Chest pain

Chest pain is discomfort in the chest that can appear in many forms, ranging from a dull ache to a sharp stab. Sometimes it can also feel like a crushing or burning sensation in the chest. In some cases, chest pain can spread to your arms, shoulders, neck, jaw or back.

Chest pain can last for several minutes or come and go. It can be a sign of a serious condition, like a heart attack. It is important to seek immediate medical help if you are experiencing chest pain.

If you think you are having a heart attack, or you are in doubt about the cause of your chest pain, call Triple Zero (000) immediately and ask for an ambulance.

Seek urgent medical help for chest pain

If you are experiencing chest pain, follow these steps:

Step 1. Stop what you are doing and rest immediately.

Step 2. Talk – tell someone how you feel.

If you take angina medicine:

• Take a dose of your medicine.
• Wait five minutes. If you still have symptoms – take another dose of your medicine.
• Wait another five minutes.

Step 3. If your symptoms are severe, getting worse or have lasted longer than 10 minutes, call Triple Zero (000) immediately and ask for an ambulance. Chew on 300mg aspirin (if available).

• Don’t hang up.
• Wait for the operator’s instructions.

Do not take aspirin if you have an allergy to aspirin, or your doctor has told you not to take it.

Remember, if you have any doubt about your chest pain, call Triple Zero (000) and ask for an ambulance anyway.

Do not drive yourself to hospital. An ambulance is the safest way to go to hospital and the quickest way to seek treatment. It has specialised staff and equipment that may save your life.

Chest pain related to your heart

There are several conditions that can cause chest pain. Sometimes, it can be difficult to tell the difference between heart-related chest pain and other types of chest pain. It is important to seek medical advice to ensure you get a proper diagnosis.

Heart attack

Chest pain can be a warning sign of a heart attack. A heart attack happens when one or more of the arteries that supply blood to the heart muscle is blocked. This stops the blood flow and reduces the amount of oxygen that gets to your heart muscle.

Chest pain caused by a heart attack can:

• feel like uncomfortable pressure, heaviness or tightness in your chest
• spread to your arms, shoulders, neck, jaw or back
• last for several minutes or come and go.

Chest pain may occur in combination with other heart attack warning signs such as:

• nausea, indigestion or vomiting
• dizziness, light-headedness or feeling faint
• feeling anxious
• sweating or breaking out in a cold sweat
• shortness of breath or difficulty breathing.

Warning signs of a heart attack vary from person to person, and they may not always be sudden or severe. You may have just one or a combination of these symptoms. It is also possible to experience a ‘silent heart attack’, where you might not have any symptoms at all.

If you, or someone you know, is experiencing the warning signs of a heart attack – tell someone. If symptoms are severe, or getting worse, or last for more than 10 minutes, call Triple Zero (000) immediately and ask for an ambulance.

Angina

Angina is temporary chest pain or discomfort that happens when your heart doesn’t get enough blood and oxygen. It often occurs when your heart is working harder than usual and needs more oxygen-rich blood than the narrowed arteries can deliver.

Angina is a symptom of an underlying heart condition, usually coronary heart disease. Coronary heart disease occurs when there’s narrowing of the coronary arteries supplying blood to the heart muscles, due to a build-up of a fatty substance in the arteries (plaque).

Chest pain caused by angina can be triggered by:

• physical exertion
• emotional stress
• cold temperatures
• eating a large meal.

Angina is not the same as a heart attack. Unlike a heart attack, angina does not cause permanent damage to the heart muscle. Pain from angina is often relieved with rest or medicines.

Other heart-related causes of chest pain

Chest pain can also be a symptom of other heart conditions:

• pericarditis – which is inflammation of the protective sac (pericardium) surrounding your heart. Pain from pericarditis usually feels sharp or stabbing. However, it may also feel like a dull, pressure-like ache for some people. The pain can get worse when you lie down or take a deep breath.
• myocarditis – which is inflammation of the heart muscle (myocardium). If severe, this inflammation can weaken the heart and decrease its ability to pump blood properly. It can also cause abnormal heart rhythms (arrhythmias).
• cardiomyopathy – a disease of the heart muscle that affects the heart’s ability to pump blood around the body.
• spontaneous coronary artery dissection (SCAD) – a condition that occurs when a split or separation suddenly develops between the layers of the wall of one of the blood vessels (artery) that provides blood flow to the heart. The space between the layers of the artery wall may fill with blood, which may reduce or block flow through the artery. This can lead to a heart attack or cardiac arrest.

Other causes of chest pain

Chest pain can also be caused by other conditions such as:

• indigestion or heartburn (reflux) - where acid from the stomach goes up into the oesophagus (muscular tube that connects the mouth to the stomach) causing a burning pain in the chest
• inflammation of the gallbladder (cholecystitis) or pancreas (pancreatitis)
• pulmonary embolism – where there is a blockage in a blood vessel that carries blood from the heart to the lungs
• pleurisy – inflammation of the tissue lining the lungs
• chest infections such as pneumonia and bronchitis
• chest trauma (rib fractures)
• chest muscle strains
• costochondritis – inflammation in the rib joints near the breastbone
• panic attack
• shingles (or herpes zoster) – an infection that can cause chest pain before a rash forms.

Diagnosing chest pain and heart conditions

To understand your chest pain, your doctor will review your symptoms, ask about your family history of heart disease and conduct a physical examination. Your doctor may also arrange one or more of the following tests:

• electrocardiogram (ECG) – to measure the electrical activity of your heart
• blood tests – including a troponin test to measure levels of enzymes (proteins) released into the blood when the heart muscle is damaged
• chest X-ray – to produce an image that shows the location, size and shape of the lungs, heart and major blood vessels
• chest computed tomography (CT) scan – to create 3D images of the organs and structures in the chest, including the heart and lungs
• exercise stress test – to find out how well the heart responds to physical activity. The heart is monitored using an ECG while you ride a stationary bike or walk on a treadmill.
• coronary angiogram – to see if the coronary arteries are narrowed or blocked from a build-up of plaque.

Treatment for chest pain

Chest pain treatment varies depending on what’s causing the pain. Treatments may involve medicines or surgery.

Chest pain from a heart attack requires emergency treatment to restore blood flow to the heart. The faster this happens, the less damage to the heart muscle.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• AUSactive
• Dietitians Australia Tel. 1800 812 942
• Heart Foundation
• Quitline Tel. 13 78 48 (13 QUIT)
• Physical Activity Australia Tel. (03) 8320 0100