When Chest Pain Doesn  t Come from the Heart

Chest pain can be scary. If you experience it, visit your healthcare provider to rule out urgent heart problems and get a referral to a specialist. But your chest pain may not actually be caused by your heart: Non-cardiac (non-heart-related) chest pain affects up to 24 percent of the adult population, according to the National Institutes of Health (NIH). That’s 70 million people.

Digestive Disorders and Chest Pain

The biggest culprit in non-cardiac chest pain? Digestive disorders. It’s easy to mistake one for the other because the heart and the esophagus (the tube that leads from the mouth to the stomach) are close together in the chest cavity, and pain emanating from either one travels to the brain through the same nerve fibers, giving it very similar features.

Gastrointestinal, or GI, difficulties account for 70 to 80 percent of non-cardiac chest pain, according to Truptesh H. Kothari, MD, MS, assistant professor of medicine in gastroenterology and hepatology and director of the developmental endoscopy laboratory at the University of Rochester. Of that, 30 percent is gastroesophogeal reflux disease (GERD), also known as frequent, persistent heartburn. GERD can also be a symptom of heart disease—yet another good reason to have a full heart work up conducted.

"GI problems in this country are primarily caused by the western lifestyle and diet. Many people are overweight, eat too much red meat, smoke, overindulge in alcohol, and are sedentary [physically inactive]," says Kothari, who adds that spicy food does not cause acid reflux: "Reflux is food backing up from your stomach and into the esophagus, and the reason for this is the lower esophagus opening (sphincter) isn’t as tight as it should be. Any food—bland or spicy—can cause acid reflux."

Aside from heartburn, other digestive disorders like ulcers, gall bladder and pancreatic diseases, and (rarely) tumors can be experienced as chest pain. Margaret Shanks, MSN, FNP/C, a nurse practitioner specializing in cardiology in Philadelphia, PA recalls a woman in her 60s—also a nurse—who thought she was having a heart attack when severe chest pain hit her hard.

"An elephant sitting on her chest was the how she described it, and she was short of breath and dizzy, too—classic female heart attack symptoms," remembers Shanks. But tests revealed no heart problems. The cause of the pain? A sluggish gall bladder.

Esophageal issues such as nutcracker esophagus (high-pressure contractions of the esophageal muscle) and achalasia (loss of nerve cells prevent the esophagus from contracting properly) can lead to chest pain, too, but can usually be treated with meds or minimally invasive surgery.

Cardiac or Non-Cardiac Chest Pain?

The best way to distinguish between cardiac and non-cardiac chest pain is see your health care professional, who should take a medical history and observe your symptoms: "Patients having a heart attack look restless and anxious. GI pain is often burning. Musculoskeletal [pain] is more a tightness that improves when the distressed person changes positions," Shanks explains.

"Pain that has been constant for three days isn’t likely the heart," she adds. "I’m more concerned if the patient tells me that the pain started during or after exercise. If it happens frequently after a dinner of wine and steak, then I’m thinking GI."

Other symptoms that are less likely to be a heart attack are:

  • Sour taste in the mouth
  • Pain that worsens with coughing or deep breathing
  • Chest pain that lasts less than 5 seconds

Non-cardiac chest pain affects both men and women. But according to the American College of Gastroenterology (ACS), some studies have found that females suffer from non-cardiac chest pain more frequently than men, though the reasons why are not well understood.

Treating Non-Cardiac Chest Pain

Medications called proton pump inhibitors (PPI) have a high success rate for patients with GERD. "About 80 percent experience relief," says Kothari. "Patients take the PPI medicine about an hour before eating breakfast for a few weeks. If the symptoms lessen, the medication is lowered and continued for eight more weeks. It works to neutralize the acid in the stomach and since it doesn’t stimulate the nerve fibers of the esophagus, the pain subsides."

For patients that do not respond to the proton pump inhibitor low dose tricyclic antidepressants are often prescribed. Side effects include mouth dryness, sleepiness, blurred vision, and urinary retention.

Many GI disorders can be remedied with lifestyle changes: "Losing weight can make a dramatic difference. Eating small portions and having four to five meals a day helps metabolize food faster and reduces stomach back up," says Kothari. "The stomach is an organ, too. When it is overworked, it gets tired and you’ll get indigestion and bloating. Being mindful of this can be helpful."

Truptesh H. Kothari, MD, MS, reviewed this article.


Truptesh H. Kothari, MD, MS, assistant professor of medicine in gastroenterology and hepatology and director of the developmental endoscopy laboratory at the University of Rochester in Rochester, NY. Phone interview, 18 August 2014.

Margaret Shanks, MSN, FNP/C, nurse practitioner specializing in cardiology. Philadelphia, PA. Phone interview, 18 July 2014.

Schey, Ron, Autumn Villarreal, and Ronnie Fass. "Noncardiac Chest Pain." Gastroenterol Hepatol, Apr 2007; 3(4): 255–262. 

Sami R. Achem, MD, FACG. "Non-cardiac Chest Pain." American College of Gastroenterology. Updated July 2013. 

"What’s Causing Your Chest Pain?" The Society for Cardiovascular Angiography and Interventions. April 20, 2013.