Chest pain: when to see a cardiologist

Overview

Chest pain is one of the most common reasons to see a doctor, and it rightly causes worry because it can be a sign of heart disease. In fact most chest pain does not come from the heart, but only a medical assessment can tell for sure. The practical rule: new, severe pain, or pain that makes you suspect the heart, should not be explained away on your own.

Pain from the heart: how it usually feels

Pain caused by reduced blood flow to the heart muscle (angina, or ischemic chest discomfort) often has these features:

• a sensation of pressure, squeezing, heaviness or burning behind the breastbone, less often a stabbing pain
• it appears when walking, climbing stairs, exerting yourself or under emotion and eases with rest within a few minutes
• it may spread to the arm (especially the left), neck, jaw, back or stomach
• it comes with dyspnea, cold sweats, nausea, sudden fatigue or dizziness

In women, older adults and people with diabetes the signs may be less typical: only fatigue, dyspnea, nausea, or pain in the back or stomach (see myocardial infarction).

Other common causes

• Gastroesophageal reflux and gastritis — burning behind the breastbone after eating or when lying down (see gastroesophageal reflux)
• Muscles and ribs — pain that changes with movement, deep breathing or touch
• Anxiety and panic — often with palpitations, tingling of the fingers, rapid breathing
• Lung infections — pneumonia, pleurisy, often with fever and cough
• Pericarditis — pain that is worse lying down and eases when leaning forward
• Shingles — burning pain on one side of the chest, before the rash appears

Some rare causes are as serious as a heart attack, such as pulmonary embolism (pain with sudden dyspnea) or aortic dissection (very severe, “tearing” pain that goes to the back). These need emergency care.

When it is an emergency and when to see a cardiologist

Emergency (call 127):

• chest pain or pressure lasting more than a few minutes, or coming and going
• pain spreading to the arm, neck, jaw, back or stomach
• pain with cold sweats, nausea, dizziness, fainting or dyspnea

Do not wait, do not drive yourself and do not take medicines without instructions from a doctor or the emergency operator.

See a cardiologist (non-emergency):

• pain that comes and goes, especially with exertion and easing with rest
• pain that passes quickly but worries you
• you have hypertension, diabetes, high cholesterol, smoking or a family history of heart disease

How it is assessed by the cardiologist

• A detailed history: where, when, how long, what triggers it and what relieves it.
• Clinical examination and blood pressure measurement.
• ECG — records the electrical activity of the heart (see ECG or Holter).
• Echocardiography — assesses the heart muscle and valves (see echocardiography).
• Blood tests — lipid profile, glucose, hemoglobin and thyroid function, as needed.
• Further tests are decided by the cardiologist according to how likely the pain is to come from the heart.

A normal resting ECG does not always rule out heart disease, so the doctor weighs the symptoms, risk factors and results together. Our clinic is not an emergency service: when a heart attack is suspected, go to the emergency department.

How to lower the risk

• do not smoke
• keep blood pressure, cholesterol and blood sugar under control
• regular physical activity, according to your ability and your doctor’s advice
• a healthy weight and a diet with more vegetables, fruit and whole grains and less salt
• do not ignore new or worsening symptoms