Chest Pain

Chest pain is one of the most common reasons people contact emergency services, and the overwhelming majority of cases turn out not to be a heart attack — muscular strain, reflux and anxiety account for a great deal of it.

The difficulty is that the reassuring statistic does not help you in the moment. Cardiac and non-cardiac pain overlap considerably, and people having heart attacks routinely describe them as indigestion. That is why the advice for anything suspicious is to call rather than to reason it out.

Needing emergency assessment — heart attack or angina, pulmonary embolism, aortic dissection, collapsed lung, pericarditis. These are the reason chest pain is treated as urgent until proven otherwise.

Common and not dangerous

• Acid reflux — burning behind the breastbone, worse lying down or after eating. Genuinely difficult to distinguish from cardiac pain
• Musculoskeletal pain — reproducible when you press on the spot, or worse with a particular movement. Often follows unaccustomed lifting or a cough
• Panic attacks — tightness with breathlessness, tingling and a sense of dread, peaking within ten minutes
• Chest infection — sharp pain worse on breathing in, with cough and fever
• Shingles — burning pain in a band, before the rash appears

If your chest pain is happening now and has any concerning feature, this is not the right service. Call 999.

Where a remote consultation genuinely helps is afterwards — or for pain that has been going on for weeks and has already been assessed as non-cardiac.

A consultation covers the character of the pain, what brings it on and relieves it, your cardiovascular risk factors, and your medication. We arrange cholesterol, HbA1c and blood pressure assessment where the picture warrants it, and refer for cardiac investigation privately where indicated.

What we cannot do: listen to your heart, perform an ECG, or examine your chest wall. Where the diagnosis depends on any of those, we will say so and direct you to in-person care.

How do I know if it is my heart?

Honestly, you often cannot — and that is exactly why chest pain is treated seriously. The features that raise concern: pain brought on by exertion and eased by rest, heaviness or tightness rather than sharpness, pain spreading to the jaw, neck, back or arm, and sweating, breathlessness or nausea alongside. If any of that fits, call 999 rather than working it out yourself.

What does a heart attack actually feel like?

Frequently not what people expect. It is more often heaviness, tightness, pressure or severe indigestion than sharp, dramatic pain — and some people describe only breathlessness, nausea, sweating or a sense that something is badly wrong. Women, people with diabetes and older adults are more likely to have these less typical presentations, which is a major reason they reach hospital later.

Can anxiety cause real chest pain?

Yes — genuinely physical pain, not imagined. Panic and hyperventilation cause chest tightness, a racing heart and tingling in the hands and around the mouth. But anxiety is a diagnosis to reach after cardiac causes have been considered, particularly on a first episode, and having anxiety does not protect anyone from heart disease.

It only hurts when I breathe in or press on it.

That pattern — sharp pain, worse on breathing or on pressing the chest wall — usually points to a musculoskeletal cause and is reassuring. With one exception: sharp pain on breathing in, with breathlessness, particularly after a long flight, surgery or immobility, or with a swollen calf, raises a clot on the lung. That needs same-day assessment.

I'm young and fit. Could it still be serious?

Heart attacks are much less likely in young people, but not impossible — particularly with a strong family history of early heart disease, or with cocaine use, which is a genuine and under-declared cause of chest pain in young adults. A family history of sudden cardiac death under 40 is always worth mentioning.

Could it be indigestion?

It might well be — but this is the commonest way heart attacks get dismissed. People reach for antacids because the sensation is burning or gnawing rather than crushing. If the discomfort comes on with exertion, or comes with sweating or breathlessness, treat it as cardiac until someone has told you otherwise.

Should I take aspirin?

If you are calling 999 for suspected cardiac chest pain, chew one 300mg aspirin — chewed rather than swallowed — unless you are allergic to it or have been told to avoid it. Do not take aspirin routinely for chest pain of unknown cause, and do not delay calling for an ambulance in order to find some.

Can you assess chest pain over a video call?

Only partly, and we will be direct about that. We cannot perform an ECG or blood tests, which are what actually exclude a heart attack. Where the pattern suggests anything cardiac, we will tell you to call 999 or go to hospital rather than continuing the consultation. Where it is clearly musculoskeletal or reflux, we can help properly.