Chest Pain: Sign of a Heart Attack or Something Else?

Millions of people seek emergency medical care for chest pain or pressure every year. If you’re experiencing this symptom, you may worry that you’re having a heart attack. But chest pain can be associated with dozens of other conditions.

So how do you know whether you’re experiencing a heart attack or something else?

“Chest pain or chest pressure is one of the most common complaints in the emergency department,” says Michelle O’Donoghue, MD, MPH, a cardiologist with Mass General Brigham who cares for patients at Brigham and Women’s Hospital and Massachusetts General Hospital. “A fraction of the time, it’s a heart attack. Many times, it turns out to be another diagnosis.”

You can ask yourself several questions to try to determine what’s causing your symptoms. But if you’re not sure, Dr. O’Donoghue says, call 911 or go directly to an emergency department.

What is a heart attack?

A heart attack (myocardial infarction) happens when blood flow to the heart is blocked and the heart muscle doesn’t get enough oxygen. The lack of oxygenated blood can damage the heart, especially if a long time passes before you receive medical treatment. A heart attack can be life-threatening.

Heart attack symptoms

Chest pain or pressure is the classic sign of a heart attack. However, Dr. O’Donoghue says, very few people actually describe the symptom as “pain.” Many say it feels like pressure, tightness, squeezing or constriction. The feeling may travel into the left arm, shoulder, neck, jaw or back. “Sharp pain that is very focal and you can point directly to with one finger is often not a heart attack but could be another emergent condition,” she explains. “People more commonly describe the chest pain associated with a heart attack as feeling like someone is sitting on their chest”. 

Different people experience heart attacks in different ways, Dr. O’Donoghue adds. Some don’t have any sensations in the chest but may experience other symptoms (this is especially common in women):

• A feeling in the chest often described as pressure, tightness, squeezing or constriction—but not always.
  
• Nausea
  
• Pain or tightness in the arm, shoulder, neck, jaw or back
  
• Shortness of breath
  
• Sweating
  
• Weakness or dizziness
  

“There are other conditions that cause chest pain and similar symptoms. Some aren’t as serious as a heart attack, but others are worrisome,” she says. “I recommend that people trust their instincts. If you feel like something isn’t right, you should be immediately evaluated in the emergency department.”

Other causes of chest pain

The chest pressure that accompanies heart attack is often confused with heartburn (acid indigestion). It also may indicate:

• Angina, when blood supply to the heart muscle is restricted but not blocked
  
• Lung issues, including infection (pneumonia) or a blood clot (pulmonary embolism)
  
• Muscle pain, such as inflammation or injury to the muscles in the chest wall  
  
• Other digestive issues, such as inflammation or spasms in the pancreas, gallbladder or esophagus
  
• Panic attack, or very intense anxiety
  
• Tear in a blood vessel, such as aortic dissection
  

How can I tell if I’m having a heart attack or another condition?

Ask yourself a few quick questions to help evaluate what’s causing chest pain or pressure:

• Is the feeling relieved by changing position? Pain that is positional may indicate a different problem. 
  
• Is the feeling quickly improved with antacids? That might indicate that heartburn is to blame. 
  
• Is the feeling a pressure or tightness over a broad area, about the size of a closed fist? That might indicate a heart attack.
  
• How long has the chest discomfort been happening? If it’s been more than 15 minutes and isn’t relieved with rest, you should seek urgent medical attention by calling 911.
  
• Do you have any of the major risk factors for heart attack?
  
  • High blood pressure or hypertension
    
  • High cholesterol
    
  • History of smoking
    
  • Previously diagnosed heart condition, particularly coronary artery disease (CAD)
• Have you been experiencing an increasing or escalating pattern of chest pain over time? For example, in the past few months, have you noticed more discomfort with less activity or exertion? That may indicate a heart condition that requires immediate attention. 

Dr. O’Donoghue says you shouldn’t spend more than 15 minutes evaluating symptoms. “We don’t want people spending too much time trying to sort it out. If you have any concerns that your symptoms may represent a heart attack, speak up, express that and get medical attention. Don’t worry about embarrassment or what the emergency department staff will think. Chest pain is an important symptom that can indicate a number of problems, and it requires urgent evaluation. You should call 911 and avoid driving yourself to seek immediate help.”