Doctors Note Logo

Back

Published on: 5/6/2025

Why Might I Still Have Chest Pain Even If My Echocardiogram Is Normal?

Even with a normal echocardiogram, chest pain can be caused by non-cardiac issues like gastrointestinal reflux, muscle or nerve problems, or stress and anxiety.

answer background

Explanation

A normal echocardiogram generally means that your heart’s structure and pumping function appear normal when checked at rest. However, chest pain can arise from other sources. For example, chest pain might be caused by problems with the esophagus, such as acid reflux or esophageal spasms. These conditions can mimic heart pain even though the heart itself is fine. Musculoskeletal issues, like costochondritis—where the cartilage linking your ribs and breastbone becomes inflamed—can also produce chest pain. In addition, nerve pain from conditions like intercostal neuralgia may lead to discomfort in your chest. Sometimes, stress and anxiety or panic attacks can cause chest tightness and pain without any heart disease. There are even cases where microvascular or exercise-induced issues that do not show up in a resting echocardiogram may cause symptoms. Lastly, even a normal echocardiogram can still mask underlying heart issues. Because many different factors can play a role, it’s very important to discuss your ongoing symptoms with your doctor, who may suggest additional tests or treatments to find the exact reason and help you feel better.

(References)

  • Chow BJW, Galiwango P, Poulin A, Raggi P, Small G, Juneau D, Kazmi M, Ayach B, Beanlands RS, Sanfilippo AJ, Chow CM, Paterson DI, Chetrit M, Jassal DS, Connelly K, Larose E, Bishop H, Kass M, Anderson TJ, Haddad H, Mancini J, Doucet K, Daigle JS, Ahmadi A, Leipsic J, Lim SP, McRae A, Chou AY. Chest Pain Evaluation: Diagnostic Testing. CJC Open. 2023 Sep 7;5(12):891-903. doi: 10.1016/j.cjco.2023.09.001. PMID: 38204849; PMCID: PMC10774086.

  • Spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. J R Soc Med. 2003 Mar;96(3):122-5. doi: 10.1258/jrsm.96.3.122. PMID: 12612112; PMCID: PMC539418.

  • Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil. 2011 Apr;17(2):110-23. doi: 10.5056/jnm.2011.17.2.110. Epub 2011 Apr 27. PMID: 21602987; PMCID: PMC3093002.

  • Lenfant C. Chest pain of cardiac and noncardiac origin. Metabolism. 2010 Oct;59 Suppl 1:S41-6. doi: 10.1016/j.metabol.2010.07.014. PMID: 20837193.

Tell your friends about us.

We would love to help them too.

smily Shiba-inu looking

For First Time Users

What is Ubie’s Doctor’s Note?

We provide a database of explanations from real doctors on a range of medical topics. Get started by exploring our library of questions and topics you want to learn more about.

Learn more about symptoms

Chest pain

Not sure about the cause of your current symptoms?

AI Symptom Check

Try our AI-based symptom checker

With an easy 3-min questionnaire, you can get a free AI-powered report on possible causes


Tips to try:

  • Provide specific, detailed info about all symptoms you have.
  • Give accurate information about yourself including current conditions.
  • Answer all follow-up questions

Purpose and positioning of servicesUbie Doctor’s Note is a service for informational purposes. The provision of information by physicians, medical professionals, etc. is not a medical treatment. If medical treatment is required, please consult your doctor or medical institution. We strive to provide reliable and accurate information, but we do not guarantee the completeness of the content. If you find any errors in the information, please contact us.