Most chest pain is not caused by a heart attack, but this cannot be judged safely from pain intensity or age alone. New, persistent or pressure-like pain — especially with shortness of breath, sweating, nausea or pain spreading elsewhere — needs immediate assessment.
At a glance
The main points
- In a possible acute cardiac event we call 112 or 166 — we don't drive alone.
- Describing pain helps, but is not sufficient for self-diagnosis.
- Pain on exertion that resolves with rest needs prompt evaluation.
- An earlier normal test does not invalidate a new symptom.
Spots that don't wait for a date
Call for emergency medical help immediately if you have sudden chest pain or discomfort that does not go away, pressure or tightness, or pain spreading to an arm, shoulder, jaw, back or upper abdomen. Cold sweats, nausea, shortness of breath, severe weakness or dizziness alongside these symptoms increase the concern.
The picture may be less typical in women, the elderly and people with diabetes. The absence of severe pain does not rule out a serious problem.
Why it's not enough to label pain "muscular"
Pain that changes with movement or pressure may be musculoskeletal, while burning may be digestive related. However, the features overlap. Neither position nor a temporary improvement is sufficient to safely rule out a cardiac cause.
Proper evaluation combines history, examination, ECG, and, in an emergency setting, appropriate laboratory or imaging tests.
Pain that occurs on exertion
Discomfort, heaviness, or pressure that occurs with walking, uphill, or cold and resolves with rest may be compatible with angina pectoris and prompt cardiac evaluation. If it is a new symptom, worsens, occurs with less effort or even at rest, the evaluation becomes more urgent.
Do not try to induce the symptom by exercising at home to “test” it. Until the assessment, follow the instructions given by a healthcare professional.
Other common and less common causes
The chest wall, esophagus, lungs, and stress can all cause pain or discomfort. There are also serious non-coronary causes, such as a pulmonary embolism or aortic problem, that require urgent care.
The cause cannot be established by ruling out possibilities through an internet search. The first priority is to assess any immediate risk, then choose the appropriate tests.
What will be discussed in a scheduled assessment
Useful details include the exact location and duration of pain, its relationship to exertion or meals, whether it spreads elsewhere, associated symptoms and risk factors. Depending on the likelihood of a cardiac cause, an ECG and targeted tests may be needed. Different causes of pain may require different tests.
Bring previous medical records and medication list. An old normal result is useful for comparison, but is not a permanent guarantee for every new symptom.
What to do right now
If the pain is now present and matches the emergency points, stop trying and call 112 or 166. Do not drive alone and wait to see if it passes. Follow the instructions of the emergency call center.
If the pain has subsided but was new or troubling, seek immediate medical advice for the appropriate level of care.
When not to wait
Immediate medical attention
New or persistent chest pain or pressure, especially with shortness of breath, sweating, nausea, fainting or pain spreading to the arm, jaw or back: call 112 or 166. The website, email and form are not intended for emergency triage.
Sources & further reading
The article provides general information and is not a substitute for an individualized medical evaluation.