Chest pain: when should you act?

Understanding chest pain

Chest pain is any uncomfortable sensation felt between the neck and the upper abdomen — and it is one of the most common reasons people come to an emergency department. It has many possible causes, from the heart and its blood supply to the lungs, the digestive system, the muscles and ribs of the chest wall, or anxiety. The feeling alone cannot tell you which of these it is, which is exactly why chest pain is always worth assessing rather than guessing at. This page explains how to tell urgency apart — but if you are having chest pain right now, skip ahead to "Is this an emergency?" below.

The heart muscle gets its own blood supply from the coronary arteries, which sit on its outer surface. When one of these arteries narrows — usually from a build-up of fatty deposits (atherosclerosis) — the heart muscle beyond the narrowing does not get enough oxygen when demand rises, such as during exertion. That mismatch produces angina, a squeezing chest discomfort. If an artery blocks off completely, the muscle it supplies begins to die within minutes; this is a heart attack (myocardial infarction), and it is a medical emergency where every minute of delay costs muscle. Other chest structures — the lungs and their lining, the oesophagus, the ribs, cartilage and chest-wall muscles, and the nerves that run between the ribs — can all produce pain that is felt in a similar place but comes from an entirely different cause.

What chest pain can feel like

Descriptions vary widely between people and between causes. These are common ways patients describe it, offered to help you put your own experience into words — not a checklist for diagnosing yourself.

• ●Pressure, tightness or squeezing, as though something heavy is sitting on the chest
• ●A dull ache, heaviness or burning sensation
• ●Discomfort spreading to an arm (often the left), shoulder, back, neck or jaw
• ●A sharp, stabbing pain that changes with breathing or posture
• ●Breathlessness, sweating, nausea, light-headedness or unusual, unexplained weakness alongside the pain
• ●Discomfort that comes on with walking, stairs or exertion and eases with rest

As a rough pattern, discomfort that is triggered by exertion, feels like pressure rather than a sharp stab, and comes with breathlessness or sweating is more suggestive of the heart — while pain that changes with breathing, pressing on the chest wall or body position is more often musculoskeletal or from the lung lining. These patterns overlap enough in real life that self-diagnosis is unreliable, which is why assessment matters more than the description alone.

What causes chest pain

Grouping possible causes by the body system involved can help you see where your own experience might fit — though only an assessment can confirm it.

Heart-related causes

Angina, from narrowed coronary arteries; heart attack, from a completely blocked artery; and pericarditis, an inflammation of the sac around the heart that often causes sharp pain easing when leaning forward.

Lung-related causes

Pneumonia (lung infection), pleurisy (inflammation of the lung's lining, often sharp and worse with breathing), a collapsed lung (pneumothorax), and a pulmonary embolism — a blood clot that has travelled to the lungs, which can cause sudden breathlessness and chest pain and needs urgent treatment.

Digestive causes

Acid reflux (gastro-oesophageal reflux disease) and spasm of the oesophagus can both produce a burning or squeezing chest sensation that mimics cardiac pain closely enough that it is often only distinguished by testing.

Musculoskeletal and nerve-related causes

Costochondritis (inflammation where the ribs meet the breastbone), muscle strain, and shingles — a nerve and skin infection that can cause band-like chest pain before any rash appears — are common, generally benign causes.

Anxiety and panic

Anxiety and panic attacks are a genuine physical experience, often with chest tightness, a racing heart and breathlessness, and can feel frightening and very similar to a cardiac event. This is a diagnosis reached by excluding other causes, not assumed from the outset.

Who is more likely to have a heart-related cause

These factors raise the likelihood that chest pain comes from the heart, and are worth mentioning at your appointment:

• ●High blood pressure — very common in Nigeria and often undiagnosed, it damages artery walls over time
• ●Diabetes
• ●High cholesterol
• ●Smoking or tobacco use
• ●Excess weight, particularly around the waist
• ●A family history of heart disease, especially at a younger age
• ●Increasing age
• ●A sedentary lifestyle
• ●Known heart or blood-vessel disease, including a previous heart attack, stent or bypass surgery

What happens if a heart-related cause goes untreated

Most chest pain is not a heart attack, but the minority that is matters greatly, and delay has real consequences.

