Chest Pain

Chest pain can actually happen due to a slew of causes, including quite a few that aren’t too hard to treat - Korin Miller

Chest Pain

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Remember the 1970’s television show Sanford and Son? Comedian Redd Foxx played a father who was known for clasping one hand on his heart, throwing the other in the air, and declaring the end whenever he had chest pain—which was pretty much every episode.

Many people think the same thing: Chest pain automatically means heart attack. But that’s not necessarily true.

“When people have pain in their chest, we obviously are concerned about the heart because this generally requires more urgent care. We like to rule that out first,” says Neel Chokshi, MD, MBA, an assistant professor of clinical medicine at Penn Medicine. “But there are many, many other reasons to have pain in the chest.”

Dr. Chokshi clears up three myths about what chest pain really means, plus he offers some tips for what to do if you’re experiencing chest pain.

Three myths about chest pain

Myth: A heart attack is always the reason for your chest pain. Fact: It could be something else.

“Along with your heart, there’s also muscle, there are bones and there are nerves in your chest,” Dr. Chokshi notes. “Your lungs, your esophagus and your stomach are in that area as well. So typically, any of those things can actually cause chest pain.”

For instance, issues with the stomach or gastrointestinal area can often be mistaken for heart-related pain, he says. So can pain caused by inflammation of the cartilage that connects your ribs to your breast bone.

It’s also possible that several other conditions could cause chest pain, from asthma or pneumonia in your lungs to panic attacks.

“Oftentimes, it’s very difficult for even the physician to figure out if the pain is related to the heart,” Dr. Chokshi notes.

That said, rather than trying to diagnose yourself, “it’s always appropriate to get checked out,” he says. “The symptoms might continue to occur, but at least you’ll know what you’re dealing with.”

Myth: Heart-related chest pain feels the same for everybody. Fact: Chest pain can be different for everyone.

“Specifically, in women, older patients and diabetics, their pain or their symptoms that might be related to a heart attack might be a little bit unique or atypical,” Dr. Chokshi says.

For example, women are more likely than men to feel their chest pain while they’re resting or sleeping, while men tend to feel it when they’re active.

And in people who have diabetes, they might not even feel any heart-related pain before they have a heart attack because nerve damage blunts the pain.

“But what we typically call chest pain that’s related to your heart is classically described as sort of a pressure,” Dr. Chokshi says. “They might describe it like an elephant sitting on their chest. This pain tends to come on with exertion or activity—when you place more demand on your heart—and resolves when you rest.”

Myth: Chest pain is only in your chest Fact: Not always. You might feel the discomfort in other areas.

“There’s often usually other symptoms associated with chest pain,” Dr. Chokshi says. Those symptoms can include:

  • Shortness of breath
  • Feeling sweaty
  • Feeling generally unwell
  • Pain in the jaw
  • Aching in the left arm

Remember, heart-related pain is usually internal. “Pushing on the outside of your heart can’t necessarily make the pain you’re feeling worse,” Dr. Chokshi explains. “And if you take a deep breath, and it hurts more, that is a little unusual for heart-related pain.” Instead, both of those feelings suggest that your chest pain is more muscle-related, or it might be something related to your lungs rather than your heart, Dr. Chokshi says.

How to figure out the cause of your chest pain

Another question that Dr. Chokshi typically asks his patients to help him figure out if a chest pain could be heart-related is how long that discomfort lasts in their chest.

Pain that lasts for a few seconds is unusual for heart-related pain. But 15 to 20 minutes? That’s a reason to head to the emergency room.

Aside from how your chest pain feels, Dr. Chokshi says you should also consider risk factors for heart problems.

“If you’re like a young person, who is 20, very healthy, and went to the gym and did a little bit too much with lifting weights—and now you’re having chest pain—chances are it’s probably related to soreness of your muscles,” he says. “That’s different than if you’re in your 50s, and have high blood pressure or high cholesterol. You have a history of prior heart problems, a family history of heart problems, and smoke or have diabetes,” he adds. “Those are all risk factors for having heart problems. So, in that case, we would take things a little more seriously.”

Better safe than sorry

“If you’re not feeling well, it’s something new and it’s persisting, seek medical care,” Dr. Chokshi advises. And if you’re feeling that pressure on your chest along with symptoms that often accompany a heart attack—nausea, shortness of breath and sweating while at rest—you should head to the emergency room.

Source: 3 Myths About the Causes of Chest Pain, Penn Heart and Vascular Blog, February 25, 2016.

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Last Updated : Sunday, February 23, 2020