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When It's Not a Heart Attack: Other Causes of Chest Pain

heart-attack-puzzleby Richard N. Fogoros, M.D.

Q. I had a double bypass in July of 2006. A couple of months ago, I started having chest pains again. My doctor admitted me to the hospital and ran some tests. They came back normal. Nitro tablets relieve the pain. What could be causing it?
—Kathy, West Virginia

A. The possibility of coronary-artery disease, of course, is usually the chief concern when someone has chest pain—especially a dull pain that occurs during exertion or emotional stress and is relieved by nitroglycerin. But many other common disorders produce chest pain or discomfort. Sometimes it can be a challenge, both to the patient and the doctor, to figure out the cause.

Things that can cause chest pain besides heart attacks include:

  • Musculoskeletal problems (such as arthritis or fibromyalgia)
  • Lung problems (a blood clot)
  • Cardiac problems other than coronary-artery disease (heart-muscle inflammation)
  • Neurologic disorders (shingles)
  • Gastrointestinal problems (especially gastroesophageal reflux disease, or GERD, which often has many of the characteristics of classic cardiac pain, including a response to nitroglycerin)

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For someone such as yourself who already has known coronary-artery disease, cardiac pain surely was the leading concern, at least initially. It's good that the tests were negative. However, one of the best ways to make absolutely sure it’s not cardiac pain would be to work with your doctor to find the cause, treat it, and make sure it goes away.


RICHARD N. FOGOROS, M.D.,
is About.com’s Heart Health Center guide. He’s also consulting medical advisor for research and development and consulting patient-safety advisor for Boston Scientific CRM, which designs implantable medical devices.


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Last updated and/or approved: March 2011.
Original article appeared in spring 2007 former print magazine. Bio current as of that issue. This general health-care information is not meant as individual advice. Please see our disclaimer.
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