Chest pains are the second-highest reason adults visit the emergency department. And it makes sense why—chest pain can signify one of the most serious conditions: a heart attack.
Yes, heart attacks are serious and pervasive. But I’ve found that most often, people experiencing chest pain are not having a heart attack. Allow me to share how my team and I determine what’s making someone’s chest hurt, and what other causes we usually discover.
But first, let me be clear: if you think you are experiencing a heart attack, please do not delay. Head straight to the emergency room or call 911.
The tried-and-true “Is it a heart attack?” chest pain scoring method
Determining the cause of someone’s chest pains is like navigating a maze. My goal is to find the most accurate path to an accurate diagnosis—quickly and without running into many dead ends. To do that, we use a simple scoring system that involves three questions.
Can you describe your chest pains?
Believe it or not, folks who experience pressure, squeezing, heaviness, gripping or other chest discomfort rarely call these sensations “chest pains.” But if you’re feeling any of these things, I need to know. Hearing people describe what they’re feeling draws out these details.
Another way this question clarifies the picture is by helping me gauge the intensity and nature of the discomfort. Is it an ache, or a sharp, stabbing feeling? Does it radiate, or throb? Where, exactly, does the feeling originate? As people describe where they hurt, I often listen and learn that they’re experiencing upper abdominal pain or even deep back pain, not chest pain.
What aggravates your chest pains?
If someone tells me that their chest pains increase with physical exertion or emotional stress, this is another indication we’re on the path to discovering a heart attack.
However, many times, folks say that other things trigger and provoke their chest pain. For example, when they tell me that lying down intensifies the discomfort, I know we’re likely dealing with something other than a heart attack.
What relieves your chest pains?
An equally insightful question is how people successfully relieve their chest pains. If a good belch, carbonated drink, deep breaths or dairy treat mitigates the discomfort temporarily, then I can likely rule out heart attack.
As you can see, the folks who arrive into my care with chest pains need to be funneled through a series of scenarios. We eliminate problems one by one to arrive at the true root cause. These questions help us start.
Non-heart attack causes of chest pain
If your chest hurts and you’re not having a heart attack, what could be the cause of your pain? Good question.
About a third of the time, I discover that a person experiencing chest pain has a problem with their gastrointestinal tract. This could mean…
1. Gastroesophageal reflux disease (GERD)
2. Esophageal ulcers
4. Oesophageal motility malfunctions (spasms, simultaneous contractions, abnormal sphincter relaxation, etc.)
…and more. It could even be due to consuming a too-large piece of food. The good news is that while I may not be the right help for you, a gastroenterologist can help you relieve chest pains are caused by an uncooperative digestive system.
Muscular skeletal problems
Another one-third of the people who feel chest pains end up discovering they have a problem with their musculoskeletal system. This could mean…
5. An undetected fracture
6. A pulled or strained muscle
7. Rheumatoid arthritis
9. Inflammation of the rib/breastbone cartilage connection (Costochondritis)
10. Painful rib syndrome
Thankfully, an orthopedic specialist can help.
Non-heart attack cardiac trouble
Just because we rule out a heart attack doesn’t mean your cardiovascular system isn’t the cause of your chest pain. This could mean…
12. Aortic aneurysm with or without dissection (usually accompanied by back pain)
13. Myocardial ischemia or infarction
14. Coronary artery disease (CAD)
Other non-heart attack causes of chest pain
We’ve covered a lot of ground, but there are still some non-heart attack related causes of chest pains you should consider.
15. Anxiety. Panic attacks and severe anxiety is one of the most common causes of chest pain that doesn’t involve the musculoskeletal, gastrointestinal or cardiovascular systems.
16. Broken heart syndrome. Known as Takotsubo cardiomyopathy, this treatable condition occurs after a psychologically, emotionally or even physically traumatic event. It usually resolves within a few weeks to two months.
17. Pulmonary embolism, pancreatitis, or acute kidney failure. Your upper abdomen and chest area is home to a lot of miraculously productive organs. When one malfunctions, you’ll likely feel it.
What to do if you have chest pains
Anytime you experience discomfort in the chest—whether that’s squeezing, tightness, heaviness, pressure, stabbing or radiating pain—and you think you might be having a heart attack, seek care right away.
Your heart is a miraculous organ. Treat it with the care it deserves. Not sure how? Find an expert to help.
About the author
Dr. Scott Ewing, DO, is an interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Fort Worth.