Chest pain is scary. We’re conditioned to always associate it with the heart. That’s a good thing though, because if you’re experiencing a heart attack, you need immediate help. But it does mean we can get worked up or miss other important causes.

Most chest pain isn’t heart related. It can be linked to acid reflux, anxiety, lungs, or even the muscles. Differentiating between these chest pains is important. It can help you decide when you need to dash to A&E or just book a GP appointment.

Below, we’ll go through the different types of non-cardiac chest pain, covering the common causes, what to look for, and when it might be serious.

What Does “Non-Cardiac Pain” Mean?

Non-cardiac chest pain simply means any form of chest pain that doesn’t involve the heart.

There are a lot of structures in the chest: your lungs, oesophagus (food pipe), muscles, and more. Each of these structures can cause pain and is often confused with your heart.

Take heartburn, for example.

It occurs when acid from the stomach flows back into your oesophagus, causing irritation. But because it’s a central, burning pain, it’s automatically associated with the heart.

Always Rule Out the Heart First

If you’re experiencing chest pain, it’s probably not your heart. That is, unless it’s new, severe, and sudden chest pain, or you have breathlessness, sweating, dizziness, or arm or jaw pain. Those symptoms are textbook heart attack. Seek immediate medical attention.

But just because chest pain can be caused by something other than your heart, it doesn’t mean you should assume it isn’t heart related. It's always smart to rule the heart out first. As it’s always better to be safe than sorry.

Common Causes of Non-Cardiac Chest Pain

Acid Reflux and Oesophageal Irritation

Acid reflux and heartburn are the most common causes of non-cardiac chest pain. It occurs when acid backflows into the oesophagus.

You’ll notice a burning sensation or sharp pain behind the breastbone. Other symptoms include a sour taste, worsening after meals or lying down, or a hoarse voice.

Oesophageal Spasms or Pain When Swallowing

Get sharp chest pain when swallowing? That could be an oesophageal spasm. The muscles in your oesophagus don’t contract like they should, creating the sensation of food “sticking” in your chest. This might be why your chest hurts when you swallow.

Muscle and Rib Problems

A common cause is often mistaken for something serious. If you lift weights, heavy boxes, or even cough a lot, you can irritate the muscles, nerves, and cartilage in your chest wall. A chest wall strain or costochondritis can mimic cardiac pain, leading to shortness of breath or shooting pain.

Anxiety and Panic Attacks

Anxiety can create a tight chest sensation. People notice a racing heartbeat and breathlessness. While it’s generally tied to a specific trigger, general anxiety disorders or panic attacks can cause symptoms without any stressor. This can give the impression of a heart-related cause.

Lung-Related Causes

Lung infections or inflammation are another cause of non-cardiac chest pain. Usually, the pain is related to breathing or coughing. There may be shortness of breath, coughing, mucus production, or even coughing up blood.

How Non-Cardiac Pain Feels Different (Sometimes)

Cardiac chest pain often has a distinct pattern. It may come on with exertion and feel like pressure, heaviness, or tightness across the chest.

Non-cardiac chest pain, on the other hand, is more often burning or sharply localised and tied to specific triggers.

With acid reflux, it might follow on from large meals, rich or acidic foods, or lying flat. Other causes include chest infections or muscle strain from intense exercise, which can leave the chest wall sore and tender to the touch.

When to Seek Medical Help Urgently

If you’re not sure if your chest pain is cardiac or not, get checked. In a heart attack, every second matters. Far better to be told you’re okay than to miss a cardiac arrest.

You should always seek medical attention if you notice:

• Sudden severe pain.

• Pain spreading to the arm, neck, and jaw.

• Shortness of breath.

• Collapse or fainting.

New symptoms in someone with heart risk factors.

Take Chest Pain Seriously but Don’t Panic

Chest pain isn’t a small symptom. It’s something that needs to be addressed. Always eliminate the possibility of a cardiac cause first. That’s usually the biggest risk. If you’re sure it’s not cardiac-related, you can book an appointment with your GP.

The Functional Gut Clinic helps people with non-cardiac chest pain determine whether their symptoms are due to acid reflux or a swallowing issue. We use 24-hour acid testing and oesophageal manometry to detect abnormalities. Take the first step towards becoming symptom-free by enquiring about testing today.