Chest Pain: A Heart Attack or Something Else?

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.

Chest pain and heart attack symptoms

Chest pain is only one of the possible signs of an impending heart attack. If you notice one or more of the signs below in yourself or someone else, call 911 or your local emergency number right away.

Uncomfortable pressure, squeezing, fullness, burning, tightness, or pain in the center of the chest
Pain, numbness, pinching, prickling, or other uncomfortable sensations in one or both arms, the back, neck, jaw, or stomach
Shortness of breath
Sudden nausea or vomiting
Lightheadedness or dizziness
Unusual fatigue
Heat/flushing or a cold sweat
Sudden heaviness, weakness, or aching in one or both arms.

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

More likely to be a heart attack	Less likely to be a heart attack
Sensation of pain, or of pressure, tightness, squeezing, or burning	Sharp or knifelike pain brought on by breathing or coughing
Gradual onset of pain over the course of a few minutes	Sudden stabbing pain that lasts only a few seconds
Pain in diffuse area, including a constant pain in middle of chest	Pain clearly on one side of the body or the other
Pain that extends to the left arm, neck, jaw, or back (see figure below)	Pain that is localized to one small spot
Pain or pressure accompanied by other signs, such as difficulty breathing, a cold sweat, or sudden nausea	Pain that lasts for many hours or days without any other symptoms
Pain or pressure that appears during or after physical exertion or emotional stress (heart attack) or while you are at rest (unstable angina)	Pain reproduced by pressing on the chest or with body motion

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).

Heart attack pain

illustration of areas where heart attack pain may be felt

Pain from a heart attack isn't confined to the area around the heart. The most typical locations are marked in dark red; light red shows other possible areas.

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 will 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.