Chest pain: First aid

Causes of chest pain can vary from minor problems, such as indigestion or stress, to serious medical emergencies, such as a heart attack or pulmonary embolism. The specific cause of chest pain can be difficult to interpret.

Finding the cause of your chest pain can be challenging, especially if you've never had prior symptoms. Even doctors may have a difficult time deciding if chest pain is a sign of a heart attack or something less serious, such as indigestion.

If you have unexplained chest pain lasting more than a few minutes, seek emergency medical help right away rather than trying to diagnose the cause yourself.

Heart attack

A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack may cause chest pain that lasts a few minutes or longer, or it can also be silent and produce no signs or symptoms.

Many people who experience a heart attack have warning signs hours, days or weeks in advance. The earliest warning sign of blocked heart arteries may be ongoing episodes of chest pain that start when you're physically active and are relieved by rest. However, during a heart attack those symptoms appear even without any physical activity.

Someone having a heart attack may experience none, any or all of the following:

• Uncomfortable pressure, fullness or squeezing pain in the center of the chest lasting more than a few minutes
• Pain spreading to the shoulders, back, neck, jaw or arms
• Lightheadedness, fainting, cold sweating, nausea or shortness of breath

If you or someone else may be having a heart attack:

• Call 911 or emergency medical assistance. Don't tough out the symptoms of a heart attack. If you don't have access to emergency medical services, have a neighbor or friend drive you to the nearest hospital.

  Drive yourself only as a last resort, and realize that driving yourself puts you and others at risk if your condition suddenly worsens.

• Chew a regular-strength aspirin. Aspirin reduces blood clotting, which can help blood flow through a narrowed artery that's caused a heart attack. However, don't take aspirin if you are allergic to aspirin, have bleeding problems or take another blood-thinning medication, or if your doctor previously told you not to do so.
• Take nitroglycerin, if prescribed. If you think you're having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Don't take anyone else's nitroglycerin.

• Begin CPR on the person having a heart attack, if directed. If the person suspected of having a heart attack is unconscious, a 911 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR).

  If you haven't received CPR training, doctors recommend performing only chest compressions (about 100 to 120 compressions a minute).The dispatcher can instruct you in the proper procedures until help arrives.

• If an automated external defibrillator (AED) is immediately available and the person is unconscious, follow the device instructions for using it.

Angina

Angina is chest pain or discomfort caused by reduced blood flow to your heart muscle. The term angina is generally used when you've already been given the diagnosis of heart disease.

Angina is referred to as stable or unstable. Stable angina can be persistent, recurring chest pain that usually occurs with exertion and is relatively predictable. Unstable angina occurs when the chest pain is sudden, new, or changes from the typical pattern, and may signal an impending heart attack.

Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion.

If you're having angina with any of the following signs and symptoms, it may indicate a more serious condition, such as a heart attack:

• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Anxiety
• Sweating
• Dizziness or fainting spells

The severity, duration and type of angina can vary. If you have new or changing chest pain, these new or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. If your angina gets worse or changes, seek emergency medical help immediately.

Pulmonary embolism

Pulmonary embolism occurs when a clot — usually from the veins of your leg or pelvis — lodges in a pulmonary artery of your lung. The lung tissue served by the artery doesn't get enough blood flow, causing problems with the oxygenation of the blood. This makes it more difficult for your lungs to provide oxygen to the rest of your body.

Signs and symptoms of pulmonary embolism may include:

• Sudden, sharp chest pain often accompanied by shortness of breath
• Sudden, unexplained shortness of breath, even without pain
• Cough that may produce blood-streaked spit
• Rapid heartbeat associated with shortness of breath
• Fainting
• Severe anxiety
• Unexplained sweating
• Swelling of one leg only, caused by a blood clot in the leg

Pulmonary embolism can be life-threatening. If you have symptoms of a pulmonary embolism, seek emergency medical help immediately.

Aortic dissection

An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is usually fatal.

Typical signs and symptoms include:

• Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates to the neck or down the back
• Loss of consciousness (fainting)
• Shortness of breath
• Sudden difficulty speaking, loss of vision, weakness or paralysis of one side of your body, such as having a stroke
• Sweating
• Weak pulse in one arm compared with the other

If you are experiencing any of these signs or symptoms, they could be caused by an aortic dissection or some other serious condition. Seek emergency medical help immediately.

Pneumonia with pleurisy

Frequent signs and symptoms of pneumonia are chest pain accompanied by chills, fever and a cough that may produce bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes that surround the lung (pleura), you may have considerable chest discomfort when taking a breath or coughing. This condition is called pleurisy.

One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This isn't usually true of a heart attack.

If you've recently been diagnosed with pneumonia and then start having symptoms of pleurisy, contact your doctor or seek immediate medical attention to determine the cause of your chest pain. Pleurisy alone isn't a medical emergency, but you shouldn't try to make the diagnosis yourself.

Chest wall pain

One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It causes pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).

In costochondritis, pressing on a few points along the edge of your sternum often results in considerable tenderness in those small areas. If the pressure of a finger causes similar chest pain, it's unlikely that a serious condition, such as a heart attack, is the cause of your chest pain.

Other causes of chest pain include:

• Strained chest muscles from overuse or excessive coughing
• Chest muscle bruising from minor injury
• Short-term, sudden anxiety with rapid breathing
• Peptic ulcer disease
• Pain from the digestive tract, such as esophageal reflux, peptic ulcer pain or gallbladder pain that may feel similar to heart attack symptoms
• Pericarditis