Chest Pain: What if it's not angina?

Updated:May 6,2013

Chest Pain Illustration with Heart BeatChest pain can be scary and confusing. What’s causing it? What should you do?

You may have angina, which occurs when your heart muscle doesn’t get enough oxygen-rich blood, if you feel incredible pressure or just tightness in the center of your chest. Other symptoms are shortness of breath, nausea or discomfort that spreads along your shoulders, arms and back.

Angina in women may have different signs, including back pain, lower chest pain or a complete absence of chest pressure. These symptoms are not always caused by angina, but if you experience any of them, you should see your doctor right away.

“This is especially true if you have any risk factors for heart disease, a family history of it or if this feeling is new or unusual for you,” said Dr. Nieca Goldberg, cardiologist and medical director of Joan Tisch Center for Women's Health at NYU Langone Medical Center and American Heart Association volunteer. “And if it starts happening when you are resting or asleep, get to a hospital. The same is true if the pressure starts to be triggered by lesser degrees of exertion.”

What if my chest pain is not angina?

Other Causes of Chest Pain
Your chest pain could also be caused by a lung infection or even reflux, which may occur an hour after a heavy meal and leave the taste of acid in your mouth. Or it could be pericarditis, an inflammation of the muscle around your heart. Another cause could be hypertrophic cardiomyopathy, a disease of the heart muscle. Pain associated with this condition is often triggered by deep breaths or lying down, and the pain or pressure worsens if you move your torso. With angina, moving your torso does not change or relieve the pain. Here are some other common causes of chest pain that are not angina:
  • Pulmonary embolism (a blockage in a lung artery)
  • Aortic dissection (tearing of a major artery)
  • A lung infection
  • Aortic stenosis (narrowing of the heart’s aortic valve)
  • A panic attack
You may be unsure about your pain, but it’s always best to talk to your doctor rather than trying to self-diagnose your condition.  “People tend to find the diagnosis they want to think is right vs. what actually is right,”  Goldberg said.

“It’s important to see your physician who can systematically isolate the root cause, exploring the most dangerous of the possibilities first.”

She added: “Early detection can help you avoid a heart attack. Many people live with angina today and never have a heart attack.”

Talk to Your Doctor
Your doctor will probably ask you a series of questions to rule out the most critical or life-threatening possibilities. Think ahead so you can provide as much information as possible. Here are some questions you might be asked:
  • How long have you had this condition?
  • On a scale of 1 (mild) to 10 (critical), what is your level of discomfort?  
  • What behavior(s) provoke the pain? Physical activity? Eating? 
  • What relieves the discomfort?
Bottom Line
“If you experience any kind of chest pain or discomfort, always assume it is the heart first,” Goldberg said. “See your doctor immediately and do not wait for the condition to worsen.  It’s important to work with your doctor to rule out the most critical condition — the most deadly — as soon as possible.”

Learn more:

Cardiovascular Conditions

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