Chest Pain: When Should You Worry?

Chest pain is common, and rarely straightforward

Chest pain sends more people to emergency departments than almost any other single symptom, and for good reason: it can be the first sign of a heart attack. But most people who experience chest pain do not have a heart problem at all. The challenge is that heart-related and non-heart-related chest pain can feel remarkably similar, which is why it should never be dismissed without a proper assessment.

What might be going on

Coming from the heart

• Angina — pain or tightness that appears with exertion or stress, as the heart muscle isn't getting quite enough blood flow, and usually eases with rest
• Heart attack (myocardial infarction) — a coronary artery becomes suddenly blocked, causing intense, persistent pain that does not settle with rest
• Pericarditis — inflammation around the outer lining of the heart, typically producing a sharp pain that is worse lying down and eased by sitting forward

Not from the heart

• Reflux (GORD) — a burning sensation rising up behind the breastbone, often triggered by certain foods, alcohol, or lying down soon after eating
• Muscle and rib pain — sharp, localised pain that gets worse when you press on the area, twist, or take a deep breath
• Anxiety and panic — can produce genuine chest tightness, a racing heart, and breathlessness, and is a diagnosis only made once heart causes have been excluded
• Lung causes — including chest infections, pleurisy, and, less commonly, a blood clot on the lung (pulmonary embolism)

The symptoms that mean call 000, now

Do not wait to see if it passes if you have:

• Chest pain or pressure lasting more than a few minutes that doesn't ease with rest
• Pain spreading to your arm, jaw, neck, or back
• Chest pain together with sweating, nausea, or light-headedness
• Sudden, severe breathlessness alongside chest discomfort

These can be signs of a heart attack, and getting to hospital quickly genuinely changes outcomes.

If it's not an emergency, but it keeps happening

Recurrent chest pain, particularly on exertion, still deserves proper assessment even if each episode settles on its own. Depending on your risk factors and how the pain behaves, this might involve:

• A resting ECG and blood tests
• A stress echocardiogram or exercise ECG to see how your heart responds to exertion
• A CT coronary angiogram to look directly at the coronary arteries without an invasive procedure

The takeaway

Most chest pain is not cardiac. But because the exceptions matter so much, it's never the symptom to try to talk yourself out of. If it's sudden, severe, or accompanied by the warning signs above, call 000. If it's recurrent or unexplained, get it properly assessed rather than living with the uncertainty.