Patient education: Chest pain (The Basics)
Written by the doctors and editors at UpToDate
Should I call for an ambulance if I have chest pain?
— You should call for an ambulance if the pain:
●Is new or severe
●Happens along with shortness of breath
●Lasts more than a few minutes
●Gets worse when you walk, climb stairs, or do other types of physical activity
●Scares or worries you
Having chest pain does not necessarily mean you are having a heart attack. Most people who go to the emergency room with chest pain are not having a heart attack. Their pain is usually caused by less serious problems, such as muscle pain, heartburn, or anxiety. Even so, you should not take any chances.
People often delay seeking help for a heart attack because they think the symptoms are not serious or will go away. When they do that, they risk permanent damage to their heart – or even death.
Is chest pain the only important symptom of a heart attack?
— No. Other symptoms are important, too. Sometimes people do not go to the hospital because they do not have any pain at all. But it is possible to have a heart attack without pain. This is more likely in women, people with diabetes, and people older than 60.
It is important to pay attention to any of the symptoms of a heart attack (figure 1), which can include:
●Pain, pressure, or discomfort in the center of the chest
●Pain, tingling, or discomfort in other parts of the upper body, including the arms, back, neck, jaw, or stomach
●Shortness of breath
●Nausea, vomiting, burping, or heartburn
●Sweating or having cold, clammy skin
●A racing or uneven heart rate
●Feeling dizzy or lightheaded or even fainting
These symptoms are important if they last more than a few minutes or keep happening over and over (coming and going). If you think you might be having a heart attack, call for an ambulance right away. Do not try to get to the hospital on your own.
Is heart attack the only cause of chest pain?
— No. Chest pain can be caused by lots of other problems, including:
●Heart problems other than heart attacks, such as infection around the heart
●Muscle soreness after an activity that involves the chest muscles
●Diseases that cause pain, such as arthritis
●Shingles (herpes zoster), a condition linked to the chickenpox virus that also causes a painful rash
●Any kind of injury to the chest, including surgery
●Digestive problems such as heartburn, acid reflux, stomach ulcers, or irritable bowel syndrome
●Problems affecting the lungs, such as pneumonia (an infection in the lungs) or blood clots in the lungs
●Psychological problems, such as panic disorder or depression
●Weakening of the lining of the big blood vessel in the chest (called the aorta)
What will happen if I go to the emergency room?
— The people treating you in the emergency room will examine you and then run tests to try to find the cause of your pain. But don’t be surprised if you do not find out right away why you have pain. The cause of chest pain is not always easy to find. Even so, doctors can usually tell if your heart is in trouble.
The tests you might have include:
●An electrocardiogram (ECG or EKG) – This test measures the electrical activity in your heart. It can help doctors find out if you are having a heart attack.
●Blood tests – During a heart attack, the heart releases certain chemicals. If these chemicals are in your blood, it might mean you are having a heart attack.
●A stress test – During a stress test, you might be asked to run or walk on a treadmill while you also have an ECG. Physical activity increases the heart’s need for blood. This test helps doctors see if the heart is getting enough blood. If you cannot walk or run, your doctor might do this test by giving you a medicine to make your heart pump faster.
●Cardiac catheterization (also called “cardiac cath”) – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then he or she moves the tube up to your heart. Next, the doctor puts a dye that shows up on X-ray into the tube. This part of the test is called “coronary angiography.” It can show whether any of the arteries in your heart are clogged.
What if I am having a heart attack?
— If you are having a heart attack, the doctor will give you treatments to reduce the damage to your heart and relieve your pain.
The sooner you get treated for a heart attack, the better treatment will work. Every minute counts when it comes to keeping your heart muscle alive!