Atypical Chest Pain: Symptoms, Causes, Treatment, and Outlook - Healthline

Atypical chest pain usually feels like a burning or stabbing pain in your chest. Your heart isn't always responsible. Lung conditions, acid reflux, or cartilage inflammation can also cause chest pain.

Atypical pain may occur in any area of your chest. Conversely, typical chest pain usually feels like a squeezing sensation in your chest near the sternum in the center.

To treat your symptoms, doctors need to find the cause of the discomfort as atypical chest pain can occur for various reasons.

This article will review what atypical chest pain is, including its many possible causes and how it differs from typical chest pain.

What is atypical chest pain?

Doctors define atypical chest pain as a type of chest pain that doesn't have all of the three characteristics that define typical chest pain. These characteristics are:

1. pain or discomfort in the center of your chest
2. pain that occurs when you're under emotional stress or during exercise
3. pain that gets better within minutes of rest or after taking medications containing nitrates

Atypical chest pain usually feels like a stabbing or burning pain in your chest and may sometimes have characteristics similar to indigestion.

If the pain also spreads to your arms, back, or neck, or if you're feeling sick or have breathing difficulties, you should immediately look for medical attention.

What's the difference between atypical chest pain and typical chest pain?

Doctors call chest pain "typical" when the pain a person experiences in their chest has three specific characteristics:

• The feeling of discomfort is in the center of the chest, in the area underneath the sternum.
• A physical effort or emotional stress brought on the chest pain.
• A person finds relief from chest pain with rest or after taking medications such as nitrates.

If you experience only two of these three characteristics, medical professionals categorize your chest pain as atypical. Doctors call this type of pain "atypical" as people with this type of discomfort are less likely to receive a diagnosis for myocardial ischemia, which is a partial or complete blockage of blood flow to the heart.

What are the symptoms of atypical chest pain?

While experiencing typical chest pain, a person may feel a sense of pressure and discomfort in their chest. If you have atypical chest pain, you may experience a stabbing or burning sensation. You may also feel pain in your back or in the upper part of your abdomen, below your rib cage.

If this type of chest pain occurs typically after you eat, the cause of your atypical chest pain may be indigestion, reflux, or related to your gastrointestinal tract.

The following symptoms alongside chest pain may instead signify gastroesophageal reflux disease (GERD):

• nausea
• difficult or painful swallowing
• cough
• the sensation of having a lump in your throat

What are the potential causes of atypical chest pain?

Atypical chest pain can have noncardiac and cardiac causes. These may include:

Heart-related causes

Atypical chest pain can occur as a symptom of certain heart conditions, including:

• Myocardial ischemia or infarction: This condition is when the blood flow in your heart decreases or ceases completely.
• Myocarditis: This type of heart inflammation usually occurs after a viral infection and is more common in younger people. However, anyone can develop myocarditis, and its cause can also be noninfectious.
• Pericarditis: This condition happens when the sac surrounding the heart (pericardium) swells up or becomes inflamed. The pericardium protects your heart and reduces its friction with the surrounding structures of the body.
• Heart valve disease: Also called aortic stenosis, this common vascular disease usually affects older adults. It consists of the narrowing of the left ventricle during the release of blood into the aorta.

Gastrointestinal tract-related causes

If you experience atypical chest pain, you may have gastrointestinal tract issues. Certain conditions that can occur in your digestive system can cause your chest pain such as gastritis and GERD.

Gastritis is the inflammation of your stomach. Its causes may include:

• excessive drinking
• smoking
• a bacterial infection

GERD is a chronic condition in which part of the contents of your stomach flows back into the esophagus, causing a burning sensation in the chest (heartburn) because of the acidity of the reflux.

Lung-related causes

Atypical chest pain can occur in the case of lung infection or other pulmonary conditions. However, these causes are less common. Lung-related causes that can result in atypical chest pain include:

• Pneumonia: This condition occurs when the lung tissue becomes infected. Bacteria, viruses, and fungi can cause lung infections.
• Lung cancer: This happens when a tumor grows into your bronchi or lungs. Lung cancer is one of the most common causes of death in the United States. The most common risk factor for lung cancer is smoking.
• Pulmonary embolism: When a blood clot stops blood flow into the pulmonary artery or one of its branches, pulmonary embolism occurs.

