Chest pain: First aid

First aid for chest pain depends on the cause. Causes of chest pain can vary from minor problems, such as heartburn or emotional stress, to serious medical emergencies, such as a heart attack or blood clot in the lungs (pulmonary embolism).

It can be difficult to tell if your chest pain is due to a heart attack or other health condition, especially if you've never had chest pain before. Don't try to diagnose the cause yourself. Seek emergency medical help if you have unexplained chest pain that lasts more than a few minutes.

Heart attack

A heart attack generally causes chest pain for more than 15 minutes. The pain may be mild or severe. Some heart attacks strike suddenly, but many people have warning signs hours or days in advance.

Someone having a heart attack may have any or all of the following:

• Chest pain, pressure or tightness, or a squeezing or aching sensation in the center of the chest
• Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or occasionally upper abdomen
• Nausea, indigestion, heartburn or abdominal pain
• Shortness of breath
• Lightheadedness, dizziness, fainting
• Sweating

In women, chest pain is not always severe or even the most noticeable symptom. Women tend to have more-vague symptoms, such as nausea or back or jaw pain, which may be more intense than the chest pain.

If you or someone else may be having a heart attack, follow these first-aid steps:

• Call 911 or emergency medical assistance. Don't ignore the symptoms of a heart attack. If you can't get an ambulance or emergency vehicle to come to you, have a neighbor or a friend drive you to the nearest hospital. Drive yourself only if you have no other option. Because your condition can worsen, driving yourself puts you and others at risk.
• Chew aspirin. Aspirin is a blood thinner. It prevents clotting and keeps blood flowing through a narrowed artery that's caused a heart attack. Don't take aspirin if you have chest pain due to an injury. Also, 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. The American Heart Association recommends starting hands-only CPR. Push hard and fast on the person's chest for 100 to 120 compressions a minute.
• 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. It's relatively common, but it can be hard to tell the difference from other types of chest pain, such as indigestion.

Angina can be stable or unstable.

• Stable angina is chest pain that usually occurs with activity and is relatively predictable. The chest pain tends to follow a pattern. In other words, there's been no change in how often you get the chest pain and how long it lasts.
• Unstable angina is chest pain that is sudden or new or changes from the typical pattern. It may be a sign of a future heart attack.

If your angina gets worse or changes, seek emergency medical help immediately.

Pulmonary embolism

Pulmonary embolism is a blood clot in the lung. It occurs when a clot, usually in the leg or pelvis, breaks free and gets stuck in a lung artery (pulmonary artery). The clot interrupts blood flow, making 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 with shortness of breath
• Sudden, unexplained shortness of breath, even without pain
• Cough that may produce blood-streaked spit
• Rapid heartbeat 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 tear in the inner layer of the aorta, the large blood vessel branching off the heart. Blood rushes through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). Aortic dissection is a life-threatening condition that needs emergency medical treatment.

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
• Heavy sweating
• Weak pulse in one arm compared with the other

If you are having any of these signs or symptoms, they could be caused by an aortic dissection or another 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. Pleurisy is inflammation of the membranes that surround the lung (pleura). It can cause chest pain when taking a breath or coughing.

Unlike a true heart attack, pleurisy pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest.

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.

Pericarditis

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding your heart (pericardium). Pericarditis can cause sharp chest pain that gets worse when you cough, lie down or take a deep breath.

Pericarditis is usually mild and goes away without treatment. If it's severe, you may need medication or, rarely, surgery.

It may be difficult to tell the difference between sudden (acute) pericarditis and pain due to a heart attack. If you have sudden, unexplained chest pain, seek emergency medical help.

Chest wall pain

Chest wall pain is a type of muscle pain. Bruised chest muscles — from excessive coughing, straining or minor injury can cause harmless chest pain.

One type of chest wall pain is costochondritis. Costochondritis causes pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).

If you have costochondritis, pressing on a few points along the edge of your breastbone often triggers considerable tenderness. If gently touching the area with your fingers causes chest pain, it's unlikely that a serious condition, such as a heart attack, is the cause of your chest pain.

When to see a doctor

Chest pain is a common reason that people seek medical treatment. Anxiety, indigestion, infection, muscle strain, and heart or lung problems can all cause chest pain.

If your chest pain is new, changing or otherwise unexplained, seek help from a doctor. If you think you're having a heart attack, call 911 or your local emergency number. Don't try to diagnose the chest pain yourself or ignore it. Your treatment will depend on the specific cause of the pain.