Chest pain
The most common reason for a cardiology visit, and the one least worth postponing.
When to seek care
Call emergency services if chest pressure lasts more than a few minutes, spreads to the arm, neck, jaw, or back, or comes with shortness of breath, cold sweat, nausea, or lightheadedness. Book a visit if pain is recurrent, appears with exertion, or if you have high blood pressure, diabetes, a smoking history, or a family history of early heart attack.
What it feels like
- Pressure or heaviness in the center of the chest
- Pain that appears with exertion and eases with rest
- Pain spreading to the arm, neck, or jaw
- Discomfort arriving with cold sweat or nausea
Not all chest pain comes from the heart. It can come from the esophagus, the chest wall, the spine, or anxiety, and in most consultations the origin turns out to be something else. The problem is that the exceptions are serious and are not distinguished by how much the pain hurts.
What guides the assessment is the pattern. Pain that appears with exertion and eases with rest points to the heart. Pain that changes when you breathe deeply or press on the chest points to the wall. Pain arriving with meals or when lying down points to the esophagus.
Even so, pattern alone is not enough to rule out. When in doubt it is documented with an electrocardiogram and, if the pain is exertional, with a treadmill test.