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The most common cause of chest pain can in fact be your heart. If you exclude this confidently as a potential cause for your chest discomfort, it’s also important to make sure that there is no problem with your aorta. This problem is an enlargement of your aorta or even in rare circumstances a tear or what we call aortic dissection. That can typically confidently excluded with a CT scan.
In addition, sometimes in rare circumstances blood clots can travel to the lungs. This is termed as a pulmonary embolism that can also be a potentially very serious cause of chest discomfort. Testing predominantly, again, CT technology can help exclude the possibility of a pulmonary embolism. Once you exclude all of these potentially important factors for your chest discomfort, oftentimes doctors left with a patient who has ongoing chest discomfort which is extremely concerning to them but not necessarily life-threatening. So this is more of an outpatient evaluation oftentimes whereas the aforementioned conditions are often addressed in the emergency room.
Causes of Non Cardiac Chest Pain
So let’s assume all life-threatening problems have been excluded. Also assume we’re in the office and we’re discussing ongoing chest discomfort which may or may not associated with activity. You have a normal exam, you have a normal electrocardiogram, and your risk factors for heart trouble are not particularly broad. In that circumstance, doctors think of two other possible causes for chest discomfort.
One can be a musculoskeletal cause. Here you can have pain or discomfort in the muscles or the ribs called intercostal discomfort. There are actually conditions such as fibromyalgia which can cause musculoskeletal discomfort. It has very similar symptoms to a cardiac cause. Fibromyalgia is very concerning to the patient but not necessarily be life-threatening. It is more of a nuisance and negatively impact your quality of life. In that setting, doctors will often send the patient to see a rheumatologist. Rheumatologists are expert in the bone and muscles and can often detect this musculoskeletal inflammation.
If that leads to no obvious cause for your chest discomfort and proves to be a dead end, another equally viable option is to see an experienced gastroenterologist. Esophageal problems such as esophageal reflux, esophageal spasm, acid problems in the stomach and the esophagus can cause chest discomfort which is actually quite similar to your heart.
After seeing all of those doctors and you’ve had the appropriate testing, most often we can identify a cause. And if a cause of the chest pain is not found, last but not least, you can consider seeing a pain management specialist. Pain management specialists can deal with patients with chronic discomfort. It’s not ideal in the sense that we’ve not come up with the cause to your chest discomfort. But in fact it can targeted to relieve your symptoms and improve your quality of life.
So there are some options, don’t despair, we have excellent experts in a multidisciplinary medical center. If the chest pain is not the heart or the lungs or the aorta, then think about gastrointestinal and rheumatologic.