Chest Pain: When to Call 911 and When to Book a Visit

What it involves

MedlinePlus defines chest pain as discomfort or pain anywhere along the front of the body between the neck and upper abdomen. Many people fear a heart attack, but MedlinePlus says there are many possible causes, some not dangerous and some life threatening, because any organ or tissue in the chest can be the source. That includes the heart, lungs, esophagus, muscles, ribs, tendons, and nerves.

Who this is for

• Patients whose chest discomfort comes and goes and who want it properly evaluated
• Patients with chest wall soreness, heartburn-type burning, or pain with a cough who are not in distress
• Patients with heart disease risk factors who have noticed new chest symptoms
• Patients who went to an emergency room, were sent home, and need follow-up

What to expect

• Questions about where the pain is, what it feels like, how long it lasts, and what triggers it
• A blood pressure and pulse check, and an EKG when your provider thinks it will help
• A review of your risk factors, medicines, and family history
• A plan for tests or a referral, and clear instructions on when to call 911

Call 911 first if you have any of these

MedlinePlus says to call 911 or the local emergency number if you have:

• Sudden crushing, squeezing, tightening, or pressure in your chest
• Pain that spreads to your jaw, left arm, or between your shoulder blades
• Nausea, dizziness, sweating, a racing heart, or shortness of breath with the chest pain
• Angina that is suddenly more intense, brought on by lighter activity, lasts longer than usual, or happens at rest
• Sudden sharp chest pain with shortness of breath, especially after a long trip or bedrest, or with one swollen leg

Why it is often not the heart

MedlinePlus lists many causes outside the heart. Lung causes include pneumonia and pleurisy, which usually hurt more when you breathe in or cough. Other causes include a panic attack, inflammation where the ribs join the breastbone, shingles, and strained muscles between the ribs. Digestive causes include heartburn or reflux, esophageal spasm, gallstones, and ulcers. Only an exam can sort these out, which is why self-diagnosis is a poor plan. Breathing trouble alongside chest pressure is a different question from either alone, and the shortness of breath evaluation covers the heart, lung, and blood causes of breathlessness. MedlinePlus advises calling 911 for sudden pressure or crushing pain in the shoulder that comes with chest symptoms, and the shoulder pain evaluation lists those signs next to the more routine causes of a sore shoulder. Chest pain, throat swelling, or trouble breathing after an insect sting can be a sign of a severe allergic reaction, and the insect bites and stings guide lists when to call 911.

Heart and blood vessel causes

MedlinePlus says angina or a heart attack most commonly causes tightness, heavy pressure, squeezing, or crushing pain that may spread to the arm, shoulder, jaw, or back. A tear in the aorta causes sudden severe pain in the chest and upper back, and inflammation of the sac around the heart causes pain in the center of the chest. It also says risk is greater with a family history of heart disease, smoking, overweight, high cholesterol, high blood pressure, or diabetes. Pain in the neck, jaw, or arm can be a sign of a heart attack, and the neck pain evaluation explains how to tell a strained neck from an emergency.

When a clinic visit makes sense

MedlinePlus says to contact your provider if chest pain is severe and does not go away, lasts longer than three to five days, comes with a fever or a cough with yellow-green phlegm, or comes with trouble swallowing. If you are unsure which category you are in, the sick visit versus urgent care versus ER guide explains how to choose, and any doubt about a heart attack means calling 911. Hives with throat tightness or trouble breathing are an emergency, not a booking question, as the hives guide explains.

What your provider will ask and check

MedlinePlus lists the questions a provider asks: where the pain sits, whether it moves, how it feels, how long it lasts, whether it is worse with exercise, breathing, eating, or pressing on the chest, and whether rest or antacids help. At the Loxahatchee and West Palm Beach offices an EKG may be part of the evaluation. Which other tests follow depends on the cause and on your other medical problems.

Planning ahead if you have risk factors

A visit after the emergency has passed, or before one ever happens, can focus on the risk factors that MedlinePlus lists. The heart disease risk review explains how blood pressure, cholesterol, diabetes, and smoking combine, and patients with an existing diagnosis can read about heart failure management. None of these pages replaces emergency care for a possible heart attack.

Sources

• MedlinePlus — Chest Pain