Chest Pain: A Heart Attack or Something Else? – Harvard Health Publishing

What makes you worry that chest pain is serious, like a heart attack

When is chest pain serious? That dull burning feeling in your chest doesn’t seem to be going away, and even feels like it is getting worse. Is it a heart attack, or something else?

It’s a vexing question, one that millions of people — and their doctors — face each year. What’s the problem? Chest pain can stem from dozens of conditions besides heart attack, from pancreatitis to pneumonia or panic attack.

Millions of Americans with chest pain are seen in hospital emergency departments every year. Only 20% of them are diagnosed with a heart attack or an episode of unstable angina, a warning sign that a heart attack may happen soon. A few have another potentially life-threatening problem, such as pulmonary embolism (a blood clot in the lungs) or aortic dissection (a tear in the inner layer of the aorta). Some are experiencing “regular” angina, which occurs when part of the heart isn’t getting as much oxygen-rich blood as it needs during periods of physical exertion or emotional stress. Most of them, though, had a condition unrelated to the heart or arteries.

The other tricky problem with heart attacks is that different people experience them in different ways. Some have classic chest pain. Others have jaw pain or back pain. Still others become breathless, or extremely fatigued, or nauseated.

Describe chest pain to your doctor

Doctors use several pieces of information to determine who is, and who isn’t, having a heart attack. In addition to the description of your symptoms and your heart risk profile, doctors use the results of an electrocardiogram (ECG) and a blood test called cardiac troponin. But sometimes these don’t immediately show abnormalities. So, what you describe to the doctor and your medical history are extremely important in determining the initial steps in your treatment.

Here are some things your doctors will want to know about what you are experiencing:

• What is it that you are feeling (pain, pressure, tightness, etc.)?

• Where is the discomfort?

• When did it start?

• Has it gotten worse or stayed the same?

• Is the feeling constant, or does it come and go?

• Have you felt it before?

• What were you doing before these feelings started?

Clear answers to these questions go a long way toward nailing down a diagnosis. A few seconds of recurrent stabbing pain is less likely to be a heart attack (see box), while pain centered in the chest that spreads out to the left arm or jaw is more likely to be one.

Chest pain symptoms and what they mean

When chest pains are serious

Unlike an achy knee or crabby lower back, chest pain isn’t something to shrug off until tomorrow. It also isn’t something to diagnose at home. Don’t play doctor — go see one, fast, if you are worried about pain or discomfort in your chest, upper back, left arm, or jaw; or suddenly faint or develop a cold sweat, nausea, or vomiting. Call 911 or your local emergency number to summon an emergency medical crew. It will whisk you to the hospital in a vehicle full of equipment that can start the diagnosis and keep you stable if your heart really is in trouble.

There are oh-so-many reasons to delay calling for help.

• I’m too young (you aren’t — even 20-somethings can have heart attacks).
• I’m in great shape (a heart attack is sometimes the first sign of heart disease).
• I have a family to take care of (all the more reason to get to the hospital fast).
• I don’t want to bother anyone (you’d be a bigger bother with advanced heart failure, or dead).

What if it isn’t a heart attack? You will be evaluated as if you are having one and, when it is ruled out as the cause of your symptoms, your doctors will look for the actual cause. They won’t be mad at you for crying wolf. Instead, they should congratulate you for taking action (if they don’t, we will) and work with you to get at the root of your chest pain and ease it. If the cause was indigestion, a panic attack, or another possibly recurring condition, the emergency department doctors and your primary care physician can help you interpret what your body is telling you.

Chest pain is serious business. If you think yours might be due to a heart attack, take action right away. The sooner you are checked out, the sooner you can get the kind of artery-opening therapy that can protect your heart from permanent damage.

Chest pain – Better Health Channel

Chest pain is discomfort in the chest that can appear in many forms, ranging from a dull ache to a sharp stab. Sometimes it can also feel like a crushing or burning sensation in the chest. In some cases, chest pain can spread to your arms, shoulders, neck, jaw or back.

Chest pain can last for several minutes or come and go. It can be a sign of a serious condition, like a heart attack. It is important to seek immediate medical help if you are experiencing chest pain.

If you think you are having a heart attack, or you are in doubt about the cause of your chest pain, call Triple Zero (000) immediately and ask for an ambulance.

Seek urgent medical help for chest pain

If you are experiencing chest pain, follow these steps:

Step 1. Stop what you are doing and rest immediately.

Step 2. Talk – tell someone how you feel.

If you take angina medicine:

• Take a dose of your medicine.
• Wait five minutes. If you still have symptoms – take another dose of your medicine.
• Wait another five minutes.

