Symptoms to Look for When Experiencing Chest Pain
When experiencing chest pain, you should be alert for pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue, as these can all indicate a potentially serious cardiac condition. 1
Primary Symptoms to Monitor
Chest Pain Characteristics
- Location and radiation: Pain may be retrosternal (behind the breastbone) and can radiate to the arm, jaw, neck, or back 1
- Quality: May feel like pressure, heaviness, tightness, or squeezing rather than sharp pain 1, 2
- Duration: Cardiac pain typically builds gradually over minutes rather than being fleeting (lasting only seconds) 2
- Pattern: May be acute, gradual, or intermittent in onset 1
Associated Symptoms (Red Flags)
- Shortness of breath (dyspnea)
- Cold sweat (diaphoresis)
- Nausea or vomiting
- Lightheadedness or fainting
- Anxiety or fear 1, 2
Warning Signs by Potential Cause
Cardiac Causes (Heart Attack/Angina)
- Pain that interrupts normal activity
- Symptoms triggered by physical exertion or emotional stress
- Pain that occurs at rest (concerning for acute coronary syndrome)
- Women may experience more accompanying symptoms like nausea, fatigue, and shortness of breath 1, 2
Aortic Dissection
- Sudden, severe "ripping" or "tearing" pain (often described as "worst pain of my life")
- Pain that migrates from chest to back
- Occurs more commonly in those with hypertension or known aortic conditions 1, 3
Pulmonary Causes
- Pain that worsens with breathing (pleuritic)
- Shortness of breath
- Cough (with or without blood)
- Recent immobility, surgery, or long travel (risk factors for pulmonary embolism) 4
Signs That May Indicate Less Serious Conditions
- Pain that varies with respiration, body position, or food intake
- Pain well-localized to a specific spot on the chest wall
- Pain accompanied by local tenderness when touched 1
- Pain lasting only a few seconds 2
Important Considerations
- Do not rely on nitroglycerin response: Relief with nitroglycerin is not necessarily diagnostic of cardiac issues and should not be used as a diagnostic criterion 1, 2, 5
- Elderly patients (>75 years) may present with atypical symptoms like shortness of breath, syncope, or confusion rather than classic chest pain 2
- Women may present differently than men, with more accompanying symptoms such as nausea and shortness of breath 1
Actions to Take
- Seek immediate medical care by calling emergency services (9-1-1) for severe or concerning chest pain 1
- Do not wait for symptoms to disappear as this does not indicate lower risk 1
- Take a fast-acting aspirin (250-500 mg) if available and not contraindicated 1
Remember that early diagnosis and treatment of serious causes of chest pain can be life-saving, and it's better to be evaluated for what turns out to be a non-serious condition than to delay care for a potentially life-threatening one 1, 6.