“Chest pain” is a general term used in the medical profession to describe ANY SYMPTOM IN THE CHEST. It may be a sign that the heart is not getting enough blood and should be evaluated in a timely manner. Pain in the chest may be described as a tightness, burning, squeezing or sharp pain. It is important to remember that every person is unique and symptoms may not necessarily come out of a textbook.

The location of chest pain is not necessarily critical in determining how serious it is. A heart attack or angina can present with right sided chest pain even though the heart is located primarily in the center and left part of the chest. The nerves inside the body (unlike the nerves on our skin) are very vague and may not exactly correlate with the location of the problem.

Pain may radiate to the back or shoulder(s) or it may go to the jaw. Cardiac chest pain may be associated more with lower jaw pain than both the upper and lower jaw hurting, but this is not a 100% rule.

In fact, there is nothing I can write about chest pain (coming from the heart not getting enough blood) that is always 100% true. Decreased blood flow to the heart may not be associated with ANY symptoms in the chest. A person can present with ONLY nausea, shortness of breath or feeling sweaty. One large retrospective study (based mostly on ECGs) suggests that up to 50% of first heart attacks were silent.

If a person has chest pain in a tiny point in the chest, it may be less likely to be coming from the heart. If the chest pain in reproducible by pushing on the chest, it is much less likely to be cardiac in nature. Whether the chest pain hurts worst with deep breathing is probably not helpful.  Again, it should be stressed that NO RULE ABOUT CHEST PAIN IS ALWAYS %100 TRUE.

When a patient presents with chest pain, the most common concern is whether there is decreased blood flow to the heart. In other words, is there a new critical blockage that is constricting blood flow to the heart. A significant blockage may present with symptoms that occur with exertion and go away at rest. During exertion the heart needs more blood because it is contracting faster and more forcefully. Therefore, symptoms occur when the patient exerts themselves and goes away with rest.

If a blockage is very critical (for example a 99% blockage) the patient may have symptoms even at rest.

The duration of chest pain is important. A twinge of chest pain lasting a second is less likely to be a significant problem. A sustained chest pain lasting minutes is more likely to represent decreased blood flow to the heart.

If you are think you are having a heart attack, the safest course of action is to dial 9-1-1. Even if you have been evaluated and told that nothing is wrong, you should still seek medical attention through 9-1-1 and the Emergency Department.

(RB)

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