When Is Chest Pain an Emergency?

Knowing When It's Time to Call 911

As almost anyone knows, 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 that demands immediate attention.

Knowing whether it is reasonable to "ride out" the symptoms is a complex one. On the one hand, a wrong decision can lead to unnecessary expense and inconvenience. On the other, a wrong decision can lead to permanent disability or death.

Variations in What Pain Means

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 percent of heart attacks are accompanied by symptoms so trivial that the person doesn't even recognize them (referred to a silent heart attack).

There are some general guidelines that may be useful for deciding when a 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.

9 Signs of a Medical Emergency

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

  1. 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). 
  2. You have a strong family history of early heart disease.
  3. The pain is accompanied by chest tightness, squeezing, heaviness, or a crushing sensation.
  4. The pain is accompanied by weakness, nausea, shortness of breath, sweating, dizziness, or fainting.
  5. The pain radiates to the shoulders, arms, or jaw.
  6. The pain is more severe than any you've had before.
  7. The pain is unlike anything you've experienced before.
  8. The pain is accompanied by a sense of impending doom.
  9. The pain gets continually 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.

In fact, it is not all that unusual for other conditions to trigger symptoms that mimic a heart attack.

Severe heartburn is one such condition commonly be mistaken for a heart attack. A sudden bout of gastric inflammation can press on the phrenic nerve of the diaphragm and trigger severe shooting pains in the left arm similar to a heart attack.

Left-sided chest pain, profuse sweating, shortness of breath, and rapid heart rate (tachycardia) are also a common features of a panic attack.

This shouldn't suggest that you dismiss the pain even if it has happened before. Certainly, if the pain is severe, persistent, or worsening, you should seek immediate medical attention.

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 doctor, 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 doctor 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 doctor 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 (ASC) 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 doctors may also want additional studies to help pin down the diagnosis, including an echocardiogram, thallium scan, CT scan, or cardiac catheterization

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

Chronic, Recurrent, or Non-Acute Symptoms

If your chest pain is something you've had before, your doctor'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 doctor 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 endoscopypulmonary function tests, and other tests to point the doctor in the direction of the likely cause.

What Right-Sided Chest Pain Means
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Article Sources
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