Decoding chest pain


‘Am I having a heart attack?’ That’s likely the first thing that comes to your mind if you experience pain or discomfort in your chest, jaw or down your arm. After all, more than 735,000 Americans have a heart attack every year. You certainly know someone who has.

NOTE: If you think you may be having a heart attack, call 9-1-1 immediately.

The causes of chest pain can run the gamut from life-threatening conditions (e.g. heart attack or blood clots) to those that are relatively benign (e.g. anxiety, heartburn). 

Ernest Mazzaferri Jr., MD, medical director of the Ohio State Richard M. Ross Heart Hospital, has the answers for common questions about chest pain that may be on your mind.

What does the pain of a heart attack feel like?

The pain during a heart attack is not often described as pain, rather it is classically described as chest heaviness, chest pressure or chest discomfort that may or may not radiate to the arm or neck, explains Dr. Mazzaferri. 

Those symptoms may be associated with other symptoms such as nausea, sweating, shortness of breath or lightheadedness. Instead of a heart attack, though, such pain or discomfort could also be angina.

Angina is believed to be due to a lack of blood flow to the heart, but not to the same degree as a heart attack. Symptoms from angina usually go away with rest in less than10 minutes. (Angina should be addressed by your doctor, so schedule an appointment to confirm.)

Dr. Mazzaferri cautions not all patients have the above classic symptoms of heart attack or angina. In fact, women are more likely to have atypical symptoms. These symptoms can range from isolated shortness of breath, palpitations, nausea and/or vomiting.

“Sometimes the symptoms of heartburn can masquerade as a heart attack and vice versa,” says Dr. Mazzaferri.

The key is if you know something is really wrong and you think it might be your heart – call 9-1-1 and don’t drive to the hospital on your own. (See more on this advice below.)

So if not heart attack, what is that chest pain?

“It seems obvious to say, but anything between – and including – the skin on your chest and the skin on your back can cause chest pain,” says Dr. Mazzaferri. 

Other causes of chest pain include radiating orthopedic pain from your shoulders or neck; issues with your lungs, such as pneumonia or asthma; gastrointestinal tract problems, such as heartburn, hiatal hernia; and a variety of other musculoskeletal trauma.

Even anxiety or panic attacks can be the culprits behind chest pain.  

Who is most at risk for heart attack?

Those at the very highest risk for heart attack are people with a prior history of heart attack or people diagnosed with symptomatic coronary artery disease, vascular disease, aortic aneurysms or peripheral vascular disease.

After that, major risk factors include:

  • Men over age 45 and women over age 55
  • Smoking
  • Diabetes
  • Hypertension
  • Family history of heart disease or sudden cardiac death

Why do women need to pay extra attention?

Women are at high risk for heart issues, and heart-related problems remain the number one cause of death in both men and women in the United States. Again, because women’s symptoms of heart attacks can differ from men, women sometimes ignore or under-recognize their heart attack symptoms. Women may also be hesitant to ask for help for fear of inconveniencing their loved ones.

(Read more: It’s time to pay more attention to heart attacks in women)

Bottom line is to have a conversation with your doctor about your risks and prevention of heart disease. And if you think you are having a heart attack, better to be safe than sorry and call 9-1-1.

Extra: Why to call for an ambulance

While it may seem faster to drive yourself – or have a friend drive you – to the hospital, in reality you are delaying time to get treatment. EMS is our partner in caring for you and they can begin treating patients as soon as they arrive. (It’s not just about transportation). 

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