Overview

Chest pain and heart attack

Chest discomfort or pain may be a key warning symptom of a heart attack. Heart attack symptoms may include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

Chest discomfort or pain that comes on or gets worse with exercise, stress, or eating a large meal and goes away with rest may also be a heart disease symptom called angina.

If you have any of these symptoms of a heart attack, call 911 or other emergency services now. After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself. Since most of the damage to the heart muscle during a heart attack occurs in the first 6 hours, emergency treatment may prevent damage to the heart muscle and death. For men and women, the most common symptom is chest pain or pressure. Women are somewhat more likely than men to have other symptoms like shortness of breath, tiredness, nausea, and back or jaw pain.

Other causes of chest discomfort or pain

Most people fear that chest pain always means that something is wrong with the heart. This isn't the case. Chest discomfort or pain, especially in people who are younger than age 40, can have many causes.

• Angina (say "ANN-juh-nuh" or "ann-JY-nuh") is a type of chest pain or discomfort that happens when there isn't enough blood flow to the heart muscle. It's a symptom of coronary artery disease, also called heart disease. Angina is called stable angina when you can usually predict when your symptoms will happen. You probably know what things cause your angina. A sudden and unexpected change in your usual pattern of angina means that the blood flow has become more impaired and you could be having a heart attack. This is called unstable angina.
• Pain in the muscles or bones of the chest often occurs when you increase your activities or add exercise to your schedule. This is sometimes called chest wall pain.
• Costochondritis is an inflammation of the joints formed by the cartilage connecting the ribs to the breastbone (sternum). It could be caused by an injury to the chest. But often the reason for the inflammation isn't known.
• Burning chest pain that occurs when you cough may be from an upper respiratory infection caused by a virus.
• Burning chest or rib pain, especially just before a rash appears, may be caused by shingles.
• An injury such as a broken rib or bruised lung can be quite painful. The pain may be worse when you cough or try to take a deep breath.
• Swelling (inflammation) of the thin layers of tissue (pleura) covering the lungs and the chest wall may occur. This is called pleurisy.
• Gastroesophageal reflux disease (GERD) can cause pain just below the breastbone. Many people will say that they have "heartburn." You can usually relieve this pain by taking an antacid or eating.

Other more serious problems that can cause chest pain include:

• An infection, such as pneumonia.
• A collapsed lung (pneumothorax). This usually causes a sharp, stabbing chest pain and occurs with shortness of breath.
• A blood clot in the lung (pulmonary embolism). It usually causes deep chest pain with sudden and extreme shortness of breath.
• Lung cancer. It may cause chest pain, especially if the cancer cells spread to involve the ribs.
• Diseases of the spine. It can cause chest pain if the nerves in the spine are "pinched."

Self-Care

Home treatment is not appropriate for chest pain if the pain occurs with symptoms of a heart attack. If you think a heart attack might be the cause of your symptoms, call 911 or other emergency services now. After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

If you have stable angina, you can probably predict when your symptoms will happen. You probably know what things cause your angina. If you and your doctor have made a home treatment plan, follow that plan. If you are having angina symptoms more often than usual or if they are different or worse than usual, call your doctor right away. If you have angina symptoms that don't go away with rest or aren't getting better within 5 minutes after you take a dose of nitroglycerin, call 911 or other emergency services now.

Home treatment for mild chest pain depends on the cause of the pain. Minor chest pain often improves with home treatment. A visit to your doctor may not be needed. Here are some ways to treat chest wall pain caused by strained muscles or ligaments or a fractured rib at home.

• Get some rest.

  Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.

• Ice the area.

  Cold will reduce pain and swelling. Apply an ice or cold pack right away to prevent or have less swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply warmth to the area that hurts.

• Don't use a bandage.

  Don't wrap or tape your ribs for support. It could cause you to take smaller breaths, which could increase your risk for pneumonia or a partial lung collapse (atelectasis).

• Apply medicine.

  Medicated creams that you put on the skin (topical) may soothe sore muscles.

• Stretch your muscles.

  Gentle stretching and massage may help you get better faster. Stretch slowly to the point just before discomfort starts. Then hold the stretch for 30 to 60 seconds. Do this 3 or 4 times a day. It's even more helpful after the use of heat.

• Return to activity when you're ready.

  As your pain gets better, slowly return to your normal activities. Any increased pain may mean that you need to rest a while longer.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• Increased difficulty breathing.
• Chest discomfort lasts longer than 1 week.
• Symptoms occur more often or are more severe.

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