Does Chest Pain Always Mean a Heart Attack?

“New onset or worsening chest pain located in the center of the chest — particularly when radiating to the neck, jaw, shoulder, or arm — and accompanied by sudden or rapidly progressive weakness, shortness of breath, sweating, lightheadedness, nausea, or vomiting can signal a heart emergency and requires evaluation by a medical provider,” says Dr. Becker.

“Delays in care not only place people with a heart attack at risk of death, they also lessen the overall benefit of well-established treatments,” says Becker. “The key message: Having heart attack symptoms? Don’t wait. Don’t hesitate.”

He advises those who suspect that they may be having a heart attack to take a regular-strength aspirin and either sit or lie down while waiting for emergency medical services to arrive.

While many doctors like Becker urge the public to err on the side of caution and get immediate medical attention when chest pain appears to be serious, some types of discomfort in the chest may be the symptom of a less serious problem.

Adriana Quinones-Camacho, MD, a cardiologist with NYU Langone Health, suggests that if chest pain occurs only when pushing on the chest, it is more likely to be a musculoskeletal issue related to muscles or bones. “If you touch the area and elicit pain, it may be due to something in the muscles in the chest wall,” she says. “Still, even if it’s less likely to be a heart attack, people present in very different ways.”

GERD

“Most common but less dangerous causes of chest pain that are often mistaken for heart attack are indigestion, acid reflux, or gastroesophageal reflux disease,” says Dr. Quinones-Camacho, adding, however, that severe heartburn can be hard to tell apart from a heart attack, even for some physicians.

Getting relief from an antacid (or even burping) suggests that the discomfort is from heartburn, but if the burning is accompanied by sweating and trouble breathing, it may be more likely that it is a sign of heart trouble.

“If the discomfort comes only when the person is eating certain foods — whether it’s spicy chili or something else — and never at other times, then it is most likely indigestion,” says Dr. Quinones-Camacho.

Angina

Angina can cause a feeling of tightness or squeezing in your chest; the pain may radiate to your arms, neck, back, shoulders, or jaw. Angina is caused by narrowing of the arteries, which can temporarily reduce blood flow to the heart. With a heart attack, blood flow is reduced for a longer period and can cause permanent damage to the heart muscle.

Costochondritis

Costochondritis is typically caused by some kind of mechanical stress — coughing too hard or reaching too far and straining your body. Costochondritis can happen to people with rheumatic diseases like rheumatoid arthritis and psoriatic arthritis, in which inflammation affects your rib cartilage. But it can also be partially caused by noninflammatory conditions, such as fibromyalgia.

Pneumonia

Chest pain, particularly if it develops suddenly and is on one side, is a common sign of pneumonia. But if you have pneumonia, you’ll likely also be experiencing other symptoms, such as chills and fever (higher than 100.4 degrees F), a cough lasting more than three weeks, shortness of breath or rapid breathing, bloody mucus, and drowsiness or confusion.

Panic Attacks

When you have a panic attack, stress hormones like adrenaline and cortisol flood your body, leading to a sudden and overwhelming physiological and emotional response. Chest pain, along with a rapid heart rate and hyperventilation, can be part of a panic attack. As with a heart attack, sweating and nausea may occur. But unlike a heart attack, during a panic attack you may experience other symptoms like trembling, a choking sensation, feelings of intense terror and fear, or feeling detached from reality.

While there can be a number of noncardiac causes of chest pain, it’s always worth getting chest pain checked. The bottom line: When in doubt, check it out and seek medical attention.

• Not all chest pain indicates a heart attack, but it’s crucial to take any sudden or severe chest discomfort seriously and consult a healthcare provider promptly to rule out a potential cardiac event.
• If you’re experiencing chest pain that radiates to your neck, jaw, or arm, especially accompanied by sweating, shortness of breath, or nausea, these could be signs of a heart attack, and immediate medical attention is necessary.
• Noncardiac causes like acid reflux (GERD), panic attacks, or costochondritis can also lead to chest discomfort. Distinguishing these from more serious conditions underscores the importance of medical evaluation.
• Quick intervention is vital. Never hesitate to seek help, and consider taking a regular-strength aspirin while awaiting emergency services if a heart attack is suspected.

Additional reporting by Deborah Shapiro.