When someone has a sudden or unfamiliar pain or discomfort in the chest, the first thought is typically, “Is this a heart attack?” While a heart attack is a potentially deadly or disabling condition, many different problems can bring on chest pain. In some cases the underlying cause may have nothing to do with your heart.
Chest pain may be caused by a cardiac, pulmonary, gastrointestinal, neurological or musculoskeletal issue. Emotional stress, panic or anxiety can trigger episodes of chest pain due to one or more of these systems. Because it is difficult to distinguish chest pain due to a heart problem from other types of chest pain, it is important to never ignore the pain. When the body gives warning signs, pay attention, talk to your primary care physician or a heart specialist and get to the cause of your chest pain. Heart attacks continue to be the number one killer in the US among both men and women.
When chest pain of any degree is present, our main goal is to identify or rule out life threatening conditions such as a heart attack or blood clot in the lungs among other things. In order to distinguish between the various causes of chest pain, patient history along with physical examination and medical diagnostic testing are usually necessary. When pain is present, it is helpful for a patient to describe the location and character of the pain. For example, we would like to know: is it located in the center of the chest, or the left or right side; what symptoms are associated with the pain (shortness of breath, sweating, nausea); is it gradual or sudden onset; what makes it worse or better (exercise, position, breathing); does it hurt when you push on the area; does the pain radiate to the arm, jaw, back, or neck; the severity of the pain; any recent travel. It is helpful to know a patient’s medications and allergies, use of alcohol, tobacco or other drugs, and personal and family history of medical problems, especially heart disease and clotting disorders. This type of history can help doctors assess the probability of each potential cause, and make decisions about what potential diagnosis should be considered and which, perhaps, may be discarded.
“Angina” is the medical term for chest pain more likely to be related to the heart and includes:
- Chest, pressure, pain or discomfort (often, but not always like “an elephant sitting on your chest”), especially if accompanied by arm, jaw or back pain
- Worsening with exertion and relieved by rest or nitroglycerin
Other symptoms may occur with angina, or in some patients, especially women, diabetics and the elderly, may occur alone, including:
- Nausea, excessive fatigue, arm numbness or tingling, dizziness or fainting
- New or increased shortness of breath
Consult your doctor with intermittent chest pain or other concerning symptoms lasting more than a couple of days. Call 911 with sudden onset or progressively worse chest pain, severe shortness of breath, chest pain with a sensation of pounding or “fluttering” followed by passing out or nearly passing out.
Even if you are not experiencing chest pain, if you are concerned about your risk for developing heart disease, have a family history of heart disease or if you have experienced symptoms in the past, talk to your primary care physician or a cardiologist. There is a broad range of diagnostic and treatment options available that can change the course of heart disease and significantly enhance your quality of life.