Chest Pain Quiz

More than 6 million Americans visit an emergency room each year due to chest pain. While chest pain can be a sign of a heart attack, it is also a symptom of a host of other conditions.

About half of all cases of chest pain are non-cardiac, that is, not related to the heart. The most common non-cardiac cause of chest pain is from gastroesophageal disorders (disorders of the digestive tract), such as gastroesophageal reflux disease (GERD). Chest pain can also come from problems in organs in the chest (heart, lungs, or esophagus), the chest wall (skin, muscle, or bone), or other parts of the chest itself (ribs, nerves). In some cases organs close to the chest, such as the stomach or gallbladder can cause pain in the chest. Chest pain may also be a symptom of anxiety disorders.

Pain on only one side of the chest is less likely to be related to heart malfunction. When an area of pain on the chest can be pinpointed, it is usually not caused by poor blood supply to the heart (cardiac ischemia).

Cardiac ischemia usually causes discomfort rather than outright pain. This discomfort may be described as an ache, tightness, pressure, squeezing, constriction, strangling, burning, heartburn, fullness in the chest, a band-like sensation, a knot in the center of the chest, like a heavy weight on the chest, or like a bra that is fitted too tightly. When a patient cannot adequately describe their chest discomfort and they place a clenched fist in the center of the chest, this is called the "Levine sign," and can be helpful to doctors trying to diagnose ischemic chest pain.

Angina is a type of chest pain that is caused by lack of blood flow and oxygen to the heart. Angina feels like a squeezing, tightness, or pressure in the chest. The pain or discomfort may also radiate to the shoulders, arms, back, neck, and even the jaw.

Angina in women may have additional symptoms such as nausea, vomiting, shortness of breath, abdominal pain, or sharp chest pain.

Angina itself if not a disease, but rather, a symptom of underlying heart disease, usually coronary heart disease (CHD).

Symptoms of anxiety disorders can include chest pain. Many patients with generalized anxiety disorder (GAD) experience chest pain or palpitations. During a panic attack, for example, patients may experience sharp chest pains, often due to contractions of the muscles of the chest wall. Other symptoms such as shortness of breath, abdominal pain, or headache may accompany the chest pain.

Because the chest pain caused by anxiety or a panic attack may resemble that of heart disease, it is important to see a doctor for a diagnosis.

Like anxiety, stress can also cause chest pain. Stress can affect just about any part of the body and can be a factor in heart attacks, stroke, high blood pressure, anxiety, and depression, as well as immune function. If you have any kind of pre-existing medical condition, stress can make the symptoms worse.

Chest pain or rapid heartbeat can be signs of stress, but they can also be signs of heart problems. See a doctor for any undiagnosed chest pain. If the diagnosis is stress, your doctor can help recommend stress management techniques.

The most common symptom of a heart attack in men and women is chest pain or discomfort; however, some people have few symptoms and may not even be aware they are having (or have had) a heart attack. Diabetics may have mild to no symptoms because they don't have the same nerve responses as people with normal blood sugar. Other symptoms of heart attack include pain in the upper body (arms, back, shoulders, neck, jaw, or upper abdomen), and shortness of breath.

More subtle symptoms of a heart attack include breaking out in a cold sweat, unusual fatigue, nausea and vomiting, and lightheadedness.

Heart attack symptoms vary from person to person. While some heart attacks can come on suddenly and painfully, they can also begin slowly, with only mild chest discomfort. Symptoms may last a few minutes, then go away and come back.

Not all chest pain is related to heart problems. As discussed in the first slide, about half of all cases of chest pain are non-cardiac, that is, not related to the heart. Non-cardiac chest pain often presents differently and feels slightly different than cardiac chest pain. Some signs your chest pain may not be caused by your heart include:
- Pinpoint pain (you can point to a specific spot where the pain is located)
- Antacids relieve your pain
- The pain gets worse when you take a deep breath
- The pain arises from moving or pressing a specific part of the chest, neck, or shoulder
- The pain lasts just a few seconds

If you have chest pain and are unsure of the cause, see a doctor to rule out possible heart problems.

If you have chest pain and think you are having a heart attack, seek emergency care and call 911 immediately. Don't drive yourself to the emergency room, and don't wait to see if the chest pain passes.

American Heart Association heart attack warning signs include:
- Chest pain or discomfort (pressure, squeezing, fullness) – may last for a few minutes, or may go away and come back
- Pain or discomfort in the arms, back, neck, jaw or stomach
- Shortness of breath – with or without chest pain
- Sweating, cold sweat
- Nausea or vomiting
- Lightheadedness