Step 3. If your symptoms are severe, getting worse or have lasted longer than 10 minutes, call Triple Zero (000) immediately and ask for an ambulance. Chew on 300mg aspirin (if available).

• Don’t hang up.
• Wait for the operator’s instructions.

Do not take aspirin if you have an allergy to aspirin, or your doctor has told you not to take it.

Remember, if you have any doubt about your chest pain, call Triple Zero (000) and ask for an ambulance anyway.

Do not drive yourself to hospital. An ambulance is the safest way to go to hospital and the quickest way to seek treatment. It has specialised staff and equipment that may save your life.

There are several conditions that can cause chest pain. Sometimes, it can be difficult to tell the difference between heart-related chest pain and other types of chest pain. It is important to seek medical advice to ensure you get a proper diagnosis.

Heart attack

Chest pain can be a warning sign of a heart attack. A heart attack happens when one or more of the arteries that supply blood to the heart muscle is blocked. This stops the blood flow and reduces the amount of oxygen that gets to your heart muscle.

Chest pain caused by a heart attack can:

• feel like uncomfortable pressure, heaviness or tightness in your chest
• spread to your arms, shoulders, neck, jaw or back
• last for several minutes or come and go.

Chest pain may occur in combination with other heart attack warning signs such as:

• nausea, indigestion or vomiting
• dizziness, light-headedness or feeling faint
• feeling anxious
• sweating or breaking out in a cold sweat
• shortness of breath or difficulty breathing.

Warning signs of a heart attack vary from person to person, and they may not always be sudden or severe. You may have just one or a combination of these symptoms. It is also possible to experience a ‘silent heart attack’, where you might not have any symptoms at all.

If you, or someone you know, is experiencing the warning signs of a heart attack – tell someone. If symptoms are severe, or getting worse, or last for more than 10 minutes, call Triple Zero (000) immediately and ask for an ambulance.

Angina

Angina is temporary chest pain or discomfort that happens when your heart doesn’t get enough blood and oxygen. It often occurs when your heart is working harder than usual and needs more oxygen-rich blood than the narrowed arteries can deliver.

Angina is a symptom of an underlying heart condition, usually coronary heart disease. Coronary heart disease occurs when there’s narrowing of the coronary arteries supplying blood to the heart muscles, due to a build-up of a fatty substance in the arteries (plaque).

Chest pain caused by angina can be triggered by:

• physical exertion
• emotional stress
• cold temperatures
• eating a large meal.

Angina is not the same as a heart attack. Unlike a heart attack, angina does not cause permanent damage to the heart muscle. Pain from angina is often relieved with rest or medicines.

Chest pain can also be a symptom of other heart conditions:

• pericarditis – which is inflammation of the protective sac (pericardium) surrounding your heart. Pain from pericarditis usually feels sharp or stabbing. However, it may also feel like a dull, pressure-like ache for some people. The pain can get worse when you lie down or take a deep breath.
• myocarditis – which is inflammation of the heart muscle (myocardium). If severe, this inflammation can weaken the heart and decrease its ability to pump blood properly. It can also cause abnormal heart rhythms (arrhythmias).
• cardiomyopathy – a disease of the heart muscle that affects the heart’s ability to pump blood around the body.
• spontaneous coronary artery dissection (SCAD) – a condition that occurs when a split or separation suddenly develops between the layers of the wall of one of the blood vessels (artery) that provides blood flow to the heart. The space between the layers of the artery wall may fill with blood, which may reduce or block flow through the artery. This can lead to a heart attack or cardiac arrest.

Other causes of chest pain

Chest pain can also be caused by other conditions such as:

• indigestion or heartburn (reflux) – where acid from the stomach goes up into the oesophagus (muscular tube that connects the mouth to the stomach) causing a burning pain in the chest
• inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis)
• pulmonary embolism – where there is a blockage in a blood vessel that carries blood from the heart to the lungs
• pleurisy – inflammation of the tissue lining the lungs
• chest infections such as pneumonia and bronchitis
• chest trauma (rib fractures)
• chest muscle strains
• costochondritis – inflammation in the rib joints near the breastbone
• panic attack
• shingles (or herpes zoster) – an infection that can cause chest pain before a rash forms.