Musculoskeletal chest pain

You may experience atypical chest pain in case of injuries or if you have certain conditions that can occur to your ribs and chest muscles.

For example, people may feel pain in their chest because of costochondritis, which causes cartilage inflammation between their ribs. This condition can cause sharp and dull chest pain that people can confuse with the symptoms of a heart attack.

If you have sharp chest pain but also experience symptoms such as nausea, dizziness, and radiating pain, you should call 911 or local emergency services immediately.

How is atypical chest pain diagnosed?

To diagnose the source of atypical chest pain, a doctor may need to perform a series of tests to rule out conditions that could cause your discomfort. A doctor or healthcare professional will start to assess your health conditions with a physical examination and by monitoring your heart to rule out any life threatening event.

To determine whether the atypical chest pain has cardiac causes, a doctor will initially conduct an electrocardiogram along with blood tests, including a cardiac enzyme (troponin) test. A chest X-ray may also be done as well as a cardiac MRI scan.

A doctor may also recommend blood and imaging tests, such as X-rays or CT scans, to rule out lung cancer, pneumonia, or any other lung-related and musculoskeletal condition.

If doctors suspect the cause of atypical chest pain is linked to GERD, they may recommend you have an esophagogastroduodenoscopy test to rule out any GERD complication. They may prescribe you some medications to manage acid reflux.

How is atypical chest pain managed or treated?

The type of treatment that a doctor will recommend depends on the cause of atypical chest pain. Treatment may include medications and surgery.

Medications for atypical chest pain treatment include:

Cause	Treatment
Pericarditis	colchicine and nonsteroidal anti-inflammatory drugs, such as ibuprofen, aspirin, and indomethacin, for 3 days to 2 weeks
Myocarditis	Medications used include beta-blocker medications, sodium-glucose co-transporter-2 inhibitors, mineralocorticoid receptor antagonists, renin-angiotensin-aldosterone inhibitors, and diuretics. NOTE: These medications are typically used for heart failure related to myocarditis (a complication of the condition).
Myocardial infarction	nitrates, beta-blocker medications, antiplatelet medications, and aspirin, as well as cardiac catheterization to evaluate or open any blockages
Pneumonia	antibiotics
Lung cancer	Depending on the stage or complications of lung cancer, treatment may include chemotherapy, radiation therapy, or drainage of pleural effusions.
Pulmonary embolism	blood thinners, such as heparin, to treat blood clots
GERD	proton pump inhibitors or histamine receptor antagonists

A doctor may recommend you undergo surgery if they need to repair a tear in your gastroesophageal tract because of acid reflux or if you don't respond to medications for stomach acid management.

Doctors may also consider surgical treatment in case of certain circulatory conditions such as aortic stenosis. Lung cancer and pulmonary embolism may also require surgery.

What's the outlook for people with atypical chest pain?

The outlook for people with atypical chest pain depends on its causes. When the cause of atypical chest pain is heart-related, your condition may require immediate treatment and could be life threatening. The earlier doctors give a diagnosis and treat the heart condition, the better the outlook usually is.

The outlook for people with conditions such as lung cancer can vary depending on the stage of cancer. People with other conditions, such as pneumonia and GERD, usually have a good outlook. Most people recover or their symptoms improve after treatment.

Takeaway

Atypical chest pain can have cardiac- and noncardiac-related causes. You may experience atypical chest pain if you have lung or gastrointestinal conditions. You may also feel discomfort in your chest if you've injured your ribs or if the cartilage in between them has inflammation.

Atypical chest pain usually feels like a sharp stabbing pain in your chest. If you also feel dizzy or weak, have difficulty breathing, or the pain is radiating to other areas of your body, you should get medical attention. Doctors have to diagnose the cause of your discomfort before they can advise the most effective treatment to improve your symptoms.

The outlook for a person with atypical chest pain varies greatly depending on its cause. If you're concerned about any new pain in your chest, you should see a doctor.