Chest Pain

Chest pain has many causes — some minor, some immediately life-threatening. Because the consequences of missing a serious cause are so severe, chest pain always deserves careful assessment.

When to dial 112 immediately

Any of these with chest pain — assume heart attack or other emergency and get help NOW:

• Severe or crushing chest pain or pressure, especially central
• Pain spreading to the arm, jaw, neck, back, or upper abdomen
• Pain with sweating, nausea, or breathlessness
• Sudden, very sharp chest pain with breathlessness (could be pulmonary embolism or pneumothorax)
• Tearing pain through the chest to the back (could be aortic dissection — rare but catastrophic)
• Fainting, near-fainting, cold clammy skin
• Chest pain in someone with known heart disease or many risk factors

Other causes of chest pain

• Heart-related — heart attack, angina (pain on effort that eases with rest), pericarditis, myocarditis
• Lung-related — pulmonary embolism (blood clot in lung), pneumonia, pleurisy, pneumothorax (collapsed lung)
• Digestive — acid reflux / GERD (burning, sometimes severe), oesophageal spasm, peptic ulcer, gallbladder disease
• Musculoskeletal — chest wall strain, costochondritis (inflammation of rib cartilage), rib injury
• Nerve-related — shingles (before the rash appears), pinched nerve
• Anxiety / panic attack — sharp chest pain with breathlessness and fear — can closely mimic heart attack. A diagnosis to make only after heart causes are excluded.
• Skin — shingles rash

Higher-risk groups

Some people have serious causes of chest pain without the "classic" features:

• Women often have less typical heart-attack symptoms (breathlessness, back/jaw pain, fatigue)
• People with diabetes may have painless or minimally-painful heart attacks
• Older adults may have confusion as the main feature
• Never dismiss chest symptoms in these groups without medical evaluation

What happens at the hospital

• ECG — usually first, within minutes
• Blood tests including cardiac troponin
• Chest X-ray
• Echocardiogram, CT scan, or other imaging as needed
• Sometimes coronary angiography — direct imaging of heart arteries

If you're in doubt about whether chest pain is serious, err on the side of getting it checked. A few hours in an emergency department for non-cardiac pain is vastly preferable to missing a heart attack at home.