Chest pain is a serious symptom meaning “heart attack” to most people. Serious chest discomfort should usually be evaluated by a physician right now. On the way to the emergency room or while waiting for the ambulance, take two aspirin tablets. While pain from the heart may sometimes be mild, it is usually intense. Sometimes a feeling of pressure or squeezing on the chest is more prominent than actual pain. Almost always the pain or discomfort will be felt in part below the breastbone. It may also be felt in the jaw or down the inner part of either arm. There may be nausea and sweating. If dizziness, shortness of breath, or irregularity of the pulse is present, it is particularly important that a physician be seen immediately.
A related form of heart pain is not a heart attack but is termed “angina pectoris” or “angina.” These pains also can occur in the upper arms or the jaw, but usually involve part of the breastbone. Angina pains occur with exercise and sometimes with stress, and they go away with rest and relaxation. They are a result of narrowed arteries to the heart that are unable to supply enough blood when the heart is working hard. In a heart attack, one of these same arteries has actually become totally blocked. However, all chest pain does not come from the heart. Pain can also come from the chest wall, the lungs, the outside covering of the lungs, the outside covering of the heart, the esophagus, the diaphragm, the spine, the skin, or the organs in the upper part of the abdominal cavity. Often it is difficult even for a physician to determine the precise origin of the pain. Therefore there are no absolute rules that enable you to determine which pains may be treated at home. The following guidelines usually work and are used by doctors, but there are occasional exceptions.
A shooting pain lasting a few seconds is common and means nothing. A sensation of a “catch” at the end of a deep breath is also trivial and does not need attention. Chest wall pain can be demonstrated by pressing a finger on the chest at the spot of discomfort and reproducing or aggravating the pain by this maneuver. Pleurisy gets worse with a deep breath, heart pain does not. When pericarditis is present, the pain may throb with each heartbeat. Ulcer pain burns with an empty stomach and gets better with food, gallbladder pain often becomes more intense after a meal. Each of these four conditions, when suspected, should be evaluated by a physician.
Spasm of the esophagus can cause severe pain mimicking a heart attack and is quite different from the acid-burning that we called heartburn. This spasm pain feels as if it is expanding from inside the chest rather than squeezing from the outside as does heart pain. And it is often relieved by a drink of water, while heart pain is not.
If your chest pain is a new sensation and you are not sure what is going on, you should be evaluated promptly in an emergency medical facility. This is a complaint for which it is better to be conservative. See a doctor. Exceptions are chest wall pain, particularly if you had unusual exertion a day or so before, or pain that you are sure is coming from the esophagus. These you can treat with rest and acetaminophen, in the case of chest wall pain, and water and antacids, in the case of pain coming from the esophagus.