Health Essentials from Cleveland Clinic

Some types of chest pain should send you to the emergency room immediately.

If you experience pain, pressure or discomfort in the center of your chest or in your arms, back, jaw, neck or stomach — along with shortness of breath, a cold sweat, nausea, fatigue or lightheadedness — for at least five minutes, call 9-1-1.

These symptoms may signal a heart attack, or myocardial infarction. Immediate treatment is essential to save heart muscle.

But when chest aches and pains are fleeting, it’s often something different.

Symptoms that suggest another problem

As Cleveland Clinic cardiologist Curtis Rimmerman, MD, writes in his book “The Cleveland Clinic Guide to Heart Attacks, the following symptoms are unlikely to signal a heart attack:

• Momentary chest discomfort, often characterized as a lightning bolt or electrical shock. Heart discomfort or pain is unrelenting, typically for several minutes. Momentary chest discomfort is more likely to result from musculoskeletal injury or inflammation, or nerve pain (e.g., a cracked rib, a pulled muscle in the chest wall or shingles involving the chest.)
• Pinpoint chest discomfort that worsens with positional changes in breathing. Heart pain is usually diffuse, or radiating. Pinpoint discomfort that changes with breathing is more likely to involve the lungs (e.g., pleurisy, an inflammation of the lung membranes; pneumonia; or asthma).
• Chest discomfort that gets better with exercise. Heart-related pain typically worsens with exercise. Sharp chest pain that improves with movement is more likely to have other causes (e.g., acid reflux.) 

Heart attack symptoms vary widely

Dr. Rimmerman emphasizes that the symptoms of heart attack or angina can vary greatly from person to person. Some people experience no symptoms at all. Others experience crushing chest pain. Still others may feel only arm discomfort.

“Regardless of the site of the discomfort, people typically can’t find a position that relieves the pain,” writes Dr. Rimmerman. “Nor do they find relief by ingesting liquids, popping antacids, or taking deep breaths.”

Heart attack discomfort is unrelenting, typically lasting five minutes or more (up to half an hour or, rarely, two hours). That’s when it’s important to call 9-1-1  to get emergency treatment.

If chest discomfort is fleeting but severe, make an appointment to see your primary care doctor.

But when in doubt, Dr. Rimmerman advises, “Err on the side of caution, and visit a doctor or emergency room.”