From the Guidelines
Chest pain that is unlikely to be due to angina typically includes sharp, stabbing, or knife-like pain, pain lasting only a few seconds, pain reproduced by pressing on the chest wall, pain localized to a very small area, pain primarily in the middle or lower abdomen, and pain associated with acid reflux or respiratory symptoms. The characteristics of chest pain that are unlikely to be due to angina can be identified based on the nature, onset, and duration of the pain, as well as its location, severity, and relationship to exertion or other factors 1. Some key features that suggest chest pain is unlikely to be due to angina include:
- Sharp, stabbing, or knife-like pain rather than pressure or squeezing sensation
- Pain that lasts for only a few seconds or continuously for days
- Pain that can be reproduced by pressing on the chest wall, changes with body position or breathing, or is localized to a very small area (point tenderness)
- Pain that is primarily in the middle or lower abdomen rather than the chest
- Pain that is associated with acid reflux, belching, or a sour taste in the mouth
- Pain accompanied by fever, cough, or other respiratory symptoms These characteristics are based on the most recent and highest quality study available, which provides guidance on the evaluation and diagnosis of chest pain 1. It's worth noting that while these features may suggest that chest pain is unlikely to be due to angina, they do not entirely exclude the possibility of acute coronary syndrome (ACS) 1. Therefore, a thorough evaluation and diagnosis are necessary to determine the underlying cause of chest pain. In general, chest pain that is unlikely to be due to angina can be categorized into several types, including:
- Musculoskeletal pain, which is often sharp or stabbing and can be reproduced by pressing on the chest wall
- Gastrointestinal pain, which is often associated with acid reflux or other digestive symptoms
- Pulmonary pain, which is often accompanied by fever, cough, or other respiratory symptoms
- Anxiety-related pain, which often occurs with hyperventilation, tingling sensations, and a feeling of impending doom.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Types of Chest Pain Unlikely to be Due to Angina
The following types of chest pain are unlikely to be due to angina:
- Sharp or stabbing pain, which is often associated with noncardiac causes such as gastroesophageal reflux disease (GERD) or musculoskeletal issues 2, 3
- Pain that is worsened by eating or relieved by antacids, which suggests a gastrointestinal cause such as GERD 3, 4
- Pain that is constant and aching, rather than episodic and squeezing, which is more typical of angina 2
- Pain that is reproducible with movement or pressure, which suggests a musculoskeletal cause 2
- Pain that is accompanied by symptoms such as heartburn, regurgitation, or difficulty swallowing, which suggests a gastrointestinal cause such as GERD 3, 5
Characteristics of Noncardiac Chest Pain
Noncardiac chest pain, including pain due to GERD, can be difficult to distinguish from cardiac chest pain based on symptoms alone 2, 5. However, certain characteristics, such as the response to treatment with proton-pump inhibitors, can help to identify noncardiac causes of chest pain 3, 4. Additionally, the use of diagnostic tests such as esophageal pH monitoring can help to confirm the presence of acid reflux and its relationship to chest pain symptoms 3, 5.