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How to tell whether your chest pain is — or isn’t — an emergency


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Chest pain can signal something serious, and it’s often an emergency. But discomfort in your chest area can also be a sign of a minor annoyance. That means that when you notice it, you may be uncertain about whom to call or what to do.

Experts agree that in the moment, it’s key to take the right action without hesitation, erring on the side of caution. Here are the most common causes of chest pain and guidance on when to seek help as soon as possible and when you can wait.

Simple or serious?

Chest pain is one of the most common reasons people go to an emergency department or a doctor’s office, says Martha Gulati, a cardiologist and president-elect of the American Society for Preventive Cardiology.

Discomfort in your chest is sometimes a result of gas, heartburn, inflammation in your rib cartilage or anxiety. But it’s important to be aware of the serious and even deadly problems that also can cause pain.

Women can have heart attacks without chest pain. That leads to dangerous delays.

For instance, the risk of a heart attack — a blockage in any artery that delivers blood and oxygen to your heart — increases with age. An aortic dissection, which is a tear along the vessel that delivers blood to the rest of your body, causes chest pain, too. The pain can sometimes be a warning sign of a lung blood clot called a pulmonary embolism, or even a rupture of the esophagus, the tube that connects your throat to your stomach. Each one of these problems is an emergency.

What doctors refer to as chest pain is generally centered in the chest area but can include other sensations and even extend to other areas of your body. The American Heart Association guidelines for diagnosing and treating chest pain list “pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw” as potentially serious symptoms. Another sign of a possible emergency is chest discomfort plus fatigue or shortness of breath.

Your symptoms can help you determine whether you need help immediately. And there are a few key factors to consider when you’re deciding what to do.

When to consult your doctor

If you’ve already been diagnosed with a condition such as angina, you may have discomfort that hasn’t changed significantly and that your doctor has already assessed. You also may have a chronic problem that’s getting worse but only gradually. Maybe you’ve already talked to your doctor about the heartburn you get after eating, but lately you’ve noticed it’s more severe and more frequent.

In such cases, you should consult a doctor as soon as possible, but not necessarily in an emergency room. “If it’s a symptom you’ve had in the past, and it feels similar and it has already been evaluated, that’s when a non-urgent evaluation would be appropriate,” says Michael Nanna, an interventional cardiologist and an assistant professor at the Yale School of Medicine.

When to call 911

Acute chest pain, or sudden discomfort you haven’t experienced before, always warrants emergency care. When in doubt, call 911.

Don’t research your symptoms online or call your doctor’s office when you have such chest pain, Nanna says. Your medical provider will probably send you to the emergency department anyway, because it’s not possible to diagnose a serious problem over the phone.

“I always suggest the patient be evaluated as soon as possible, because there’s no way for a patient to be able to differentiate a heart attack from reflux,” Nanna says.

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For potentially serious causes, quick treatment can be critical to survival. That’s one reason it’s best not to drive or get a ride to a hospital if you have acute chest pain. If you call 911, paramedics can begin administering necessary medication in the ambulance, and a team will be ready for you when you arrive at the hospital.

If a serious cause is ruled out, Nanna says your provider will work with you to manage whatever is causing your chest pain and discuss ways to prevent future problems. Either way, never be embarrassed about a false alarm.

“Yes, for the majority of people, it will not be cardiac or life-threatening, but we don’t want to miss anyone,” Gulati says. “We can joke about it later being reflux or gas, but I would rather you be around to joke about it.”

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