Chest pain: when is it your heart?

Chest pain is one of the most common reasons people seek medical help. Most cases do not come from the heart, but some are a sign of a serious condition, such as a heart attack. That is why chest pain should never be ignored: it is important to recognise the signs that need urgent help and to get checked by a doctor when the pain keeps coming back.

When should you call 127 immediately?

Call the emergency number 127 without delay if the pain:

• feels tight, pressing or burning and lasts longer than a few minutes
• spreads to the arm (especially the left), neck, jaw, back or upper abdomen
• comes with breathlessness, a cold sweat, nausea, dizziness or fainting
• starts suddenly, is very severe and moves towards the back
• comes with sudden breathlessness after a long journey, surgery or a long period in bed

Do not drive yourself to hospital and do not wait to see whether the pain passes. In women, older people and people with diabetes, a heart attack may cause less typical symptoms, such as extreme tiredness, breathlessness or a vague discomfort in the chest.

When chest pain comes from the heart

• Angina pectoris – pain or tightness that appears with exertion, climbing stairs, cold or stress, and settles with rest within a few minutes. It is caused by narrowing of the arteries that supply the heart (coronary artery disease).
• Heart attack – similar pain, but stronger and longer-lasting, that does not ease with rest. It is an emergency.
• Pericarditis – inflammation of the sac around the heart; a sharp pain that gets worse when you breathe deeply or lie down and eases when you sit up and lean forward.
• Valve disease and cardiomyopathies – can cause pain during exertion, together with breathlessness or dizziness.
• Aortic dissection – rare but very dangerous; sudden, very severe pain that goes through to the back.

Causes not related to the heart

• Chest muscles and bones – a muscle strain or inflammation of the rib cartilage. The pain often gets worse when you press on the area or move your body.
• Gastro-oesophageal reflux – burning behind the breastbone, especially after eating or when lying down, sometimes with a sour taste in the mouth.
• Anxiety and panic attacks – chest tightness with fast breathing, palpitations, tingling hands and intense fear.
• The lungs – pneumonia, pleurisy, a collapsed lung or a pulmonary embolism. The pain often gets worse with breathing or coughing; a pulmonary embolism is an emergency.
• Shingles – burning pain on one side of the chest, before the blisters appear on the skin.

These features help, but the description of the pain alone cannot safely rule out a heart cause. That is why a medical assessment remains important.

How a cardiologist assesses chest pain

When the pain is not an emergency, or once an acute condition has been ruled out, the cardiologist carries out a step-by-step assessment:

• Cardiology consultation – detailed questions about the pain and your risk factors (smoking, high blood pressure, cholesterol, diabetes, family history), plus a physical examination.
• ECG – shows signs of reduced blood supply, rhythm disorders or a previous heart attack.
• Echocardiogram – assesses how the heart walls move, the valves and the pericardium.
• Treadmill stress test – shows whether the heart gets enough blood during exertion.
• Laboratory tests – cholesterol, blood sugar and other tests as needed.

If coronary artery disease is suspected, the cardiologist may recommend further tests, such as coronary angiography, which is performed in hospital.

When should you see a cardiologist?

Book a consultation if you have chest pain or tightness that keeps returning with exertion, if you had an episode of pain that passed but left you worried, or if you have risk factors for heart disease and would like a check-up. At Dr. Medical Clinic & Lab, our cardiologists carry out the consultation, ECG, echocardiogram and stress test in the same clinic, and guide you when hospital treatment is needed.

This article is for information only and does not replace a consultation with a doctor.