Chest Pain – NonCardiac NonPulmonary NonGI

Beyond the Heart


Chest pain is a symptom that often leads to immediate concern about heart disease, but not all chest pain is cardiac in origin. Beyond cardiac, pulmonary, and gastrointestinal causes, chest pain can stem from various musculoskeletal, neurological, and psychological conditions. This article explores the causes, diagnostic workup, and interventional treatment options for non-cardiac, non-pulmonary, and non-gastrointestinal chest pain.

Causes of Non-Cardiac, Non-Pulmonary, and Non-Gastrointestinal Chest Pain

  1. Musculoskeletal Causes:
    • Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum, causing sharp, localized chest pain.
    • Muscle Strain: Overuse or injury to the chest muscles, often resulting from physical activity or repetitive movements.
    • Rib Fractures: Trauma to the chest wall can lead to rib fractures, causing significant pain during movement or breathing.
  2. Neurological Causes:
    • Herpes Zoster (Shingles): Reactivation of the varicella-zoster virus can cause a painful rash and nerve pain in the chest area.
    • Nerve Compression or Entrapment: Conditions such as thoracic outlet syndrome or intercostal neuralgia can lead to chest pain due to nerve irritation or compression.
  3. Psychological Causes:
    • Anxiety and Panic Disorders: These conditions can manifest as chest pain, often accompanied by palpitations, sweating, and shortness of breath.
    • Somatization Disorder: Psychological distress that manifests as physical symptoms, including chest pain, without an identifiable physical cause.
  4. Other Causes:
    • Tietze Syndrome: Similar to costochondritis but involves swelling of the affected cartilage.
    • Fibromyalgia: A chronic condition characterized by widespread musculoskeletal pain, including chest pain.

Diagnostic Workup

Accurately diagnosing non-cardiac, non-pulmonary, and non-gastrointestinal chest pain requires a comprehensive approach:

  1. Clinical History and Physical Examination:
    • Detailed patient history, including onset, duration, nature, and triggers of pain.
    • Physical examination focusing on the chest wall, looking for tenderness, swelling, or signs of trauma.
  2. Laboratory Tests:
    • Basic blood tests to rule out systemic inflammation or infection.
  3. Imaging Studies:
    • X-rays: Useful for detecting rib fractures or signs of other musculoskeletal abnormalities.
    • MRI or CT Scan: Provides detailed images of soft tissues, nerves, and bones, useful for identifying nerve compression or soft tissue injuries.
  4. Nerve Conduction Studies:
    • Electromyography (EMG): Assesses the health of muscles and the nerve cells that control them, useful for diagnosing nerve-related causes of chest pain.
  5. Psychological Evaluation:
    • Assessment for anxiety, panic disorders, or other psychological conditions if a psychological cause is suspected.

Interventional Treatment Options

Treatment for non-cardiac, non-pulmonary, and non-gastrointestinal chest pain varies based on the underlying cause:

  1. Musculoskeletal Pain:
    • Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for pain relief.
    • Physical Therapy: Exercises to improve strength, flexibility, and posture; manual therapy for pain relief.
    • Injections: Corticosteroid injections for persistent inflammation or pain.
  2. Neurological Pain:
    • Antiviral Medications: For shingles, antiviral medications can reduce the severity and duration of the condition.
    • Pain Management: Neuropathic pain medications such as gabapentin or pregabalin; nerve blocks or steroid injections for severe cases.
    • Surgical Intervention: In rare cases, surgery may be necessary to relieve nerve compression.
  3. Psychological Pain:
    • Cognitive Behavioral Therapy (CBT): Effective for treating anxiety and panic disorders, helping patients manage symptoms and reduce chest pain.
    • Medications: Antidepressants or anxiolytics may be prescribed to manage underlying psychological conditions.
  4. Other Conditions:
    • Fibromyalgia Management: Includes medications such as duloxetine or milnacipran, physical therapy, and lifestyle modifications.
    • Management of Tietze Syndrome: Similar to costochondritis, involving pain management strategies and, in severe cases, corticosteroid injections.


Non-cardiac, non-pulmonary, and non-gastrointestinal chest pain encompasses a wide range of conditions, each requiring a tailored approach for diagnosis and treatment. A comprehensive workup, including a detailed history, physical examination, and appropriate diagnostic tests, is crucial to identify the underlying cause. Treatment strategies should be individualized, focusing on alleviating symptoms and addressing the root cause to improve patient outcomes and quality of life.


  1. Hsiao, C. J., Cherry, D. K., Beatty, P. C., & Rechtsteiner, E. A. (2010). National Ambulatory Medical Care Survey: 2007 summary. National health statistics reports, (27), 1-32.
  2. Stern, S. A., Cifu, A. S., & Altkorn, D. (2015). Symptom to Diagnosis An Evidence-Based Guide. McGraw-Hill Education.
  3. Fukuhara, Y., & Tanaka, Y. (2013). Non-cardiac chest pain and psychogenic chest pain. In The Nervous System in Gastroenterology (pp. 163-172). Springer, Tokyo.
  4. Fleisher, L. A., & Roizen, M. F. (2012). Essence of Anesthesia Practice. Elsevier Health Sciences.
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