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Health Tips

What to Do If You Have Chest Pain

If You Have a History of Heart Disease, Take Chest Pain Seriously

"Everyday, nearly everyone experiences chest pain," says Jerry Gliklich, MD Professor of Medicine at Columbia University College of Physicians & Surgeons and a cardiologist at Columbia University Medical Center, NewYork-Presbyterian Hospital. "People need to know that chest pain is not necessarily a sign of a heart attack. Life would be miserable if each of us became hypervigilant about every single chest pain."

Sometimes, however, chest pain is a warning of a serious problem. "There are certain chest pains that should not be ignored," Dr. Gliklich says. "Angina pectoris, the sensation associated with heart attack, should be taken very seriously. The problem is that it is sometimes difficult to distinguish angina from a benign chest pain."

Trying to describe angina brings the reasons for confusion into sharp focus:

• Angina pectoris is usually a pressure, a heaviness, a tightness, or an oppressive sensation. Sometimes it is not painful at all, and at other times it is associated with pain.
• It is usually located in the region of the breastbone or just under the breastbone, but it also can occur in the shoulder only, or only in the arm or jaw or throat, or, rarely, in the back only.
• Angina that occurs in the chest may radiate to the left arm, or it may travel along the right arm, or move to the back or jaw, or be felt in the throat.

Dr. Gliklich suggests using the following guidelines in assessing chest pain:

• If chest pain is accompanied by shortness of breath, sweating, nausea, and/or dizziness, it may be a sign of true angina or a heart attack.
• If chest pain occurs with a twisting movement of the torso or with a deep breath, it most likely is not coming from the heart.
• Classic angina starts following some kind of physical exertion–for example, after walking uphill–particularly if the physical activity comes after a meal or in cold weather. Rest may relieve it.
• Although it is associated with physical activity, angina can also occur when the person is at rest.

"The one rule about angina is that there are no hard and fast rules," Dr. Gliklich concludes. "There are classic presentations of angina, but it's a common disease, and common diseases often present in atypical ways. People with a history of heart disease should take chest pain even more seriously than others, because they are at higher risk for a heart attack."

Dr. Gliklich urges people to have a doctor they can call if they experience chest pain. "Call as quickly as possible, and let your doctor guide you," he says. "If your symptoms are frightening and you can't get through to a doctor, call an ambulance."

"If you can't reach a doctor, or if your angina is particularly severe or associated with shortness of breath and sweating, call 911 and go to the nearest hospital. Don't try to drive yourself anywhere – call 911."