Diagnosing chest pain and heart conditions

To understand your chest pain, your doctor will review your symptoms, ask about your family history of heart disease and conduct a physical examination. Your doctor may also arrange one or more of the following tests:

• electrocardiogram (ECG) – to measure the electrical activity of your heart
• blood tests – including a troponin test to measure levels of enzymes (proteins) released into the blood when the heart muscle is damaged
• chest X-rayExternal Link – to produce an image that shows the location, size and shape of the lungs, heart and major blood vessels
• chest computed tomography (CT) scan – to create 3D images of the organs and structures in the chest, including the heart and lungs
• exercise stress test – to find out how well the heart responds to physical activity. The heart is monitored using an ECG while you ride a stationary bike or walk on a treadmill.
• coronary angiogram – to see if the coronary arteries are narrowed or blocked from a build-up of plaque.

Treatment for chest pain

Chest pain treatment varies depending on what’s causing the pain. Treatments may involve medicines or surgery.

Chest pain from a heart attack requires emergency treatment to restore blood flow to the heart. The faster this happens, the less damage to the heart muscle.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• AUSactiveExternal Link External Link
• Dietitians AustraliaExternal Link Tel. 1800 812 942
• Heart FoundationExternal Link
• QuitlineExternal Link Tel. 13 78 48 (13 QUIT)
• Physical Activity AustraliaExternal Link Tel. (03) 8320 0100

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articles of the Oxford Medical Medical Center Zaporozhye

Sharp or, on the contrary, dull pain in the chest area has happened to each of us at least once . .. “Heart hurts” – we decide and drink validol offered by well-wishers. Of course, no one goes to the doctor. What for? After all, it has passed …

As it turned out, this characteristic pain can have completely “non-cardiac” causes. Here is a list of the most common problems.

Heartburn. Disease of the esophagus.
Symptoms: burning sensation in the chest. Most often, pain occurs after eating, when bending the body or in a supine position.
Cause: Ejection of gastric juice from the stomach into the esophagus.
Advice: Book an appointment with a gastroenterologist at the Oxford Medical – Zaporizhia Medical Center.

Panic attacks.
Symptoms: chest pains, palpitations, rapid breathing, profuse sweating and attacks of causeless fear.
Reason: dysfunction of the autonomic nervous system.
Advice: Make an appointment with a cardiologist and neuropathologist at the Oxford Medical – Zaporozhye Medical Center, make an appointment with a good psychotherapist.

Pleurisy.
Symptoms: Acute pain in the chest, aggravated by inspiration or coughing.
Causes: inflammation of the membrane that lines the inside of the chest cavity and covers the lungs. Most often, pleurisy occurs with pneumonia.
Advice: Make an appointment with a pulmonologist, an internist at the Oxford Medical – Zaporozhye medical center, take an x-ray.

Tietze syndrome.
Symptoms: sudden and rather intense pain, as in an attack of angina pectoris, but with different localization. Pain may increase when pressing on the sternum or ribs near the sternum.
Causes: inflammation of the cartilaginous parts of the ribs, especially the cartilages attached to the sternum.
Advice: Make an appointment with a general practitioner of the Oxford Medical – Zaporizhia Medical Center.

Osteochondrosis of the cervical or thoracic spine
Symptoms: pain in the sternum or in the left half of the chest. The pain is intense and prolonged, can “give” to the hands or the interscapular region. The intensity of pain sensations changes with a change in body position, head turns or hand movements.
Advice: Make an appointment with a general practitioner and neurologist at the Oxford Medical – Zaporozhye Medical Center, do an MRI of the spine.

Pulmonary embolism.
Symptoms: sudden, sharp pain in the chest, most often caused or aggravated by deep breathing or coughing. It is also characterized by shortness of breath, palpitations, an unreasonable feeling of anxiety and loss of consciousness.
Causes: A blood clot enters the pulmonary artery and blocks blood flow to the heart.
Advice: Call an ambulance, make an appointment with a general practitioner and pulmonologist at the Oxford Medical – Zaporizhia Medical Center

Muscle diseases.
Symptoms: Pain in the region of the heart that occurs when turning the body or raising the arms.

Rib injuries and pinched nerves.
Symptoms: the pain is localized along the intercostal spaces and increases with pressure.
Causes: bruises and fractures of the ribs, pinched nerve roots.
Advice: Make an appointment with a general practitioner and neurologist at Oxford Medical Center – Zaporozhye

Shingles .
Symptoms: pain in the left half of the chest or are of a shingles character.
Causes: an infection caused by herpes that affects the nerve endings.
Advice: Make an appointment with a dermatovenereologist at Oxford Medical – Zaporizhzhia Medical Center

Disease of the gallbladder and pancreas.
Symptoms: pain in the upper abdomen radiating to the region of the heart.
Causes: gallstones, cholecystitis (inflammation of the gallbladder) or pancreatitis (inflammation of the pancreas).