It’s 2 AM and you wake up with chest pain, aka angina. What should you do? Maybe it’s just indigestion, but maybe it’s a heart attack. How do you know what to do?
When Is Chest Pain Serious?
Heart disease kill more people in the U.S. than any other single disease, and the main symptom that people have from a heart attack is chest pain. It’s also the leading cause of death in women in the US, according to the Centers for Disease Control and Prevention. But the term chest pain is actually misleading. Heart pain is not always described as being painful, and it’s not always in the chest. For that reason, I like the Latin term angina pectoris, which means “sensation in the chest.” This is not just a vocabulary lesson; people die because what they are feeling isn’t actually chest pain and so they stay at home and have a heart attack.
See Also: 6 Heart Attack Risk Factors
Today I’ll focus on the symptom that brings people into my office, and then over the next few weeks I’ll cover the cause and the treatment of heart disease.
When Is Chest Pain a Heart Attack?
So how can you tell if you should worry with your angina symptoms? There are two main factors that help me decide when to worry: the details of the actual symptoms, and the patient's risk factors for heart disease.
The typical symptoms of angina are described as:
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Chest “tightness,” “squeezing,” or “heaviness.” People describe this feeling as a weight or as a band being tightened around their chest. The pain is usually located on the left side of the chest above the bottom of the ribcage, but it’s sometimes hard to define its exact location.
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Shortness of breath
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Sweating, nausea, and an anxious feeling
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Radiation of the chest pain into the left arm, neck, and jaw
What Are Other Symptoms of a Heart Attack?
Those are the typical symptoms, and the presence of all of the above descriptions certainly is cause for worry. But many people have other atypical symptoms that may still be a cause for concern. These atypical symptoms of heart attacks are especially common in women, according to a study in the Journal of the American Medical Association. Here are some of the other symptoms and misconceptions about heart attack signs:
Pain isn’t on the left side: Sometimes the pain is not on the left, but on the right, the center, or even at the top of the abdomen.
Absence of pain: Some people have no pain at all; instead they just have shortness of breath. Some patients, particularly diabetics, can have no symptoms at all. One-half of the people having heart attacks didn’t even notice it.
Varied quality of pain: Some experience a sharp, burning, gassy pain, or a feeling of indigestion.
I also had one patient describe his symptoms as “a cold feeling in the chest” whenever he breathed.
How Long Does Chest Pain Related to a Heart Attack Last?
Aside from what the chest pain feels like, you should also pay attention to how long the pain lasts. Chest pain related to a heart attack doesn’t typically last just a few seconds. Heart chest pain almost always lasts at least 5 minutes, and doesn’t typically last more than 20 to 30 minutes continuously.
Pain that comes on after exercise or exertion but consistently goes away with rest may represent a narrowing of the blood vessels that supply blood to the heart. That could lead to a heart attack eventually, but it isn’t always an emergency, either. However, it is vital that you discuss these symptoms with your doctor right away..
What are the Risk Factors for a Heart Attack?
The other major things to consider when determining whether your chest pain is a heart-related emergency are your risk factors. It’s a big difference when a 20-year-old woman comes in with chest pain than when a 50-year-old male diabetic who smokes comes in. The risk factors for heart attacks include:
Age – risk for heart attacks begins to rise for men at age 40 and women at 50. It can still happen below that age, but it’s a lot less likely.
Sex – men are at higher risk than women, although the disease still kills a huge number of women each year.
Genetics – if a member of your immediate family (parent or sibling) has coronary heart disease, your risk is substantially higher. That risk is especially high if that family member is a man under 55 or a woman under 65
Smoking – people often think of smoking as a danger to the lungs (which it is), but the biggest risk of death from smoking is from heart attacks. I recommend my patients quit smoking and take up something safer, like tightrope walking, javelin catching, or training pit bulls.
Using the results of the revolutionary large Framingham Study, you can calculate your own risk of developing cardiovascular disease in the next 10 years using their interactive calculator online. This is a tool that some physicians often use to determine a patient’s risk.
Hypertension and diabetes – Having these diseases also increase risk for heart attack.
High cholesterol – this is a complex subject, so please refer to my article on cholesterol to get an accurate picture. If you need help interpreting your cholesterol, or tips on how to lower it, we’ve covered those topics, too.
See Also: 10 Strategies for Lowering Cholesterol and How to Interpret Your Cholestrol.
The more of these risk factors you personally have, the more seriously you should take any chest pain you experience. I will often be more concerned about a high-risk person with atypical symptoms than a low-risk person with classic symptoms.
When Is Chest Pain NOT a Heart Attack?
There are some symptoms that reassure me the chest pain isn’t related to the heart:
Pain that persists for hours – heart chest pain will either go away after 20-30 minutes, or will end up in a heart attack.
Pain that gets worse with movement – or pain that gets worse when you press on that area of the chest is probably from the muscles or the bones in the chest, not the heart.
Pain that you can point to with a single finger – heart pain tends to be hard to pinpoint.
Pain that is triggered with breathing in – very brief, sharp pain that occurs with taking a deep breath is a typical presentation of pleuritis, inflammation of the lining of the lungs.
I hope these tips help you. Learn the symptoms of heart pain and know your risk factors. If you are experiencing an acute chest pain more consistent with heart symptoms and/or have atypical symptoms and risk factors for heart disease, get to the emergency room immediately, even if you have to call an ambulance. If you are high risk and have classic symptoms, get to the emergency room immediately, even if you have to call an ambulance.
Remember: it’s always OK to get things checked out. It’s far better to be seen for symptoms that are not serious than to stay home with serious symptoms.
Check out the episodes on what causes heart attacks and on how to detect heart problems to learn more. The American Heart Association’s page on heart attacks is also a good resource
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Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Sanaz Majd, MD, also contributed to this article, which was updated on September 28, 2016.
Woman with Chest Pain and Man with Chest Pain images from Shutterstock
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