Acute chest pain is caused by various conditions. Of them, only 15% to 25% have chest pain due to heart attacks (Acute coronary syndromes). Few others have other life-threatening conditions like acute aortic dissection (tear in the wall of the major blood vessel) or pulmonary embolism (Blockage of blood vessels supplying the lung by blood clots). All the others have non-cardiac (other than heart) conditions like musculoskeletal pains (muscle or bone pains). Abdominal causes including APD and GERD and psychological conditions.
‘Angina pectoris’ is chest pain produced due to diminished blood supply to the heart. This pain is most commonly located in the centre or left of the chest and spreads to the left shoulder and arm, neck or jaw. Less commonly the pain may be in the upper abdomen. Rarely may it be perceived in the right side of the chest or in between the shoulder blades.
The pain is usually described as burning, tightness, heaviness or crushing and suggests a deeper origin. The discomfort ranges from mild to very severe depending on the individual perception and the amount of heart muscle affected. This pain caused by decreased blood supply to the heart increases with exertion and decreases with rest.
In minor to moderate heart attacks (UA/NSTEMI), the pain is typically gradual in onset and may not reach peak intensity for several minutes. In minor heart attack ( unstable angina) , the pain frequently waxes and wanes lasting from a few minutes to as long as but usually less then 20 minutes.
In major heart attack (myocardial infraction), this pain characteristically begins abruptly, is steady and lasts for more than 30 minutes. Patients with heart attack may have other symptoms like breathlessness, excessive sweating, nausea, vomiting, sensation of heart beating (palpitations), generalized weakness, transient loss of consciousness or fear of impending doom.
20% of patients especially elderly, women, diabetics, post operative patients or patients with heart failure in the past may not have any symptoms, so called silent heart attack.
Some characteristics of pain that are unlikely to represent heart attack are:
- Pain that the patient can localize by pointing with one finger especially left and out wards.
- Sharp pain increasing with breathing movements or coughing.
- Pain mainly or only in the middle or lower abdominal region.
- Pain reproduced with movement or palpation of the chest wall or arms.
- Constant pain that persists for many hours.
- Very brief episodes of pain that last for a few seconds or less.
- Pain that spreads into legs.
Some patients with a heart attack may have unusual symptoms also and no single factor can be used to rule out a heart problem, especially in women, elderly and diabetic patients. Therefore, when in doubt it is important to immediately consult a cardiologist.