You Need Emergency Care Immediately — Call 911 Now
Your combination of radiating chest pain, shortness of breath, and vomiting for two days with two weeks of preceding symptoms represents a potentially life-threatening emergency requiring immediate hospital evaluation — you should not wait for an ultrasound reading or any other test, but should call 911 or go directly to an emergency department by ambulance immediately. 1, 2, 3
Why This Is an Emergency
Your symptom pattern raises serious concern for acute coronary syndrome (ACS), which includes heart attack, because:
- Radiating chest pain is a cardinal feature of cardiac ischemia, particularly when it builds over time and is associated with other symptoms 1, 3
- Shortness of breath (dyspnea) is one of the most common symptoms accompanying myocardial ischemia and significantly increases mortality risk — patients with unexplained dyspnea have more than twice the risk of death compared to typical angina alone 2, 3
- Nausea and vomiting are recognized associated symptoms of ACS, particularly in certain populations 1, 2, 3
- Two-week duration with worsening suggests either progressive cardiac ischemia or another serious condition that has now decompensated 1, 3
What You Must Do Right Now
Call 911 immediately — do not drive yourself or have friends/family transport you 2, 4:
- EMS can provide life-saving interventions en route if you develop cardiac arrest or other complications 2, 4
- EMS can obtain a pre-hospital ECG, which reduces mortality and hospital delay time 3
- EMS can administer aspirin, oxygen, and defibrillation if needed 2, 4
While waiting for EMS (if you have these medications available):
- Take aspirin 162-325 mg (chew it, don't swallow whole) unless you have an aspirin allergy or active bleeding 2, 4, 3
- If you have previously prescribed nitroglycerin and your blood pressure is not low, you may take one dose 2
What Will Happen at the Hospital
The emergency department will perform time-critical evaluations 1, 3:
- 12-lead ECG within 10 minutes to identify heart attack patterns (ST-elevation, ischemic changes) 1, 2, 3
- Cardiac troponin blood test immediately to detect heart muscle injury 1, 3
- Chest X-ray to evaluate for other causes like pneumonia, collapsed lung, or fluid 3
- Continuous cardiac monitoring for dangerous heart rhythms 3
Other Serious Conditions Being Considered
Beyond heart attack, your symptoms could represent 1, 3:
- Pulmonary embolism (blood clot in lungs) — sudden dyspnea with chest pain 1, 3
- Acute aortic syndrome (tear in major artery) — though typically presents with sudden "ripping" pain to the back 1, 3
- Pericarditis (heart lining inflammation) — though pain typically worsens lying flat and improves leaning forward 1
Critical Point About Cost Concerns
If you're worried about hospital costs 3:
- Federal law (EMTALA) requires emergency departments to evaluate and stabilize you regardless of ability to pay 3
- Most hospitals have financial assistance programs and charity care for emergency services 3
- The cost of delayed diagnosis of a heart attack far exceeds the cost of emergency evaluation — untreated heart attacks cause permanent heart damage and death 3
Why Waiting Is Dangerous
Every minute of delay matters 3:
- Heart attack treatment saves 35 lives per 1,000 patients when given within the first hour, but only 16 lives per 1,000 when given 7-12 hours after symptom onset 3
- If you're having a heart attack, the goal is door-to-balloon time <90 minutes or door-to-needle time <30 minutes for clot-busting medication 3
- Patients who delay seeking care have higher mortality rates and more complications 2
Do not attempt to get an ultrasound read or any other outpatient testing first — call 911 now. 2, 4, 3