Health Library Chest PainFrom Healthwise

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.

• Chest discomfort or pain is crushing or squeezing, feels like a heavy weight on the chest, or is occurring with any of the following symptoms:
  • 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 (see an illustration of chest pain)
  • Dizziness or feeling like you are going to faint (lightheadedness)
  • A fast, slow, or irregular heartbeat
• Shock
• Moderate to severe difficulty breathing or severe shortness of breath
• Severe fatigue with any other symptoms of a heart attack
• Angina that has been diagnosed by your doctor but has not gone away after using your home treatment plan

After calling 911 or other emergency services:

• If the person becomes unconscious, see Rescue Breathing and Cardiopulmonary Resuscitation (CPR) in the topic Dealing With Emergencies.
• If the person is awake, alert, not vomiting, and not allergic to aspirin, have the person chew and swallow 1 adult aspirin (325 mg) or 4 low-dose aspirin (80 mg each) before emergency medical personnel such as paramedics arrive. Be sure to tell emergency personnel that aspirin has been taken.
• Remember it is important to have the person taken to the hospital by emergency personnel because his or her condition may get worse on the way.

NOTE: If a person collapses in a public place, call 911 and then ask if anyone knows CPR or if there is an automatic external defibrillator (AED) nearby.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Have you been diagnosed with angina and your angina is occurring more often or is getting worse?
When to See a Doctor See significance of change in angina if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Call 911 or other emergency services immediately if: You have chest pain and other symptoms of a heart attack. Your pain continues unchanged or gets worse after using your home treatment plan for angina. Call your health professional immediately if you answer "Yes" to the following question. Yes Has your angina gotten better but not gone away after using your home treatment plan? Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you having angina more often? Yes Is your angina getting more severe? Yes Do you have angina with activities that have not caused angina in the past? Yes Does angina wake you up at night? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had symptoms that you think may be related to a problem with your heart, but all symptoms are gone now?
When to See a Doctor See significance of symptoms that may be related to a heart problem if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have symptoms of a heart attack now, call 911 or other emergency services immediately. After calling 911 or other emergency services: If the person becomes unconscious, see Rescue Breathing and Cardiopulmonary Resuscitation (CPR) in the topic Dealing With Emergencies. If the person is awake, alert, not vomiting, and not allergic to aspirin, have the person chew and swallow 1 adult aspirin (325 mg) or 4 low-dose aspirin (80 mg each) before emergency medical personnel such as paramedics arrive. Be sure to tell emergency personnel that aspirin has been taken. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Did you have chest pain or discomfort? Yes Did you have pressure, heaviness, or tightness in the chest, upper belly, or jaw? Yes Did you have pain or numbness in your shoulders or arms, especially on the left side? Yes Did you have pain in the upper back or neck? Yes Did you have shortness of breath, sweating, or nausea? Yes Did you have severe tiredness or exhaustion that came on suddenly? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had a recent injury to the chest?
When to See a Doctor See significance of an injury to the chest if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe pain after a chest injury but no other symptoms? Yes Have you coughed up blood after a chest or back injury? Yes Do you have blood in your urine after a chest or back injury? Yes Do you have moderate to severe belly pain after an injury to the chest? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you feel or hear a crackling or popping noise with deep breathing and you are having pain with breathing, but you do not have shortness of breath? Yes Do you have mild difficulty breathing after a chest injury? Yes Do you have a fever after a chest injury? Yes Do you have a new cough after a chest injury? Yes Do you have moderate pain in your chest without other symptoms that is not getting better 6 hours after the injury? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have mild to moderate pain in your chest when you take a deep breath that has not improved after 24 hours of home treatment? Yes Do you have mild pain that has not improved after 24 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have any pain in your chest that has lasted longer than 1 week after an injury? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain when you breathe but you do not have symptoms of a heart attack?
