Patient education: Chest pain (The Basics)

Should I call for an ambulance if I have chest pain? — You should call for an ambulance (in the US and Canada, call 9-1-1) 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 that you are having a heart attack. Most people who go to the emergency department 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. They might think that their symptoms are not serious or will go away. But waiting to get help can risk permanent damage to the heart, or even death.

Can a heart attack cause other symptoms besides chest pain? — Yes. Chest pain or discomfort is the most common symptom of a heart attack. But there can be other symptoms, 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 chest pain. This is more likely in females, people with diabetes, and people older than 60.

Symptoms of a heart attack (figure 1) can include:

●Pain, pressure, or discomfort in the center of the chest

●Pain or discomfort in other parts of the upper body, including the shoulders, arms, back, neck, jaw, or stomach

●Shortness of breath

●Nausea, vomiting, burping, or heartburn

●Sweating or having cold, clammy skin

●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 come and go. If you think that you might be having a heart attack, call for an ambulance (in the US and Canada, call 9-1-1) 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. Examples include:

●Heart problems other than a heart attack, 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 like heartburn, acid reflux, stomach ulcers, or irritable bowel syndrome

●Problems in the lungs, such as pneumonia or blood clots

●Mental health 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 department? — The staff in the emergency department will do an exam. They will also 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.

Some tests are done right away in the emergency department. The goal is to figure out as quickly as possible if something serious is causing your chest pain. Other tests are done after this, in the hospital.

Tests might include:

●Electrocardiogram ("ECG") – This test measures the electrical activity in your heart (figure 2). 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.

●Chest X-ray – This can show some of the problems that can cause chest pain.

●Stress test – During a stress test, you might be asked to run or walk on a treadmill while you also have an ECG (figure 3). 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 give 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, they move 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.

●Echocardiogram – This test uses sound waves to create an image of your heart as it beats. During a heart attack, not all parts of the heart pump normally.

●CT scan – This is a special kind of X-ray. Your doctor might use this to look at the blood vessels going to your heart.

If it turns out that your pain is related to something other than your heart, your doctor will talk to you about what to do next. You might need other tests or treatments.

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!

More on this topic

Patient education: Treatment choices for angina (chest pain) (The Basics)
Patient education: Medicines for angina (chest pain) (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Medicines after a heart attack (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: ECG and stress test (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: Nuclear heart testing (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Coronary artery disease in women (The Basics)
Patient education: Stenting for the heart (The Basics)
Patient education: Stress cardiomyopathy (The Basics)
Patient education: Troponin test (The Basics)
Patient education: Angina (The Basics)

Patient education: Medications for angina (Beyond the Basics)
Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)
Patient education: Chest pain (Beyond the Basics)