While not all episodes of chest discomfort turn out to be life-threatening, chest pain is the most common symptom of a heart attack in adults of all ages, so it needs to be taken seriously. Richard C. Becker, MD, director and physician-in-chief at the University of Cincinnati Heart, Lung, and Vascular Institute and a national volunteer expert with the AHA, notes the specific signs that suggest a person may be having a heart attack. “New onset or worsening chest pain located in the center of the chest, particularly when radiating to the neck, jaw, shoulder, or arm, and accompanied by sudden or rapidly progressive weakness, shortness of breath, sweating, or lightheadedness, nausea, or vomiting can signal a heart emergency and requires evaluation by a medical provider,” says Dr. Becker. The Mayo Clinic notes that chest pain due to a heart attack (also called myocardial infarction) may feel like pressure or tightness, but it is not always severe or even the most detectable symptom, particularly in women. A heart attack can happen without any noticeable chest pain; it can present only with other symptoms, such as shortness of breath and lightheadedness.
Immediate Treatment Is Key to Survival
Heart attacks throughout the United States are frequent and affect people of many different ages. The AHA estimates that every 39 seconds an American will have a heart attack. “Despite a decline in the number of overall heart attacks, this number is rising among young adults,” said Darcy Banco, MD, chief resident for safety and quality in the department of medicine at the NYU Grossman School of Medicine in New York City in a statement this year. In 2020, about 2 in 10 deaths from coronary artery disease happened in adults younger than 65, according to the Centers for Disease Control and Prevention. If a person experiences serious symptoms, time is of the essence. Cedars-Sinai Medical Center in Los Angeles stresses that about half the deaths due to a heart attack occur in the first three to four hours after symptoms begin. More than 90 percent of heart attack victims can survive if treated quickly, Harvard Medical School reports. “Delays in care not only place people with a heart attack at risk of death but also lessen the overall benefit of well-established treatments,” says Becker. “The key message is: Having heart attack symptoms? Don’t wait. Don’t hesitate.” He advises those who suspect that they may be having a heart attack to take a regular-strength aspirin and either sit or lie down while waiting for emergency medical services to arrive.
Signs That Chest Pain May Be Something Else
While many doctors like Becker urge the public to err on the side of caution and get immediate medical attention when chest pain appears to be serious, some types of discomfort in the chest may be the symptom of a less serious problem. “Most common but less dangerous causes of chest pain that are often mistaken for heart attack are indigestion, acid reflux, or gastroesophageal reflux disease,” says Adriana Quinones-Camacho, MD, a cardiologist with NYU Langone Health, adding, however, that severe heartburn can be hard to tell apart from a heart attack, even for some physicians. The Cleveland Clinic estimates that gastroesophageal reflux disease (GERD, otherwise known as chronic acid reflux) accounts for 50 to 60 percent of non–heart related chest pain cases. Typically, heartburn feels like a burning in the chest that is actually in the esophagus (the muscular tube through which food passes from the throat to the stomach), and it often occurs after eating or while lying down or bending over, according to the Mayo Clinic. Getting relief from an antacid (or even burping) suggests that the discomfort is from heartburn, but if the burning is accompanied by sweating and trouble breathing, it may be more likely that it is a sign of heart trouble. “If the discomfort comes only when the person is eating certain foods — whether it’s spicy chili or something else — and never at other times, then it is most likely indigestion,” says Dr. Quinones-Camacho. The Cleveland Clinic says that some people describe angina (a chest pain that comes and goes) as feeling similar to indigestion. Angina is caused by narrowing of the arteries, which can temporarily reduce blood flow to the heart. With a heart attack, blood flow is reduced for a longer period and can cause permanent damage to the heart muscle. With angina, rest or medication (nitroglycerin) can quickly stabilize the heart, but if you’re having a heart attack, rest or medication does not ease symptoms. Angina can sometimes be a warning sign of heart attack, so if the condition does not improve quickly or worsens, individuals are advised to call 911. Other sources of noncardiac chest pain include chronic lung diseases, ulcers, and psychological disorders, such as stress, anxiety, and depression. Even when the source of chest pain is not known, research indicates that the risk of heart attack is higher. A study published in the spring of 2022 and supported by the National Institute for Health and Care Research found that that individuals with unattributed chest pain had a 15 percent greater risk of a heart attack in the first year after visiting their general practitioner than those without chest pain. The study authors said that the increased risk continued over the next 10 years. Quinones-Camacho also suggests that if chest pain occurs only when pushing on the chest, it is more likely to be a musculoskeletal issue, related to muscles or bones. “If you touch the area and elicit pain, it may be due to something in the muscles in the chest wall,” she says. “Still, even if it’s less likely to be a heart attack, people present in very different ways.” The bottom line: When in doubt, check it out and seek medical attention.