When to See a Doctor See significance of pain with breathing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have any of the following symptoms, evaluate those symptoms first. Difficulty breathing or coughing: Go to the topic Respiratory Problems, Age 12 and Older. Fever: Go to the topic Fever, Age 4 and Older. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Does your pain become severe when you take a deep breath? Yes Are you coughing up blood or sputum mixed with blood? Yes Do you have pain deep in your leg or calf that is not from a leg injury? Yes Do you have pain and you have had a pulmonary embolus or a blood clot ( deep vein thrombosis, or DVT) in the past? Call your health professional today if you answer "Yes" to the following question. Yes Do you have mild to moderate pain when taking a deep breath but no other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain in your chest muscles or ribs (chest wall pain)? Note: Pain may or may not increase with coughing or deep breathing.
When to See a Doctor See significance of chest wall pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe chest wall pain? Yes Are you coughing up blood or sputum mixed with blood? Yes Do you have pain deep in your leg or calf that is not from a leg injury? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have new, moderate pain that does not have an obvious cause, such as a muscle strain or other injury to the chest wall? Yes Do you have new, moderate pain that does not have an obvious cause, such as coughing, wheezing, sneezing, or difficulty breathing? Yes Have you had ongoing, violent coughing for longer than 24 hours and you are unable to rest or sleep? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes For the past 24 hours, have you had sudden, sharp pain that comes and goes but only lasts for a few seconds? Yes For longer than 2 days, have you had mild pain when you cough or take a deep breath? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had any chest wall pain for longer than 1 week? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain in your chest and a fever?
When to See a Doctor See significance of pain in your chest and a fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you have symptoms of a respiratory illness, such as a runny nose, cough, or sore throat, see the topic Respiratory Problems, Age 12 and Older or Respiratory Problems, Age 11 and Younger. If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have moderate to severe pain in your chest and a fever? Yes Do you have a fever of 104 °F (40 °C) or higher that persists after 2 hours of home treatment? Yes Do you think that you have a high fever but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 101 °F (38 °C) to 104 °F (40 °C) that persists after 4 hours of home treatment? Yes Do you think that you have a moderate fever but you are unable to measure your temperature? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a fever of 100 °F (37.5 °C) to 101 °F (38 °C) with mild chest pain for 3 full days? Yes Do you think that you have had a mild fever for 3 full days but you have been unable to measure your temperature? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain with a band-shaped rash?
When to See a Doctor See the significance of pain with a band-shaped rash if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have pain with a band-shaped rash on one side of your chest? Note: Call your doctor as soon as possible. If shingles is causing your symptoms, there may be a medicine you can take that will limit the pain and rash. Medicines are most effective if begun within 2 to 3 days of the start of the rash. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had chest discomfort that spreads in a band-shaped area on one side of the chest for more than 3 to 4 days? Note: If a rash develops, call your doctor as soon as possible. There may be a medicine you can take to help the pain and rash. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had mild pain in your chest without symptoms of a heart attack?
When to See a Doctor See significance of mild pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Has mild chest pain interfered with your daily activities? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has mild chest pain caused you to limit your usual activities for longer than 1 week? Yes Have you had any chest pain for longer than 1 week? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your chest pain may be caused by a medicine?
When to See a Doctor See significance of chest pain caused by a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think your chest pain may be caused by a medicine? Note: If your answer is Yes: Call the health professional who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. Do not take another dose of the medicine until you have spoken to your health professional. If you are taking a nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Pain that started in the upper belly and may be caused by heartburn: Go to the topic Heartburn.
• Pain that is actually located in the back or neck: Go to the topic Back Problems and Injuries or Neck Problems and Injuries.
• Repeated pain in your chest or fullness or tightness that may be caused by hyperventilation: Go to the topic Hyperventilation.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment is not appropriate for chest pain if the pain occurs with symptoms of a heart attack. If you think a heart attack might be the cause of your symptoms, call 911 or other emergency services immediately.

Home treatment for people who have been diagnosed with chest pain (angina)

Most people who have been diagnosed with angina have a pattern to their angina attacks that they can recognize. If you and your doctor have made a home treatment plan for your angina attacks, follow that plan. If the pain gets worse or does not go away or if you are unsure how to use your plan, call 911 or other emergency services immediately.

