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Chest Pain: Know When to Call for Help

Cardiologists have a saying: "Time is heart muscle." In other words, the longer you wait to get help for a heart attack, the more damage is done to the heart muscle. "Unlike other muscles, heart muscle does not heal itself. Once it dies, it will never get better," said Leslie Cho, M.D., a cardiologist at Loyola University Health System.

Fortunately, there are "clot-busting" medications that can stop a heart attack in progress. They work best within the first two to six hours of the onset of a heart attack. "We call the first two hours the 'golden hours' because they are our best chance of saving heart muscle and saving a life," Cho said.

Chest pain may be caused by many different things, some life threatening and some not. Whether or not emergency treatment is needed depends on the type and location of pain and accompanying symptoms. People who may be having a heart attack or another life-threatening condition, should not drive or be driven to the hospital. They should call 911 for an ambulance. Here are some guidelines on how to interpret chest pain:

How would you describe
the pain?

The classic symptom of heart attack is a severe feeling of pressure or squeezing in the center of the chest. It is often described as an elephant or a Mack truck sitting on the chest. A burning pain in the lower chest or upper abdomen that comes soon after eating may be a stomach problem.

Where is the pain located?

Heart attack pain usually occurs in the center of the chest and may run down the left arm or up to the jaw. Pain on only one side of the chest that is tender to the touch may be an injury to muscle, ligaments or cartilage in the chest from a severe cough or a sports injury.

Is the pain constant or changing?

If heart attack symptoms remain constant, get worse or go away and come back after several minutes of rest, it is important to get help. Anyone who develops severe chest pain for the first time - even if it goes away after several minutes - should seek emergency medical care.

How does the pain respond to different things?

If the pain worsens when you swallow, bend forward or lie down, or if it goes away after taking an antacid, then heartburn was the likely cause.  

What are the other symptoms?

Difficulty breathing is always an emergency, with or without chest pain. It could indicate a heart attack or another serious problem, so it is important to call an ambulance right away. Shortness of breath, sweating and nausea are symptoms that often accompany a heart attack.

Not everyone feels the classic heart attack symptoms, Cho noted. Some heart attack victims - especially women - may feel back or shoulder pain, nausea, faintness or other vague symptoms instead of chest pain. It is not known why women are more likely to feel atypical symptoms, but it may account for the tendency among women to wait longer before seeking help. "It pays to know the warnings signs of a heart attack, but if you are unsure about your symptoms, get to an emergency department right away. It is better to be safe than sorry," Cho said.

In addition, annual exams from a primary care physician are an important preventive measure to detect heart disease before it becomes life threatening.

Cho sees patients at Loyola University Medical Center in Maywood. For an appointment, call (708) 216-8563.

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