Chest pain and coronary artery disease
Chest pain does not always come from the heart, but sometimes it is an emergency sign. This page explains which pain should not wait for an appointment, how a doctor investigates it, and what angina and narrowed heart arteries are.
What does chest pain mean?
Most chest pain is not serious, but the NHS stresses that it should be followed up to make sure. There are many causes. The sources list, among others:
- Indigestion or heartburn, especially after a meal
- A strained chest muscle, which is worse with a deep breath and better with rest
- Anxiety or a panic attack
- An infection of the lungs or the lining of the lungs
- Shingles (blisters and rash on the skin)
- Inflammation of the lining around the heart (pericarditis)
- Angina or a heart attack
You cannot say with certainty from the feel of the pain alone which of these it is. The NHS also stresses not to diagnose it yourself.
Who should see a doctor?
If you have pain that comes and goes, or goes away quickly but you are still worried, the NHS says to see a doctor. For angina, the same source says that if you think you have angina, see a doctor as soon as you can. A few things make an assessment more important:
- Chest pressure or pain during activity or excitement that settles with rest (a pattern like angina)
- Underlying conditions such as high blood pressure, diabetes or high cholesterol
- Smoking
- A heart attack or angina in close relatives, especially before the age of 60 (NHS)
These raise the risk; they do not make a diagnosis. But if you have warning signs right now (see the last section of this page), do not wait for an appointment.
What is angina?
Angina is pain or pressure caused by not enough blood reaching the heart muscle. The NHS says it is usually caused by coronary heart disease: fatty deposits in the heart’s arteries narrow or block them.
Angina pain can be a tightness, pressure or dull ache in the chest, neck, shoulders, jaw or arms. It may come with nausea, breathlessness, dizziness or sweating. Exercise, stress, excitement or cold usually bring it on. An attack usually lasts less than 10 minutes and should ease with a few minutes of rest or angina medicine.
How does a doctor investigate it?
History and examination are the first step. For coronary heart disease the NHS says the doctor asks about your medical and family history and lifestyle, and takes a blood test. Depending on your situation, these tests may also be needed:
- ECG: records the electrical activity of the heart. An exercise ECG (exercise test) is done on a treadmill or bike, and the NHS says it usually takes 40 to 60 minutes.
- Heart echo: shows the size of the heart, the movement of its wall and the valves. The NHS says after a heart attack an echo can also show damage to the heart.
- Plain chest X-ray
- Coronary angiography: the NHS says it shows exactly where a blockage is and sometimes treatment is done at the same time. CT and MRI are also mentioned in the sources for angina.
Not everyone needs all of these tests. The doctor chooses based on your symptoms and risk. Which tests are done at this clinic is not stated on this page, and you need to ask the clinic.
What does treatment look like in general?
The NHS says coronary heart disease has no cure, but treatment can control the symptoms and reduce the chance of a heart attack. The approaches include:
- Lifestyle changes: a balanced diet, regular activity, stopping smoking, controlling cholesterol and blood sugar
- Medicines: to control symptoms and lower risk. Only a doctor decides the type and amount.
- Opening the artery with a balloon and stent (angioplasty)
- Heart bypass surgery
If you have angina, continue treatment as your doctor directs. The NHS says if angina gets worse, happens more often, lasts longer or comes on at rest, get medical help straight away and do not wait for an appointment.
What can you do yourself?
- Write down the symptom: what you were doing, how long it lasted, what made it better.
- Know your triggers. For angina the NHS names stress, cold and a heavy meal.
- Stop smoking and keep your weight and diet balanced.
- Stay active, as far as your symptoms allow, and talk to a doctor before new activity.
- Keep your medicines with you and take enough supply when you travel (NHS).
- Do not start, stop or change medicines on your own.
When to seek urgent care
Call 115 (Iran’s emergency number) and do not drive yourself if:
- You have sudden chest pain or discomfort that does not go away: squeezing, pressure, burning or an indigestion-like feeling
- The pain spreads to the left or right arm, neck, jaw, shoulder, belly or back
- Chest pain comes with sweating, nausea, dizziness or breathlessness
- You have been diagnosed with angina and the pain does not stop with rest and your prescribed medicine
- The skin or lips have turned pale, bluish or grey
The NHS says this may be a heart attack and urgent hospital treatment is needed. The WHO also says not to wait to see whether it gets better. If someone collapses and does not respond, call 115 straight away.
For the full guide, see “When to seek urgent care”.
Symptoms and treatment plans differ from patient to patient. Talk to a doctor about your own situation.
Frequently asked questions
How can I tell if my pain is from the heart?
You cannot be sure yourself, and the NHS also says not to diagnose it yourself. If the pain is sudden, continues, feels like squeezing, pressure or burning, spreads to the arm, neck, jaw, belly or back, or comes with sweating, nausea, dizziness or breathlessness, it may be a heart attack. Call 115 (Iran's emergency number).
My ECG was normal. Does that mean my pain is not from the heart?
An ECG records the electrical activity of the heart during those few minutes. The NHS says an ECG and a blood test are used together to diagnose a heart attack. If your pain continues or comes back, talk to a doctor about it again, and do not wait if you have warning signs.
Does angina mean a heart attack?
No, but they are related. The NHS describes angina as pain caused by not enough blood reaching the heart, usually because of coronary heart disease. Angina raises the risk of a heart attack and a stroke, which is why treatment and lifestyle changes matter.
I have been diagnosed with angina and my pain did not settle with rest. What should I do?
The NHS says if you have angina and the pain does not stop with rest and your prescribed medicine, call the emergency services. In Iran that is 115. The exact instructions for using your medicine are set only by your own doctor.
Can coronary heart disease be cured?
The NHS says coronary heart disease has no cure, but treatment can control the symptoms and reduce the chance of problems such as a heart attack.
Can I exercise with chest pain?
It depends on the cause of the pain. For angina the NHS says to talk to your doctor before starting new activity or if you are worried about exercise. If chest pain or pressure comes on with activity, stop and do not continue until a doctor has assessed you.