You may be able to control how much your angina bothers you by making changes in your lifestyle. You may find it helpful to:

• Avoid strenuous activity that bring on angina.
• Eat balanced, nutritious meals. Try to limit the amount of fats and fatty foods you eat.
• Maintain a healthy weight.
• Limit the amount of alcohol you drink. Safe amounts are less than 2 drinks a day for men and 1 drink a day for women. One drink is 12 fl oz (360 mL) of beer, 5 fl oz (150 mL)of wine, or 1.5 fl oz (45 mL)of hard liquor. Do not drink every day.
• Do not smoke or use other tobacco products.
• Reduce stress. For more information, see the topic Stress Management.
• Control your blood pressure with diet and medicine. For more information, see the topic High Blood Pressure (Hypertension).
• Avoid extremely cold or hot environments.
• Take all medicines as instructed by your doctor.
• Follow the exercise or activity program you and your doctor developed.

If you do not need 911 emergency medical treatment for your chest pain or angina, take your pulse before reporting your symptoms to your doctor. Your heart rate and rhythm at the time of your chest pain may help your doctor evaluate your symptoms.

Home treatment for minor pain in the chest

Home treatment for minor chest pain depends on the cause of the pain. Minor chest pain often improves with home treatment. A visit to your health professional may not be needed.

Chest wall pain

For chest wall pain caused by strained muscles or ligaments or a fractured rib:

• Rest. Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
• Ice. Cold will reduce pain and swelling. Apply an ice or cold pack immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply warmth to the area that hurts.
• Do not wrap or tape your ribs for support. This may cause you to take smaller breaths, which could increase your risk for developing pneumonia or partial lung collapse (atelectasis).
• Medicated creams that you put on the skin (topical) may soothe sore muscles.
• Gentle stretching and massage may help you get better faster. Stretch slowly to the point just before discomfort begins, then hold the stretch for 30 to 60 seconds. Do this 3 to 4 times a day. It is really helpful after the use of heat.
• As your pain gets better, slowly return to your normal activities. Any increased pain may mean that you need to rest a while longer.

If you have other symptoms along with your minor chest pain, see the Related Information section for topics that relate to your other symptoms. Review the Home Treatment sections for those symptoms.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• You have increased difficulty breathing.
• Chest pain is not relieved by home treatment.
• Chest pain lasts longer than 1 week.
• Chronic pain has become worse or other symptoms have developed with the pain.
• Symptoms become more severe or frequent.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• When did the chest pain begin?
  • How long does the pain last?
  • How often does the pain occur?
  • How severe is the pain?
  • What does the pain feel like?
  • Where is the pain located?
• What were you doing when it started? Is the pain related to activity? Is it related to eating? Is it related to body position?
• Does the pain start in the chest and spread to another part of the body? Or does it start somewhere else and spread to the chest?
• Did you have other symptoms with the chest pain? What are the other symptoms?
• Has this ever happened before? If so, did you see a doctor?
  • What was the diagnosis?
  • What tests were done?
  • How was it treated?
• Have you had a chest injury or a fall?
  • How and when did an injury occur?
  • Have you had any chest injuries in the past? Do you have any continuing problems because of the previous injury?
• What activities make your symptoms better or worse?
• What home treatment have you tried to relieve the pain? Did it help?
• What nonprescription medicines have you taken? Did they help?
• Do you have any health risks?

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Acute Bronchitis
• Anxiety
• Aortic Aneurysm
• Asthma in Children
• Asthma in Teens and Adults
• Atrial Fibrillation
• Bradycardia (Slow Heart Rate)
• Change in Heartbeat
• Coronary Artery Disease
• Coughs
• Deep Vein Thrombosis
• Gallstones
• Gastroesophageal Reflux Disease (GERD)
• Heart Attack and Unstable Angina
• Heartburn
• Hiatal Hernia
• High Blood Pressure (Hypertension)
• High Cholesterol
• Hyperventilation
• Mitral Valve Prolapse
• Panic Attacks and Panic Disorder
• Peptic Ulcer Disease
• Pericarditis
• Pneumonia
• Respiratory Problems, Age 11 and Younger
• Respiratory Problems, Age 12 and Older
• Shingles
• Shock
• Stress Management
• Supraventricular Tachycardia

Author:	Jan Nissl, RN, BS	Last Updated: April 27, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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