Feeling pain, pressure or tightness in the chest is one of the most worrisome symptoms. Sometimes it is due to something relatively common such as reflux or muscle tension, but at other times it can be an emergency. The key is to recognize warning signs and know when not to wait.
TL;DR (the essentials)
- Consider urgency if the pain is severe, comes on suddenly, lasts more than a few minutes, or is accompanied by shortness of breath, cold sweat, nausea, dizziness or fainting.
- Not all chest pain is a heart attack, but cannot be ruled out with certainty without a medical evaluation., especially if it is a new symptom.
- If you have reasonable doubt, it is safer to go to the emergency room to wait.
How can chest pain be felt?
It is not always felt as “pain” in the strict sense. It can present itself as:
- Pressure or tightness in the center of the chest
- Feeling of weight or “squeezing”
- Burning similar to heartburn
- Discomfort that moves or radiates to the arm, neck, back, or jaw
- Sensation that appears with exertion (climbing stairs, fast walking) or even at rest.
This is why the context and accompanying symptoms matter so much.
Warning signs: when is it an emergency?
Seek immediate medical attention if chest pain:
- It is new, intense, sudden or does not yield in a few minutes
- Feels like marked pressure/oppression (not just an isolated “sting”)
- It is accompanied by shortness of breath, cold sweat, nausea, vomiting, unusual weakness, dizziness, or fainting
- Radiating to one or both arms, back, neck, jaw, or upper abdomen
- Appears together with very rapid/irregular palpitations and a feeling of significant discomfort.
In women, older adults and people with diabetes, symptoms may be less “typical”. In these cases, it is even better not to minimize.
What to do if you suspect an emergency?
- Do not attempt to drive if the pain is severe or there are warning signs. Call for support or emergency services.
- Don't “try” exercise, food, coffee or home remedies to see if it goes away.
- If the pain is severe or there are warning signs, do not expect.
If you want to learn more about what to do in a critical event, check the guide of cardiopulmonary resuscitation (CPR) and the article on acute myocardial infarction.
Common Causes of Chest Pain (and Helpful Hints)
These “clues” are not a substitute for an assessment. They serve to understand why pain can be confusing.
1) Cardiac causes (the most important to rule out)
Angina or ischemia (decreased blood supply to the heart)
It usually feels like pressure/oppression. May appear with exertion or stress and improve with rest. Sometimes radiates to the arm, neck, back or jaw.
Infarction
It may feel like pressure, tightness or persistent pain. Sometimes it is accompanied by shortness of breath, sweating, nausea, malaise or a feeling of “something is not right”. It is not always sudden or “dramatic”.
If the pain comes with irregular heartbeats, check palpitations: common causes and when to worry about them.
2) Respiratory causes (lung/pleura)
They usually give pain that worsens with deep breathing or coughing. There may be shortness of breath, fever or respiratory symptoms. Depending on the case, serious causes are ruled out in the emergency department when the symptoms suggest it.
3) Digestive causes (very frequent)
The reflux may cause retrosternal (behind the sternum) burning, sometimes after eating or at bedtime. It can be confused with cardiac pain.
Caution: if the pain is new, intense or comes with warning signs, do not assume “it is reflux” without assessment.
4) Musculoskeletal causes (muscle/ribs/chest)
Localized pain that increases with movement, posture or pressure on the area. It may appear after carrying weight, doing unusual exercise or spending many hours in bad posture.
5) Stress and anxiety
They can cause chest tightness, rapid breathing, palpitations, choking sensation or fear. It is real and can be very intense, but may resemble cardiac causes. If it is new or strong, it is worth evaluating. You can complement with stress, sleep and heart health.
What will the cardiologist do in the evaluation?
Depending on your symptoms and history, the cardiologist will seek to rule out serious causes and guide the study. He may indicate, for example:
- A electrocardiogram (ECG)
- A stress test
- And other studies if the case warrants it (according to risk, exploration and evolution).
The goal is to come up with a safe explanation and a clear plan, not just to “calm the symptom”.
When to schedule a consultation, even if it is not an emergency?
Cardiological evaluation is advisable if:
- Pain occurs with exertion and is repeated
- There have been recurrent episodes in days or weeks
- You have hypertension, diabetes, high cholesterol, smoking or a family history of cardiovascular disease.
- Lower exercise tolerance (you get more tired with the same exercise).
- The pain is accompanied by palpitations or repeated shortness of breath.
In these cases, you can know the cardiological check up o schedule an appointment.
About the specialist
Dr. Karla Castolo is a cardiologist with a focus on early diagnosis, cardiovascular prevention and comprehensive patient care. Learn more about her training and experience at About me.
References
- American Heart Association. Warning Signs of a Heart Attack. See source
- Gulati, M., et al. (2021). 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. See guide
- Mayo Clinic. Chest pain: Symptoms and causes. See source
- NHS. Chest pain. See source