Characteristics of Cardiac and Non-Cardiac Chest Pain and How to Diagnose a Case by Pain’s Nature

1. Understanding Chest Pain: An Overview

Chest pain can be a harrowing experience, but it’s not always a sign of a heart problem. It can be tricky to distinguish, as cardiac and non-cardiac chest pains vary in intensity and location. The nature of pain, its duration, and associated symptoms can provide essential clues for diagnosing the cause.

Differential Diagnosis of Chest Pain
Differential Diagnosis of Chest Pain

Cardiac Chest Pain: Deep Dive into the Details

1. Location

Cardiac chest pain, or angina, is typically located in the centimetre or left side of the chest. It can sometimes be challenging to pinpoint and may feel like it’s coming from the upper abdomen or the neck.

2. Radiation

The pain often radiates or spreads from the chest to other areas. Common radiation sites include the jaw, left arm, shoulder, back, and teeth.

3. Mode of Onset

Cardiac chest pain often has a sudden onset. It’s usually triggered by physical exertion, emotional stress, or even cold weather, and it tends to come on gradually, building in intensity over several minutes.

4. Character

The character of cardiac chest pain is often described as squeezing, pressing, crushing, or a sense of heaviness. A feeling of impending doom often accompanies it.

5. Temporal Pattern

Cardiac chest pain usually lasts from a few minutes to 15 minutes. It may suggest a heart attack (myocardial infarction if it lasts longer).

6. Exacerbating and Relieving Factors

The pain typically worsens with physical exertion or emotional stress and improves with rest or medications such as nitroglycerin.

7. Intensity

The intensity of cardiac chest pain can range from mild to severe. However, the severity of pain doesn’t necessarily reflect the extent of heart damage.

Non-Cardiac Chest Pain: Unfolding the Spectrum

1. Location

Non-cardiac chest pain can be located anywhere in the chest. It might be pinpointed to a specific area and is often not restricted to the left side.

2. Radiation

Thof pain generally doesn’t radiate to the arm, neck, or jaw. However, it might extend to the abdomen, particularly to gastroesophageal reflux disease (GERD) or gallbladder disease.

3. Mode of Onset

Non-cardiac chest pain might have a sudden or gradual onset. Eating, stress, or changes in body position often trigger it.

4. Character

The character of non-cardiac chest pain is often sharp, stabbing, or burning. It might also feel like pressure or fullness in the chest.

5. Temporal Pattern

The duration of non-cardiac chest pain is variable. It can last for seconds, minutes, or even hours.

6. Exacerbating and Relieving Factors

The pain may worsen with deep breathing, coughing, eating, or changes in body position. It often doesn’t improve with rest or nitroglycerin but may improve with antacids if it’s due to GERD.

7. Intensity

The intensity of non-cardiac chest pain can also vary greatly, from mild to severe. Pain severity, however, doesn’t necessarily correlate with the seriousness of the underlying condition.

The Art of Diagnosing Chest Pain

Diagnosing the cause of chest pain ed an art form, blending detailed patient history, clinical examination, and scientific tests. A multi-faceted approach is essential to distinguish between cardiac and non-cardiac chest pain accurately.

1. Clues from the Patient’s History

A thorough patient history is the cornerstone of diagnosing chest pain. The healthcare provider will delve into the nature of the pain—its location, radiation, onset, character, temporal pattern, exacerbating and relieving factors, and intensitSpecificain characteristics suggest a cardiac origin. For instance, central chest pain radiates to the left arm or jaw, comes on with exertion, and is relieved by rest or nitroglycerin leans towards a cardiac cause.

In addition, the patient’s age, gender, risk factors for heart disease (smoking, hypertension, diabetes, high cholesterol, family history of heart disease), and history of heart disease are all considered in the evaluation.

2. Physical Examination

Next, a physical examination will provide additional clues. This can include blood pressure and heart rate measurements, chest and heart examinations, and signs of other potential causes of chest pain, such as checking the abdomen for digestive issues.

3. Diagnostic Tests

Several diagnostic tests can help clarify the cause of chest pain. The specific tests ordered depend on the suspected underlying condition.

3.1. Electrocardiogram (EKG)

An EKG is a quick, noninvasive test that records the heart’s electrical activity. It can reveal signs of heart disease, a heart attack, or other cardiac conditions.

3.2. Blood Tests

Specific proteins leak into the bloodstream during a heart attack. Blood tests can detect these proteins, confirming a heart attack or other damage.

