Why chest pain needs immediate medical attention

Chest pain isn’t always related to the heart, but when it is, it’s serious. Chest pain is the most common symptom of a cardiac event, such as a heart attack. People who experience chest pain or discomfort should call 911 right away—and not wait to seek care.

In 2021, the American Heart Association (AHA) and the American College of Cardiology (ACC) updated their guidance to reflect this approach, affirming that chest pain should be considered a medical emergency and be checked out right away.

“Everyone should know the symptoms that can indicate a heart attack and that calling 911 is the most important thing to do to save their life or that of their loved one experiencing chest pain,” said Chair of the guideline writing group Martha Gulati, MD, MS, FACC, FAHA, a professor of cardiology and former academic division chief of the division of cardiology at the University of Arizona in Phoenix, in a news release.

What does it mean to have chest pain?

Chest pain is pain, pressure, tightness, or discomfort that occurs in the chest, though it may not stay there. It can extend to the shoulders, arms, jaw, neck, back, and upper part of the belly.

This pain is the second most common reason adults go to emergency departments (EDs) in the United States. It accounts for more than 6.5 million ED visits each year, plus another 4 million trips to urgent care and other outpatient clinics, according to the AHA. About 5 percent of these visits end up involving an acute heart issue. While that may seem like a relatively small proportion, each of those cases is life-threatening.

During serious heart events such as a heart attack, both men and women can have chest pain. But women are more likely to experience lesser-known symptoms, as well, such as nausea, trouble breathing, or fatigue. Older people may also develop some less-obvious warning signs of a heart event, such as trouble breathing, fainting, unexplained falls, or confusion.

Studies suggest that women and nonwhite people may wait longer to be seen by physicians after presenting with chest pain. While the ACC/AHA guidelines provide recommendations for more equitable care, it’s critical for both HCPs and patients to recognize chest pain and other less-common symptoms of heart problems.

Evaluating chest pain

Chest pain can be a challenge for healthcare providers (HCPs) to sort through. So, when a person visits an ED with chest pain, it’s important for HCPs to first identify a potential heart emergency. These may include:

• Heart attack due to coronary artery disease
• Aortic dissection, a spontaneous tear in the lining of the body’s main artery
• Pulmonary embolism, a blood clot in the lung
• A ruptured esophagus, a tear in the tube between the throat and the stomach

Testing can help determine whether a person needs hospitalization, or if they’re at intermediate or low risk for a heart event. If they’re not in danger, they can make an informed decision with an emergency medical provider on the next steps—additional heart tests or follow-up care with their own HCP.

“Often, patients have additional concerns because they fear a heart attack or other severe cardiac event, which is understandable. However, we have advanced tools that help us determine whether a cardiac emergency or severe heart event is likely or not,” Gulati explains.

Bottom line: Chest pain is always an emergency symptom, and it’s critical to have it evaluated by a medical professional. Even if the root issue turns out to be acid reflux, anxiety, a muscle pull, or another common cause of chest pain, it’s better to be safe.