When Is Chest Pain an Emergency?

Knowing When It's Time to Call 911

Chest pain is one of those symptoms that should never be ignored. While it’s true that sometimes chest pain can be caused by some pretty benign and inconsequential conditions, it’s also true that chest pain can be your five-alarm signal that something very dire and life-threatening may be happening—something that demands immediate attention.

Knowing whether it is reasonable to "ride out" the symptoms can be difficult. A wrong decision in one direction can lead to unnecessary expense and inconvenience; but a wrong decision in the other direction can lead to permanent disability or death.

What Does Chest Pain Mean?

Chest pain can be caused by a number of different medical conditions, some minor and others serious. Moreover, symptoms of "chest pain" can vary tremendously from person to person and condition to condition. As such, there are no hard and fast rules as to when it's time to call 911.

Sometimes, even a minor chest pain may be a sign of coronary artery disease (CAD). In fact, up to 30% of heart attacks are accompanied by symptoms so trivial that the person doesn't even recognize them (referred to a silent heart attack).

chest pain causes
Illustration by Alexandra Gordon, Verywell 

Clues for Decision-Making

There are some general guidelines that may be useful for deciding when chest pain is serious. But keep in mind that these guidelines are only that—guidelines—and that "better safe than sorry" may be the most appropriate, overriding rule to follow.

Signs of chest pain.

Alex Dos Diaz / Verywell

Signs Chest Pain Is Due to a Dangerous Condition

Chest pain is more likely to represent a dangerous condition—and should be treated as such—if any of the following nine items are true:

  • You are 40 years old or older and have one or more risk factors for CAD (including family history, smoking, obesity, elevated cholesterol, and diabetes).
  • You have a strong family history of early heart disease.
  • The pain is accompanied by chest tightness, squeezing, heaviness, or a crushing sensation.
  • The pain is accompanied by weakness, nausea, shortness of breath, sweating, dizziness, or fainting.
  • The pain radiates to the shoulders, arms, or jaw.
  • The pain is more severe than any you've had before.
  • The pain is unlike anything you've experienced before.
  • The pain is accompanied by a sense of impending doom.
  • The pain progressively worsens over the first 10 to 15 minutes.

Signs That Are Less Serious

Chest pain is less likely to represent a dangerous cardiac event if any of the following are true: 

  • The pain occurs only with specific, reproducible body movement.
  • The pain is momentary or fleeting with no other symptom.
  • You have had identical pain in the past in which a cardiac disorder was ruled out.

Should You Make the Call?

Certainly, if you have any of the signs that your chest pain may be a medical emergency, call 911 or get yourself to an emergency room. But keep in mind that sometimes even mild chest discomfort can represent a serious problem.

If your chest pain just seems unusual, or is disturbing to you in any way, you should get yourself checked out. Even if you are sure it is benign, at the very least you should let your healthcare provider know about your symptoms. 

Evaluating Chest Pain

If you decide you need immediate attention for your chest pain, the safest thing to do is to call 911 and be taken to a nearby emergency room. The responding EMTs or paramedics will be able to do a rapid baseline evaluation and help to stabilize your condition even before you arrive at the hospital

Once you are in front of a healthcare provider, the first evaluation will typically be to determine whether the chest pain is acute (arising suddenly and rapidly) and chronic (occurring over the long term).

Acute Onset of Symptoms

If you are being evaluated for acute onset chest pain, the healthcare provider can usually get to the root of your problem quite rapidly by:

This evaluation most often will determine whether you are dealing with a cardiac emergency. If after this initial evaluation the diagnosis is still in doubt, further testing will be needed, depending on which medical conditions seem likely to your healthcare provider at that point.

In an emergency room setting, the first rule of order is to rule out a potentially life-threatening cardiac event, namely acute coronary syndrome (ACS) with or without myocardial infarction (heart attack).

Almost as important is the diagnosis of unstable angina since rapid and aggressive treatment of this condition is also necessary to avoid permanent cardiac damage.

If ACS is suspected, you will probably be admitted to an intensive care unit and medical treatment will be instituted. Your healthcare providers may also want additional studies to help pin down the diagnosis, including an echocardiogram, thallium scan, computerized tomography (CT) scan, or cardiac catheterization.

If a life-threatening cause has been ruled out, most emergency room healthcare providers will then make a presumptive diagnosis and refer you to your own healthcare providers for follow-up evaluation and treatment.

Chronic, Recurrent, or Non-Acute Symptoms

If your chest pain is something you've had before, your healthcare provider's main concern probably will be whether you have angina. Angina is usually caused by typical CAD, but can also be produced by less common cardiac conditions such as coronary artery spasm or cardiac syndrome x.

Depending on the diagnostic clues, a cardiologist may be consulted or you may be referred back to your own healthcare provider for a fuller evaluation.

When something other than angina is thought to be causing your chest pain, a firm diagnosis is needed so that appropriate therapy can be started. Depending on the suspected cause, you may need X-rays, GI endoscopy, pulmonary function tests, and other tests to point the healthcare provider in the direction of the likely cause.

A Word From Verywell

If you have chest pain, the first order of business is to make sure you are not going to die or suffer permanent cardiovascular damage. Accomplishing this goal depends on two things.

First, you yourself need to make an appropriate decision about seeking immediate medical care. (When in doubt, do so.) And second, the healthcare provider needs to perform an expeditious evaluation to make sure there is no ongoing or impending cardiac catastrophe or any other truly life-threatening medical emergency.

Once this is done, assuming that a life-threatening condition has been ruled out, you likely will be referred for an evaluation outside of the emergency room setting.

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8 Sources
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