Overview

Various conditions, not always related to the heart, can cause chest pain.^1,2 Certain characteristics define a typical chest pain, if these characteristics are different, then the pain is referred to as atypical pain. 

In this article, we will analyse the differences between typical and atypical chest pain, some of the causes of atypical chest pain, and when it is necessary to seek medical help.

What is chest pain?

It is defined as the feeling of being hurt or discomfort in the area of the chest. Chest pain is one of the most common reasons for consultation in emergency services.² In addition, its characteristics will vary depending on what is causing it. Making an accurate diagnosis is a challenge because while some of the causes can be not so serious, others can put life at risk.³ Therefore, it is important to have the different characteristics that chest pain can present in mind. 

Differences between typical and atypical chest pain

Characteristics of typical chest pain:⁴

• The pain feels like pressure or pushing on your chest
• It is usually longer than 2 minutes
• It is more intense when performing any kind of effort
• The pain can be felt in your upper extremities (jaw, neck or arms)
• Resting usually diminishes pain

Characteristics of atypical chest pain:⁴

• The pain feels like a quick stabbing pain
• It passes in less than a minute
• It is not associated with making any effort
• It feels at the same intensity and in the same place

Common causes of atypical chest pain

There are many causes of atypical chest pain. They can be divided into cardiac causes, which are related to the heart, and noncardiac causes, which are not related to the heart. Next, we will analyse some of the most common of them.

Cardiac causes

Angina: It occurs when there is a lack of blood flow to the cardiac muscle, hence, causing ischemia, which is when the levels of oxygen are low. All of this generates chest pain. Stable angina happens when the pain lasts less than 5 minutes and it is usually during the exercise. Unstable angina occurs when the pain is present while resting and lasts more than 5 minutes.⁵

Heart attack: It is also known as myocardial infarction. The difference with angina is that the low oxygen is over a while long enough to cause damage in a part of the cardiac muscle.^2,5 It is an emergency, and it is essential to look for medical assistance as soon as possible. The chest pain is associated with a heart attack; however, the characteristics of atypical chest pain can also be presented in this condition.³

Pericarditis: It happens when the fibre sac that covers the heart, named the pericardium, is swollen. Many conditions can cause pericarditis, the most common is an infection caused by a virus or bacteria. Unlike other causes of atypical chest pain, in this case, fever tends to appear too.⁶  

Noncardiac causes 

Gastroesophageal reflux disease (GERD): It happens when, during a long period, the acid produced in the stomach has been rising and hurting the oesophagus, the pain feels like burning in the chest area ³, also known as heartburn. 

Gastritis: Different mechanisms can cause the inflammation of the lining of the stomach. Depending on the area of pain and the severity of this condition, heartburn can be present too.

Costochondritis: This condition is the inflammation of the cartilage that links the ribs with the breastbone. It generates pain in the centre of the chest, hence, making it difficult to breathe or move the chest. 

Intercostal muscle strain: Strains in the muscles between the ribs can cause chest pain. It usually improves resting muscles for two weeks or more, depending on the severity of the strain.

Pulmonary embolism: It happens when a blood clot obstructs a blood vessel in the lung. This causes severe pain and it, as a heart attack, is a condition that requires immediate medical attention.

Pleuritis: It is also known as pleurisy, and occurs when the tissue layer covering the lung, named pleura, suffers an inflammation. In this case, the pain is like being stabbed. There are many causes, thus, it is important to look for medical attention because some can put life at risk.^2,3

Depression and anxiety: psychological stress can cause atypical chest pain, usually accompanied by a sensation of difficulty breathing. 

Risk factors

Some risk factors associated with atypical chest pain are:⁷

• To be 50 years old or more
• To have diabetes, hyperlipidemia, high blood pressure or kidney disease
• To be a person assigned as female at birth
• To usually consume marihuana or tobacco

Diagnosis and treatment

Depending on the specific cause of the atypical chest pain, the diagnosis and treatment will vary. In general, when arriving at the emergency room, it is crucial to rule out or quickly provide treatment to the causes that can be life-threatening,³ for example, heart attack or pulmonary embolism. 

The first part of the diagnosis requires questioning the person's current symptoms and antecedents. The physical exploration needs to be very precise, including obtaining all the vital signs and checking the blood oxygen level. Then, blood tests, focusing on specific measures to get information about the function of the heart and electrocardiogram (EKG), which analyses the electrical activity of the heart are needed. While these events happen, and depending on the characteristics of the patient, the general treatment starts with the administration of oxygen, the use of IV fluids and specific medicines if they are required. 

Prevention

Although there are factors that cannot be changed, like age, these are general measures to prevent atypical chest pain:^5,7

• To look for nutritional counselling to improve the quality and quantity of the daily diet
• To maintain a healthy weight
• To do regular exercise depending on the characteristics of each person and their specific conditions.
• Properly caring for and maintaining blood sugar levels, blood pressure and fats
• To stop the consumption of tobacco and/or marihuana

In addition, specific measures should be followed depending on the cause of the atypical chest pain.

When to seek medical help?

It is important to contact medical services at 999/112 in the UK or to go to A&E if the next warning symptoms are presented:^2,7

• A pain that is continuous, lasting more than 5 minutes, and that feels like something is pushing or pressuring in the chest area
• Pain occurs alongside shortness of breath, heavy or light sweating, nausea and dizziness
• To feel that the pain spreads to the arms, neck, jaw, stomach or back

These symptoms indicate the presence of a heart attack and it requires immediate medical attention inside the hospital. 

It is also important to make an appointment with your doctor, in case you present chest pain that lasts less than 5 minutes, but it appears constantly when you do your daily activities.⁷ This is intending to rule out something serious. 

Summary

Chest pain is a symptom that can have different characteristics depending on what is causing it. Hence, it can be a challenge when looking for diagnosis and treatment. To help analyse this symptom, there have been specific features assigned that are known as typical, and when they are different, then the pain is referred to as atypical. Considering that some of the causes of chest pain can be life-threatening, it is essential to be alert about the warning symptoms and to look for medical attention as soon as possible when it is required.