3.3. Stress Testing

During a stress test, the patient exercises (or is given medication if unable to exercise) to make their heart work hard during heart tests. It can reveal signs of coronary artery disease.

3.4. Imaging Tests

Imaging tests like a chest X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) can show the structures in and around the chest, revealing causes of chest pain such as pneumonia, aortic dissection, or lung conditions.

3.5. Endoscopy

An endoscopy is a procedure that uses a thin, flexible tube with a camera to visualize the oesophagus and stomach. It can reveal gastrointestinal causes of chest pain, like GERD oesophageal spasms.

4. Specialist Referral

In some cases, further evaluation by a specialist may be required. For instance, a cardiologist can perform more detailed heart evaluations, while a gastroenterologist can explore potential digestive causes.

Diagnosing chest pain is a thoughtful and deliberate process that involves a deep understanding of the human body, a keen eye for detail, and a comprehensive approach to patient care. With advances in medicine, this process is continually refined and improved, offering hope and healing for those affected by chest pain.


The characteristics of cardiac and non-cardiac chest pain and their diagnosis can be complex. However, understanding these differences is crucial for prompt and accurate treatment. While this guide provides a comprehensive overview, always seek professional medical advice when experiencing unexplained chest pain. Remember, it’s always better to be safe than sorry about chest pain.


Q1. Can physical activity trigger non-cardiac chest pain?

While physical activity is a common trigger for cardiac chest pain, non-cardiac chest pain can also be provoked by certain movements or physical strain, particularly if the pain is due to musculoskeletal conditions.

Q2. Is cardiac chest pain more common in men or women?

Historically, men have been more prone to cardiac chest pain, but the gap is narrowing. Both men and women can experience cardiac chest pain, but it’s worth noting that women may experience symptoms differently, such as feeling a sharp, burning chest pain rather than the classic pressure or squeezing.

Q3. Does smoking cause chest pain?

Yes, smoking can contribute to both cardiac and non-cardiac chest pain. It increases the risk of atherosclerosis (clogging of arteries), which can lead to angina or heart attacks. It can also irritate the lungs, causing chest discomfort.

Q4. Are there home remedies for chest pain relief?

It depends on the cause of the chest pain. For some forms of non-cardiac chest pain, like GERD, over-the-counter antacids may help. For mild musculoskeletal pain, rest and heat application might help. However, any new, severe, or persistent chest pain should be evaluated by a doctor.

Q5. Can dehydration cause chest pain?

Dehydration can indirectly contribute to chest pain by causing an electrolyte imbalance, which can affect heart function, or by leading to heart palpitations or low blood pressure. Drinking adequate fluids can prevent these issues.

Q6. What’s the connection between chest pain and high blood pressure?

High blood pressure can damage the arteries that supply blood to the heart, leading to conditions like angina or heart attacks which can cause chest pain.

Q7. Can chest pain be a sign of asthma?

Chest tightness and discomfort can be symptoms of asthma, especially if they’re accompanied by shortness of breath, wheezing, or coughing.

Q8. Can non-cardiac chest pain cause fainting?

While it’s less common, non-cardiac chest pain can cause fainting if the pain is severe or if it triggers a vasovagal response (a sudden drop in heart rate and blood pressure).

Q9. Does deep breathing help with chest pain?

Deep, slow breathing can help manage stress and anxiety, which can be beneficial if these factors are contributing to chest pain. However, for other types of chest pain, deep breathing may not help and could even exacerbate the pain.

Q10. Are there any exercises I should avoid if I have chest pain?

If chest pain is due to a heart condition, strenuous exercises or activities that cause the heart rate and blood pressure to spike suddenly should be avoided unless advised by a healthcare provider. Always discuss your exercise routine with your doctor if you’re experiencing chest pain.

Disclaimer : This article provides general information about the characteristics of cardiac and non-cardiac chest pain. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment options.


  1. Cleveland Clinic
  2. Mayo Clinic
  3. American Heart Association
  4. Harvard Health
  5. Medline Plus
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Tanzir Islam Britto

Hello, I'm Dr. Tanzir Islam Britto. As a dedicated physician, I've embarked on my medical journey at Bangabandhu Sheikh Mujib Medical College (BSMMC), previously known as Faridpur Medical College, where I pursued my Bachelor of Medicine and Bachelor of Surgery (MBBS). I completed my degree at Shahabuddin Medical College (SMC). Alongside my medical career, I am an amateur writer and an active social media advocate, where I share insights into health, wellness, and more.

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