Chest Pain

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Topic Overview

Chest pain and heart attack

Chest discomfort or pain is a key warning symptom of a heart attack. Heart attack symptoms include:

• Chest discomfort or pain that is crushing or squeezing or feels like a heavy weight on the chest.
• Chest discomfort or pain that occurs with:
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain that spreads from the chest to the back, neck, jaw, upper belly, or one or both shoulders or arms. The left shoulder and arm are more commonly affected. See an illustration of areas that may be affected by chest pain .
  • Dizziness, lightheadedness, or feeling like you are going to faint.
  • A fast, slow, or irregular heartbeat.

If you have any of these symptoms of a heart attack, call 911 or other emergency services immediately. Since most of the damage to the heart muscle during a heart attack occurs in the first 6 hours, emergency treatment may prevent damage to the heart muscle and death. Some people, especially those who are elderly or have diabetes, may not have typical chest pain but may have many of the other symptoms of a heart attack. Women are more likely than men to have neck and shoulder pain along with other symptoms.

Chest discomfort or pain that comes on or gets worse with exercise, stress, or eating a large meal and goes away with rest may be a warning symptom of heart disease. If you are having this type of discomfort or pain now and you are not being treated for angina, call 911 or other emergency services immediately.

Other causes of chest discomfort or pain

Most people fear that chest pain always means something is wrong with the heart. This is not the case. Chest discomfort or pain, especially in people who are younger than age 40, can have many causes.

• Pain in the muscles or bones of the chest often occurs when you increase your activities or add exercise to your schedule. This is sometimes called chest wall pain.
• Burning chest pain that occurs when you cough may be caused by an upper respiratory infection caused by a virus.
• Burning chest or rib pain, especially just before a rash appears, may be caused by shingles.
• A broken rib can be quite painful, especially when you cough or try to take a deep breath.
• Gastroesophageal reflux disease (GERD) can cause pain just below the breastbone. Many people will say they have "heartburn." This pain is usually relieved by taking an antacid or eating.

Other, more serious problems that can cause chest pain include:

• A collapsed lung (pneumothorax), which usually causes a sharp, stabbing chest pain and occurs with shortness of breath.
• A blood clot in the lung (pulmonary embolism), which usually causes deep chest pain with the rapid development of extreme shortness of breath.
• Lung cancer, which may cause chest pain, especially if the cancer cells spread to involve the ribs.
• Diseases of the spine, which can cause chest pain if the nerves in the spine are "pinched."

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

Last updated:	April 27, 2007
Author:	Jan Nissl, RN, BS
Reviewed By:	William M. Green, MD - Emergency Medicine, H. Michael O'Connor, MD - Emergency Medicine
Editors:	Susan Van Houten, RN, BSN, MBA, Tracy Landauer