Health Essentials from Cleveland Clinic

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

If you experience new or unexplained pain, pressure or discomfort in the center of your chest or in your arms, back, jaw, neck or upper stomach — along with shortness of breath, a cold sweat, nausea, fatigue or lightheadedness — for at least five minutes, call 911.

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

Cardiologist Curtis Rimmerman, MD, notes that the following symptoms are unlikely to signal a heart attack:

1. 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.)
2. Pinpoint chest discomfort that worsens with positional changes in breathing. Heart pain is usually diffuse, or radiating. Pinpoint discomfort that worsens with chest expansion (breathing, for instance) is more likely to involve the lungs.
3. 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, throat or jaw discomfort.

But the discomfort is unrelenting, typically lasting five minutes or more (even up to half an hour or, rarely, two hours).

“Regardless of where the pain is, people typically can’t find a position that relieves the pain,” Dr. Rimmerman says. “Nor do they find relief by taking a drink of water, popping antacids or taking deep breaths.”

That’s when it’s important to call 911  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.”