Ongoing muscle damage. During a heart attack, heart muscle continues to die for as long as the blocked artery stays closed — the reason emergency treatment is so time-critical.

Heart failure. Muscle damaged by a heart attack cannot pump as strongly afterwards; enough damage can leave the heart unable to keep up with the body's needs.

Dangerous heart rhythms. Damaged heart muscle is prone to electrical instability, which can trigger a dangerous rhythm and, rarely, cardiac arrest.

Recurrent or worsening angina. Untreated narrowing tends to progress, so pain that is dismissed once often returns, and can escalate to a heart attack.

How Cardiocare finds the cause

The right pathway depends on your symptoms, examination and overall health. It typically draws on some or all of the following:

• 01
  History and examination. When the pain started, what it feels like, what brings it on and eases it, plus an examination of your heart, lungs, pulse and blood pressure.
• 02
  12-lead ECG (electrocardiogram). A painless recording of the heart's electrical activity from pads on the chest and limbs, taking minutes and often the first test done.
• 03
  Cardiac blood tests. Troponin, a protein released by damaged heart muscle, helps confirm or rule out a heart attack.
• 04
  Chest X-ray. Looks at the lungs, heart size and chest structures.
• 05
  Echocardiogram. A painless ultrasound scan showing the heart's structure and pumping function.
• 06
  Exercise or stress testing. Monitors the heart's response, symptoms and ECG changes during controlled exertion.
• 07
  Coronary CT angiography. A scan that images the coronary arteries directly, useful for selected patients.
• 08
  Coronary angiography. A catheter-based test, performed in Cardiocare's on-site cath lab, that images the coronary arteries directly and can lead straight into treatment if a blockage is found.

How chest pain is treated

Treatment depends entirely on the cause — there is no single treatment for chest pain as such.

Immediate emergency treatment

If a heart attack is confirmed or strongly suspected, treatment begins immediately in the emergency department, aiming to restore blood flow to the heart muscle as fast as possible — this is why time matters so much and why calling ahead and going straight to the nearest emergency department is the right first move.

Medicines, by class

Where medicine is needed for a heart-related cause, it is chosen by what it does, and your clinician will discuss the right option and dose for you:

• ●Antiplatelet medicines — help prevent the clots that block coronary arteries
• ●Statins — lower cholesterol and stabilise artery deposits
• ●Beta blockers — reduce the heart's workload and oxygen demand
• ●Nitrates — widen blood vessels to relieve angina
• ●ACE inhibitors — protect heart function and control blood pressure

Procedures

Available through Cardiocare's on-site cardiac catheterisation ("cath") laboratory and cardiac surgery service:

• ●Coronary angioplasty and stenting — a catheter opens a narrowed or blocked artery and a small mesh tube (stent) holds it open
• ●Bypass surgery — grafts a new route for blood around a severely narrowed artery, for selected patients

Living well after a cardiac cause is found — or ruled out

Whatever the outcome of assessment, these habits reduce the risk of future chest pain from the heart:

• ✓Take prescribed medicines consistently, even once you feel well
• ✓Control blood pressure, blood sugar and cholesterol through follow-up care
• ✓Stop smoking — one of the most powerful changes you can make
• ✓Build up regular activity as advised by your clinician
• ✓Eat a heart-healthy diet and work towards a healthy weight
• ✓Manage stress and protect your sleep

If it happens again

Do not assume a repeat episode is "the same as last time." Any new, worsening or different chest pain deserves fresh assessment using the same emergency guidance above.

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Any previous ECGs, blood test results or hospital letters
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

When the pain started, exactly what it feels like, what brings it on and relieves it, how long it lasts, and what else you notice alongside it, such as breathlessness or sweating.

Questions worth asking us

• ●What do you think is causing my chest pain?
• ●Do I need any tests, and what will each involve?
• ●Is this likely to be from my heart?
• ●What should I do if the pain happens again before my next visit?