What should I do if I have chest pain (thoracic pain) and jaw pain?

Immediate Action Required: Seek Emergency Care Now

You must call emergency services (911 or your local emergency number) immediately or go to the nearest emergency department without delay. Chest pain combined with jaw pain is a recognized presentation of acute myocardial infarction (heart attack) and requires urgent evaluation within minutes, not hours 1.

Why This Is an Emergency

• Jaw pain is a classic radiation pattern for cardiac ischemia. The American College of Cardiology/American Heart Association guidelines explicitly identify pain radiating to the neck, jaw, shoulders, back, or arms as a key diagnostic feature of acute coronary syndrome 1.
• Sternal (chest) pain with jaw radiation has high mortality risk if untreated. Without proper observation and treatment, 20-30% of patients with unstable angina either die or have a myocardial infarction within 4 weeks 1.
• Time is muscle. Every hour of delay results in 23 additional deaths per 1000 patients 1. Rapid availability of reperfusion therapy reduces mortality by 53% 1.

What to Do Right Now (Before EMS Arrives)

Call 911 first, then consider these steps:

• Take aspirin immediately (162-325 mg) by chewing and swallowing it, unless you have a known aspirin allergy or have been specifically told by a doctor not to take aspirin 1. Early aspirin administration (within 1.6 hours of pain onset) significantly improves survival compared to delayed administration 1.
• Sit down and remain still to reduce cardiac workload and prevent falling from potential lightheadedness 2.
• Do NOT drive yourself to the hospital. Approximately 1 in 300 patients with chest pain transported by private vehicle have cardiac arrest en route 1.

Critical Warning Signs That Confirm High Risk

Your symptoms meet multiple high-risk criteria that mandate immediate emergency evaluation 1:

• Pain location and radiation pattern: Central/substernal chest pain radiating to jaw is the classic presentation of myocardial ischemia 1, 3
• Associated symptoms to watch for: Sweating, nausea, vomiting, shortness of breath, lightheadedness, or a sense of impending doom 1
• Pain lasting >20 minutes that doesn't resolve with rest is particularly concerning 1, 3

What Will Happen in the Emergency Department

The medical team will follow a time-critical protocol 1:

• 12-lead ECG within 10 minutes of arrival to identify ST-segment elevation or other ischemic changes 1
• Continuous cardiac monitoring to detect life-threatening arrhythmias 1
• Blood tests for cardiac biomarkers (troponin, CK-MB) on arrival and at 10-12 hours after symptom onset 1
• Immediate treatment if acute coronary syndrome is confirmed, including aspirin, antiplatelet agents, anticoagulation, and potentially emergency cardiac catheterization or thrombolytic therapy 1

Common Pitfalls That Delay Life-Saving Treatment

• Assuming it's "just indigestion" or muscle pain. Up to 30% of heart attack patients present with atypical symptoms, and these patients have worse outcomes because they present later and receive less aggressive treatment 1.
• Waiting to see if symptoms resolve. The European Heart Journal guidelines emphasize that waiting for symptoms to disappear is a poor indicator of risk 1.
• Attributing jaw pain to dental problems. Multiple case reports document patients with cardiac ischemia initially misdiagnosed with dental issues, leading to dangerous delays 4.

Why Jaw Pain Specifically Matters

The American College of Cardiology explicitly recognizes that chest discomfort in myocardial infarction can be referred to the throat and lower jaw through shared nerve pathways 3. The vagus nerve and other cardiac nerves create referred pain patterns that manifest as jaw, neck, or throat discomfort 5, 4. Research shows that patients presenting with jaw pain as their primary cardiac symptom are more likely to be older, female, or have diabetes—and they face higher mortality because of delayed recognition 5.

Life-Threatening Conditions to Rule Out

Beyond acute coronary syndrome, your symptoms require urgent evaluation for 1:

• Aortic dissection (tearing of the major artery from the heart)
• Pulmonary embolism (blood clot in the lungs)
• Acute pericarditis (inflammation of the heart sac)
• Pneumothorax (collapsed lung)

All of these conditions can present with chest pain and are immediately life-threatening 1.

Do Not Wait—Act Now

The single most important action is activating emergency medical services immediately. Even if you're uncertain whether this is truly a heart attack, the risk of missing acute coronary syndrome far outweighs the inconvenience of being evaluated 1. The American Heart Association emphasizes that patients with chest pain should be placed in an environment with continuous ECG monitoring and defibrillation capability as soon as possible 1.