Cardiac chest pain is quite severe. When you have obstruction to blood flow to the heart vessels, the muscle screams out for oxygen. It’s in pain. Typically this is going to happen with other associated symptoms, shortness of breath, profuse sweating, nausea. This is not going to go away quickly. My advice is to go to the emergency room.
Your history is going to be helpful. If you’re out in the garden doing a certain activity or you’re at the gym and maybe lifting some weights, it will be the same muscle affected. If you do that same motion, that should bring out the pain. Again, it shouldn’t have other associated symptoms like sweating, dizziness, shortness of breath, profuse nausea.
The symptoms of a panic attack can certainly feel exactly like a heart attack. That can have other associated symptoms. If you’re prone to panic attacks and you know that is what it may be, the advice is still to get it checked out. Typically, with panic attacks we can get our breath under control. Chest pain from a heart attack is not going to go away quickly.
A lot of people can have reflux symptoms, feeling like it’s GERD, feeling like it’s reflux. But again, that should come on more with exertion and maybe other associated symptoms like shortness of breath. If you associate your reflux with activity, that needs to be checked out because that could be cardiac in nature.
With acid reflux, it may feel like it’s in the epigastric area right under the rib cage. You may think it’s coming from your gut, but that is a very common referred area that may be coming from the heart. Again, when in doubt always have it checked out. Cardiac chest pain is typically going to come on more with activity, with exertion and it’s not intermittent. It’s not every couple of weeks. That comes with us more and more.
The risk factors haven’t changed. Most at risk are people with high blood pressure, high cholesterol, diabetes, obesity, sleep apnea, smokers with positive family history and increased ages. So, we’re thinking men and women from 50 years and above. There are always going to be outliers, but the common risk factors have not changed in the last 10 years.
That is going to depend on the person. If you still feel that you’re having symptoms and need to be checked out, go see a cardiologist to do some really in-depth detection.
Maybe it’s a different type of chest pain you’re experiencing that is still coming from the heart, such as chronic inflammation around the heart sac called pericarditis. That’s a possibility as well. Inflammation of the heart muscle can happen. That’s myocarditis. There are a lot of other things that could be chest pain coming from the heart that isn’t necessarily a heart attack.
Angina is a lack of blood flow to the heart muscle resulting in symptoms. For some people, that’s chest pain. Other people, it’s shortness of breath and people who’ve had a heart attack or stents or bypass typically they will report the same anginal symptoms. Lack of blood flow to the heart is basically what it is.
It really depends on what’s happening. In some people, they’ll take a nitroglycerine pill and put it underneath their tongue. Those are people with known heart disease. In other people, the blood pressure could be high. You need to get the blood pressure down. It really depends on the etiology or the cause of the chest tightness.
It depends on why you’re having the chest pain. If it’s chest pain coming from inflammation around the heart or pericarditis, we treat that with nonsteroidal anti-inflammatories like Aleve. If it’s chest pain because you’ve got poor blood flow to the heart, that can be treated with stents, bypass or simply medications. Overall, though, it’s blood pressure control, cholesterol control, diabetes control and exercise.
If this is new chest pain, you’ve never experienced it before, you’re not sure what it is, it’s not going away within seconds and you have other symptoms, go right to the emergency room.
If it’s something you’ve experienced before and you’ve talked to your doctor already about it or let’s say you already have a cardiologist, give your cardiologist a call. When in doubt, the emergency room is the best bet because it’s always best to get checked out at the time you’re actually having symptoms.
The best treatment for heart disease is prevention. I tell my patients do your own stress test every day and make sure you’re exercising regularly. If your exercise tolerance changes, see your doctor immediately.
Lightly edited for clarity.
Watch the San Diego Health video with host Susan Taylor and Dr. Adams discussing the causes of chest pain.