Heart Health
Every chest pain deserves an ECG, but many turn out to be muscular, digestive or anxiety-related. Understanding the patterns helps — without becoming a substitute for assessment.
The purpose of this article is to reduce anxiety after assessment, not to help you avoid assessment. An ECG takes two minutes and costs very little, and no pattern of symptoms is reliable enough to exclude cardiac pain on its own — particularly in diabetics, women and people over 45.
With that said, once cardiac causes have been excluded, it helps to understand what else produces chest pain, because uncertainty itself becomes a source of distress.
The commonest non-cardiac cause. Pain from the chest wall muscles, ribs or costal cartilage is typically sharp, well localised to a spot you can point at with one finger, reproducible when you press on that spot, and worse with certain movements, twisting or deep breathing. It often follows unaccustomed lifting, coughing or an awkward sleeping position.
Reflux produces burning behind the breastbone, often rising towards the throat, with an acid or bitter taste. It is worse lying flat or bending forward, worse after large, spicy or oily meals and late-night eating, and often eases with antacids.
The overlap with cardiac pain is genuine and is a common source of dangerous misdiagnosis in both directions. Response to an antacid does not exclude a heart problem — some cardiac pain settles temporarily too.
Panic attacks are genuinely distressing and are not imaginary. They are also very treatable, and the treatment works better than repeated cardiac testing.
Doctors are trying to establish a pattern, so specific detail helps enormously. Say where exactly it is and whether you can point to it with one finger; what it feels like — burning, pressing, sharp, tearing; whether it moves anywhere; what brings it on and what relieves it; how long each episode lasts; and what else happens with it — sweating, breathlessness, nausea, palpitations.
'Chest pain since two days' tells us very little. 'Heaviness in the centre of the chest that comes when I walk uphill, lasts five minutes, goes when I stop, and makes me sweat' tells us a great deal — and that particular description would take you straight to the cath lab conversation.
This article is general health education written and reviewed by the Department of Cardiology at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
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