by Rob Lamberts, MD
It’s 2 AM and you wake up with chest pain. What should you do? Maybe it’s just indigestion, but maybe it’s a heart attack. How do you know what to do?
When is Chest Pain Serious?
Heart attacks kill more people in the US than any other single disease, and the main symptom that people have from a heart attack is chest pain. But the term chest pain is actually misleading. Heart pain is not always described as being painful, and it’s not always in the chest. For that reason, I like the Latin term angina pectoris, which means “sensation in the chest.” This is not just a vocabulary lesson; people die because what they are feeling isn’t actually chest pain and so they stay at home and have a heart attack.
Today I’ll focus on the symptom that brings people into my office, and then over the next few weeks I’ll cover the cause and the treatment of heart disease.
When Is Chest Pain a Heart Attack?
So how can you tell if you should worry with your angina symptoms? There are two main factors that help me decide when to worry and when I can safely rule out heart disease: the actual symptom, and the risk of the person having those symptoms.
The typical symptoms of angina are:
Chest “tightness,” “squeezing,” or “heaviness.” People describe this feeling as a weight or as a band being tightened around their chest. The pain is usually located on the left side of the chest above the bottom of the ribcage, but it’s often hard to define its exact location.
Shortness of breath
Sweating, nausea, and an anxious feeling
A pain in the left arm, neck and jaw
What are Other Symptoms of a Heart Attack?
Those are the typical symptoms, and the presence of all of the above symptoms certainly is cause for worry. But many people have other, atypical symptoms that are still cause for concern:
Pain isn’t on the left side: Sometimes the pain is not on the left, but on the right, the center, or even at the top of the abdomen.
Absence of pain: Some people have no pain at all; instead they just have shortness of breath. One study showed that nearly 1/3 of people having a heart attack didn’t have pain.
Sharper pain: Some experience a sharper pain, or a feeling of indigestion.
I also had one patient describe his symptoms as “a cold feeling in the chest” whenever he breathed.
How Long Does Chest Pain Related to a Heart Attack Last?
Aside from what the chest pain feels like, you should also pay attention to how long the pain lasts. Chest pain related to a heart attack usually comes on over several minutes, not suddenly. Severe pain that comes on suddenly may be something else serious, but it’s not consistent with angina from the heart. Heart chest pain almost always lasts at least 5 minutes, and doesn’t continuously last more than 20 to 30 minutes. Finally, pain that comes on at rest or exertional pain that doesn’t go away with rest is more serious and more indicative of a heart attack.
I am not saying that pain that comes and goes isn’t worrisome; it’s just not consistent with a heart attack. Pain that comes on after exercise but consistently goes away with rest may represent a narrowing of the blood vessels that supply blood to the heart. That could lead to a heart attack, but it isn’t an emergency unless it doesn’t go away after 5 minutes of rest.
What are the Risk Factors for a Heart Attack?
The other major things to consider when determining whether your chest pain is heart-related an emergency are the risk factors. It’s a big difference when a 20-year-old woman comes in with chest pain than when it’s a 50-year-old male diabetic who smokes. The risk factors for heart attacks include:
Age – risk for heart attacks begins to rise for men at age 40 and women at 50. It can still happen below that age, but it’s a lot less likely.
Sex – men are at higher risk than women, although the disease still kills a huge number of women each year.
Genetics – if a member of your immediate family has coronary heart disease, your risk is substantially higher. That risk is especially high if that family member is a man under 50 or a woman under 60
Smoking – people often think of smoking as a danger to the lungs (which it is), but the biggest risk of death from smoking is from heart attacks. I recommend my patients who smoke quit and take up something safer, like tightrope walking, javelin catching, or training pit bulls.
Hypertension and diabetes – Having these diseases also increase risk.
High cholesterol – this is a complex subject, so please refer to my article on cholesterol to get an accurate picture.
The more of these risk factors there are, the more seriously you should take the pain. I will take a high-risk person with atypical symptoms more seriously than a low-risk person with classic symptoms.
When is Chest Pain NOT a Heart Attack?
There are some symptoms that reassure me the chest pain isn’t related to the heart:
Pain that is sharp and brief – stabbing pain that lasts a few seconds is not from the heart.
Pain that persists for hours – heart chest pain will either go away after 20-30 minutes, or will end up in a heart attack.
Pain that gets worse with movement – or pain that gets worse when you press on that area of the chest is probably from the muscles or the bones in the chest, not the heart.
Pain that you can point to with a single finger – heart pain tends to be hard to pinpoint.
I hope these tips help you. Learn the symptoms of heart pain and know your risk factors. If you have a worrisome-sounding pain, get it checked out. If you are high risk and have any symptoms that are consistent with heart pain, get it checked out. If you are high risk and have classic symptoms, get to the emergency room immediately, even if you have to call an ambulance.
Remember: it’s always OK to get things checked out. It’s far better to be seen for symptoms that are not serious than to stay home with serious symptoms.
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Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!