people consult about experiencing chest pain. I know through training all chest pain is supposed to be referred to the emergency room for evaluation, but realistically many including myself am able recognize symptoms come from many different causes and may have different care needs. The emergency need for consultation is due the fact that many people will deny their symptoms are from a cardiac cause, delaying treatment and thus have pretty extensive heart damage or death. Evaluation thus is helpful in determining the cause.   When one gets evaluated there are many different areas of anatomy where the cause may be from.


Here is a list of many different causes for chest pain:

  • the chest wall including the ribs, the muscles, and the skin;

Possibilities: A rib in poor alignment, shingles, pulled muscle, cartilage between the ribs being inflamed,

  • the back including the spine, the nerves, and the back muscles;

Vertebra alignment, pinched nerve, shingles,

  • the lung, the pleura (the lining of the lung), or the trachea;

Recent cold/cough, bronchitis, blood clot, pulmonary embolism, pleurisy, pnumothorax – collapsed lung,

  • the heart including the pericardium (the sac that surrounds the heart);

Pericarditis, aortic dissection, angina, heart attack, blood clot

  • the aorta; aortic dissection
  • the esophagus;  Acid reflux, narrowed esophagus, regurgitation
  • the diaphragm, the flat muscle that separates the chest and abdominal cavities; 
  • referred pain from the abdominal cavity including organs like the stomach, gallbladder, and pancreas, as well as irritation from the underside of the diaphragm due to infection, bleeding or other types of fluid.

Gastric bleeding, septicemia, blood infections, gastric ulcers,


The symptoms of heart attack  for men or women.




Exercise Induced Angina

Do you get chest discomfort with activity?

This is known as exercise induced angina. Angina is generally caused from not getting enough blood through the arteries to supply the walls of the heart with enough blood flow to adequately pump. Angina can be caused by blockage, injury or spasms. It can be particularly irritating when it comes on with exercise. Here are some things to know about symptoms you might experience when exercising.

  • Warm up adequately to prevent angina with activity/exercise.Try to do 5-10 minutes of very light exercise with minimal resistance before pushing the intensity up and before increasing the resistance on your exercise equipment. This allows the arteries to dilate – or widen thus increasing the ability to bring more blood flow to the heart.
  • Never try to push through angina, as it is a warning that your heart isn’t getting enough oxygenated blood. When symptoms come on reduce your exercise intensity to see if it will resolve. Many patients can back down for several minutes and the symptoms resolve. If the symptoms do not resolve use your nitroglycerin medication as prescribed.
  • Keep documentation of the frequency of the symptoms. In particular you are looking to see if the symptoms are coming on at a specific workload, or if the frequency of the symptoms is increasing.
  • If you watch your heart rates, most physicians will advise you to keep your exercise heart rates 10 points below where you get the onset of symptoms. It is recommended you purchase a heart rate monitor – a watch and strap for the chest to be able to gauge your exercise intensity from your heart rate. I am old school and hold allegiance to the Polar Heart Rate Monitors, they will run you about $50.
  • Recognize you are not a perfectly tuned machine, some days are going to be rough and you will need to take it easy. Many factors contribute to increased angina symptoms including increased  physical and emotional stress on the body, fighting illness, blood pressure, sleep, temperature being very cold or high heat and humidity, timing of medications, timing type and amount of food in the system, blood sugar, hormones…you get the picture.
  • Some patients will always have angina symptoms due to the injury to the heart, the size of the vessels, or spasm. It is important to work with you physician to determine what amount of angina is acceptable. With small vessel disease (microvascular angina) many have to accept a certain amount. It is often graded on a 1-10 scale with 10 being the worst, and some patients were allowed by their physicians to exercise with symptoms of 1-3 on the 1-10 scale if they did not have abnormal blood pressure or ekg changes and were free of symptoms such as shortness of breath. Gradually as they improved their physical conditioning their angina threshold (the intensity of exercise which produces symptoms) increased to where they could tolerate more intense workloads without symptoms worsening.

When is it angina dangerous?

There is a difference in stable and unstable angina. Stable angina is predictable. It can be triggered by emotional stress, exercise, exposure to cold air, after eating large heavy meals. It is relieved with rest, and doesn’t usually have other symptoms such as shortness of breath, profuse sweating, nausea associated with it.

Unstable angina is angina that is different as it can occur at rest or wake you from sleep. It is a change in the stable angina symptoms meaning the symptoms are more frequent, more intense – may require more nitro than usual to relieve symptoms. It may be paired with other symptoms, profuse sweating, nausea, shortness of breath, weakness, a feeling of doom, lightheadedness. If you are experiencing symptoms of unstable angina you must contact your medical provider ASAP. Time is muscle and you don’t want to risk losing heart muscle.