Chest Pain: Cardiac and Non-Cardiac Causes and When to See a Cardiologist

Chest pain is one of the most common reasons for medical consultation and one of the most anxiety-inducing symptoms for patients. While many causes of chest pain are benign, this symptom can also be the first sign of a serious heart condition requiring immediate attention. That is why it is essential to know how to distinguish between different causes and recognize warning signs. Dr. Elders Jimenez Iglesias, cardiologist at Hospital Galenia, Cancun, has the experience and equipment needed to accurately evaluate the source of your chest pain.

Cardiac causes of chest pain

Cardiac causes are the most concerning and must be ruled out with any chest pain. Angina pectoris occurs when coronary arteries narrow due to atherosclerotic plaque buildup, reducing blood flow to the heart muscle. It typically presents as pressure, tightness, or heaviness in the center of the chest that may radiate to the left arm, neck, jaw, or back, and usually appears with physical exertion or emotional stress. Acute myocardial infarction occurs when a coronary artery becomes completely blocked, causing similar but more intense, prolonged pain (more than 20 minutes), accompanied by cold sweating, nausea, shortness of breath, and a sense of impending doom. Other cardiac causes include pericarditis (inflammation of the sac surrounding the heart), myocarditis, aortic dissection, and mitral valve prolapse.

Non-cardiac causes of chest pain

• ●Musculoskeletal causes: chest wall pain from muscle strain, costochondritis (inflammation of rib cartilage), or rib injuries. It usually worsens when pressing the area or with certain movements
• ●Gastrointestinal causes: gastroesophageal reflux disease (GERD) is one of the most common non-cardiac causes and can mimic angina pain. Esophageal spasm, gastritis, and peptic ulcer can also cause chest pain
• ●Pulmonary causes: pulmonary embolism, pneumothorax, pneumonia, and pleuritis can cause chest pain, usually accompanied by respiratory difficulty and coughing
• ●Psychological causes: panic attacks and generalized anxiety produce acute chest pain accompanied by tachycardia, hyperventilation, tingling in the hands, and a sensation of breathlessness. Although the pain is real, it does not have a cardiac origin
• ●Herpes zoster: reactivation of the varicella-zoster virus can cause intense pain on one side of the chest before the characteristic skin rash appears

Red flags: when to call emergency services

Call emergency services (911) immediately if you experience any of the following symptoms:

• ●Crushing or squeezing pain in the center of the chest lasting more than 15 minutes that does not subside with rest
• ●Pain radiating to the left arm, jaw, neck, or back
• ●Profuse cold sweating accompanying chest pain
• ●Severe shortness of breath along with the pain
• ●Nausea, vomiting, or intense dizziness associated with chest pain
• ●Feeling of fainting or loss of consciousness
• ●Rapid or irregular heartbeat with chest pain
• ●History of heart disease, diabetes, or multiple cardiovascular risk factors

When to schedule a cardiologist appointment

Not all chest pain requires an emergency room visit, but it should be evaluated by a cardiologist within the next few days if you experience chest pain that appears with exertion and resolves with rest, recurrent episodes of chest pain or discomfort even if mild, frequent palpitations accompanied by chest discomfort, chest pain associated with shortness of breath during normal activities, a family history of coronary artery disease or sudden death, or if you have risk factors such as hypertension, diabetes, high cholesterol, smoking, or obesity. A preventive consultation is always better than ignoring a symptom that could indicate a developing cardiac problem.

How the cardiologist evaluates chest pain

The cardiological evaluation of chest pain includes a detailed clinical history about pain characteristics (location, duration, radiation, triggering and relieving factors), a complete physical examination, a 12-lead electrocardiogram to detect arrhythmias or signs of ischemia, and blood tests that may include cardiac troponins (markers of myocardial damage) and BNP. Based on initial findings, the cardiologist may order an echocardiogram to evaluate cardiac function, a stress test to assess the heart's response to exercise, or nuclear cardiology studies to detect areas of the heart with reduced blood flow.

Preventing cardiac chest pain

Prevention focuses on controlling cardiovascular risk factors. Keep blood pressure below 130/80 mmHg, control cholesterol with diet and medications if necessary, maintain normal glucose levels if you have diabetes, quit smoking, engage in at least 150 minutes of moderate physical activity per week, maintain a healthy weight, and manage stress. An annual cardiac checkup starting at age 40 can detect problems before they manifest as pain.

Dr. Elders Jimenez Iglesias

Cardiologist · Nuclear Cardiology

Professional License: 13819257 · Specialty: 12543211