Is every chest pain from the heart?

Chest pain is one of the most frightening symptoms, because we all think of the heart straight away. The good news is that most chest pain does not come from the heart. The bad news is that you cannot say with certainty from the pain itself which pain is from the heart and which is not. The NHS also stresses that you should not diagnose it yourself.

What are most pains?

The NHS lists several common causes with their distinguishing features:

• Indigestion or heartburn: after a meal, with food or bitter liquid coming back up and a feeling of fullness and bloating
• A strained muscle: after an injury or exercise, worse with breathing and better with rest
• Anxiety or a panic attack: sharp, constant pain with palpitations, sweating or dizziness, often following stress
• A chest infection: pain that is worse when breathing, with yellow or green phlegm or a fever
• Shingles: tingling of the skin and then a rash that turns into blisters
• Inflammation of the lining around the heart (pericarditis): sudden, sharp, stabbing pain that is worse with a deep breath or lying down

These patterns are a guide, not a diagnosis. If a sign worries you or does not fit any of them, do not wait; get it checked.

When the pain is from the heart

There are two main conditions: angina and heart attack. The NHS says their signs are similar, but a heart attack is life-threatening.

Angina means not enough blood is reaching the heart. The pain can be a tightness, pressure or dull ache in the chest, neck, shoulder, jaw or arms. It usually starts with activity, stress, excitement or cold, lasts less than 10 minutes and should ease with a few minutes of rest or angina medicine (NHS).

A heart attack is life-threatening and needs urgent treatment in hospital. The pain is sudden and continues.

What should you not wait with?

Call 115 (Iran’s emergency number) and do not wait for an appointment if:

• You have sudden chest pain or discomfort that does not go away: squeezing, pressure, burning or like indigestion
• The pain spreads to the left or right arm, neck, jaw, belly or back
• The pain comes with sweating, nausea, dizziness or breathlessness
• The colour of your skin or lips has become pale, bluish or grey
• You have been diagnosed with angina and the pain does not stop with rest and your prescribed medicine

The NHS says in this case it may be a heart attack. Do not drive yourself. The WHO also says not to wait to see whether the signs pass, because the heart muscle begins to be damaged within minutes of the blood supply being cut off.

If the pain comes and goes

The NHS says if your chest pain comes and goes, or it eased quickly but you are still worried, see a doctor. About angina it also says that if you think you have angina, see a doctor as soon as you can. If you have angina and the attacks have become worse, more frequent, longer or come on at rest, tell a doctor and do not wait for your next appointment.

Who is at higher risk?

The NHS lists these factors: older age, smoking, obesity, high blood pressure, diabetes, high cholesterol, and a heart attack or angina in relatives, especially before the age of 60. These factors mean you have more reason to take pain seriously, not that every pain comes from the heart.

What should we do?

1. If you have a warning sign, call 115.
2. If your pain comes and goes or you are worried, tell a doctor soon.
3. When you see the doctor, be ready to say where the pain is, what brings it on, how long it lasts and what makes it better.
4. Do not start or stop any medicine without a doctor’s advice.

The doctor may ask for an ECG, a blood test and, if needed, an echo or other checks. The NHS lists these for diagnosing a heart attack and angina.

Symptoms and treatment plans differ from patient to patient. Talk to a doctor about your own situation.