Chest Pain: Should I Worry?

by Karen Lee Richards Patient Advocate

When we live with pain on a daily basis, we often wonder if a new pain is something we should be concerned about.
It can be particularly difficult to tell if you have a condition like fibromyalgia, where the pain typically moves around from day to day.
Right or wrong, most of us wait to see if the pain gets worse before getting it checked out.
But when it's chest pain, we naturally wonder if we could be having a heart attack.

Heart Attack Symptoms

So how do we know when chest pain is something to worry about?
Following are signs that can indicate a possible heart attack:

- Uncomfortable pain, pressure, squeezing or fullness in the center of the chest that lasts more than a few minutes.
- Discomfort that spreads to other areas of the upper body including the back, neck, jaw, stomach, shoulders, or one or both arms.

- Shortness of breath.
- Sweating, anxiety, nausea, or lightheadedness.
- A feeling of impending doom.

The most common symptom of a heart attack is chest pain/discomfort, but women are somewhat more likely than men to experience some of the other symptoms, particularly shorness of breath, nausea and back or jaw pain.

Additionally, according to Dr. Isadore Rosenfeld, Professor of Clinical Medicine at Wild-Cornell Medical Center, if you've had these symptoms before that came on with exertion and now they are
suddenly there all the time, you need to be concerned.
You should also be concerned if you have one or more risk factors for heart attack.
You are at risk if you:

- Have high blood pressure.
- Are overweight.
- Have diabetes.
- Are a smoker.
- Have a family history of heart disease.

If you have chest discomfort, especially accompanied by one or more of the signs above, don't wait.
Call 9-1-1 or get to a hospital right away.
Getting help right away may not only save your life, but it may also prevent serious damage to your heart.

Other Possible Heart Problems

Besides a heart attack, there are other heart-related problems that can also have chest pain as a symptom, such as:

- Angina - restricted blood flow to your heart.
Angina usually causes pressure or tightness in the chest.
It is often brought on by physical or emotional stress.

- Pericarditis - inflammation and possibly excess fluid in the sac that surrounds the heart.
Acute paricarditis causes sharp, stabbing pain in the chest that may travel to the shoulder and neck.
The pain of chronic paricarditis is more dull and pressure-like and may vary in intensity.

- Coronary artery spasm - arteries that supply blood to the heart spasm, temporarily shutting down blood flow to the heart.
This can cause varying degrees of chest pain.

- Aortic dissection - inner layers of the aorta separate, forcing blood between them.
Symptoms may occur in the chest and back.
They are sudden and feels like something is tearing.

Non-cardiac Causes

Although we usually think of chest pain in relation to heart problems, there are many other non-heart-related conditions that can cause chest pain, such as:

- Gastric reflux (heartburn) - a painful burning sensation behind the breastbone.
Heartburn usually follows a meal and may last for several hours.

- Pinched or irritated nerve - When nerves from the neck that go into the chest are pinched or irritated,
it can cause chest pain.

- Muscle strain or spasm - A pulled muscle or a muscle spasm in the chest or back areas can cause chest pain.
It's not unusual for this to happen in a condition like fibromyalgia.

- Gallbladder or pancreas problems - Usually there is acute abdominal pain that may radiate to the chest, but in some cases, there is chest pain only.

- Pleurisy - an inflammation of the membrane that lines the chest cavity.
Chest pain from pluersy is usually sharp and gets worse when the person coughs or inhales.

- Costochondritis - an inflammation of the rib cage's cartilage.
The chest pain from costochondritis may be sudden and intense.
It will usually be tender when the sternum or the ribs near the sternum are pressed.

- Panic attack - Symptoms of a panic attack can be very similar to symptoms of a heart attack, including chest pain, rapid heartbeat, sweating, and rapid breathing or shortness or breath.

- Pulmonary embolism - blockage of a lung artery.
Chest pain from a pulmonary embolism may be sudden and sharp and worsen when you inhale or cough.
Other symptoms may include lightheadedness, anxiety, rapid heartbeat and shortness of breath.

- Esophageal spasms - the tube that runs from the throat to the stomach spasms.
This can result in chest pain and usually makes it difficult and even painful to swallow.

False Alarms

What I hear most from people who are questioning whether or not they should go to the emergency room when they have chest pain is the fear that it will turn out to just be something like indigestion and they'll be embarrassed.
Believe me when I say there's nothing to be embarrassed about.
Medical professionals would much rather you come in, even if it turns out to be something minor, than wait and possibly jeopardize your life.

I speak from experience.
Several years ago, I went to the emergency room two different times with chest pains.
The first time, they didn't find anything wrong and sent me home.
When it happened again, they did more extensive tests and discovered that I had gallstones which were causing my chest pain.
After having my gallbladder removed, my chest pains went away.

On the other hand, my Dad, who had ulcers and was used to gastric problems, thought he had a bad case of indigestion.
Thankfully he went to his doctor because it turned out that he'd had a mild heart attack.

The bottom line is, any chest pain that worries you should be looked into.
If there's any question in your mind, get it checked.
When it comes to chest pain, the old idiom is quite true - It's better to be safe than sorry.

American Heart Association. (2009, October 31). Heart attack symptoms and warning signs. Retrieved from
Rosenfeld, Isadore. (2009, October 11). Sunday Housecall with Dr. Rosenfeld.
Mayo Clinic. (2007, November 15). Chest pain. Retrieved from

Karen Lee Richards
Meet Our Writer
Karen Lee Richards

Karen is the co-founder of the National Fibromyalgia Association. She writes for HealthCentral as a patient expert for Pain Management.