Chest pain has two very different answers. One settles with an antacid and a week of rest; the other is a heart attack measured in minutes. Nothing you can feel at home reliably tells them apart — not how sharp it is, not whether it moved, not how long it has lasted. So the first decision is not what the pain is. It is whether to treat it as the serious one until someone who can test that says otherwise.

Stop reading and get help if

Pressure, heaviness, tightness or squeezing in the centre of the chest — the kind that makes you stop what you are doing.
Pain that has spread to the arm, both arms, the jaw, the neck, the back or the upper stomach.
Chest discomfort with breathlessness, cold sweat, nausea, lightheadedness, or a feeling of impending collapse.
Pain that came on with effort and has not eased after several minutes of sitting still.
Any chest pain in someone with known heart disease, diabetes, high blood pressure, or a previous heart attack or stent.
A sudden tearing pain in the chest or back, or chest pain after a blow to the chest.

Call the emergency number in the header of this page, or dial 112, and say chest pain. Do not decide to sleep it off, and do not let anyone talk you out of calling because it might turn out to be nothing. Coming in for nothing is a normal and accepted outcome of an emergency service; the reverse is not recoverable.

While you wait

Stop moving. Sit down, unsupported if you need to, and stay sitting. Whatever the pain is, an effort-made chest pain should not be tested further.
Do not drive yourself, and do not be driven by a relative. An ambulance has a clinician, oxygen and a monitor in it; a family car has none of those, and if you collapse on the way the people in the car cannot help you.
Unlock the front door or send somebody to wait outside for the paramedics, and put the phone down where they can find it.
Take only what a doctor has already prescribed for exactly this situation. Do not take somebody else’s tablets, and do not take a dose “just in case” — including aspirin, if a clinician has told you to avoid it, if you have had a reaction to it, or if you are vomiting blood.
Nothing to eat or drink, including tea or coffee. If you need a procedure, a full stomach is a complication.
Gather the medicine strips and any reports in one bag and hand them over at the door. For a cardiac patient the list of what they already take is part of the treatment.

What casualty does with a chest pain

A chest pain is not put in the waiting queue. The first two things are an ECG — a ten-second tracing of the heart’s electrical activity, done at the bedside rather than in a room down the corridor — and a blood sample taken in the building. A troponin result, the test that shows whether heart muscle has been injured, is what allows a doctor to say either “this is not a heart attack” or “this is, and here is what we are doing”. A second sample some hours later is normal and is not a sign that something has gone wrong; it is how the trend is read. Monitoring, medicines and the decision about admission follow from those results rather than from how the patient looks at the door.

Cardiac causes are the ones everyone fears, and they are not the only ones. A collapsed lung, a pulmonary clot, a torn vessel, pneumonia, severe reflux, a musculoskeletal pain and anxiety can all present as chest discomfort — and several of them are equally time-critical. That is the honest reason a triage nurse will ask you to stay rather than go home when the ECG looks ordinary.

Pain that settled is still a pain that needs a name

The chest pain that went away after ten minutes of rest is the one people forgive themselves for, and it is worth being seen again this week — the emergency and casualty department is open around the clock, and the appointment desk can book a day visit when the pain is not current. Pain brought on by effort and relieved by rest is the body describing a narrowed artery, and the difference between an outpatient visit about it and a midnight ambulance ride is the visit.

Published by R.R. Healthcare as general patient information. It is not advice about your own condition, and it cannot replace being examined — see the medical disclaimer. To be seen: book a consultation or contact the hospital.