Many kinds of health problems can cause chest discomfort, with symptoms so intense that you rush to the hospital. “I see older adults with chest pain or something related to it every time I work in the emergency department,” says Dr. Kei Ouchi, an emergency medicine physician at Harvard-affiliated Brigham and Women’s Hospital.
The big fear
You may worry that chest pain is due to a heart attack, which occurs when blood flow to the heart is blocked, typically by a blood clot and narrowed arteries. Classic symptoms include pressure or squeezing in the chest, lightheadedness, and pain in the shoulder, arm, neck, jaw, or back.
However, Dr. Ouchi points out that the heart attack symptoms he sees most often in older adults do not fit that standard list. “Older adults with other medical conditions, like diabetes, might not get classic, crushing chest pain with a heart attack. They often have nausea, vomiting, shortness of breath, or fatigue that’s new and other-wise unexplained,” he says.
Other causes
Beyond a heart attack, chest pain may stem from a number of conditions. Here are some of the most common.
Stable angina.
This occurs when clogged arteries slowly reduce the amount of oxygen-rich blood reaching your heart. It causes pain similar to a heart attack, but doesn’t cause the death of heart muscle cells. “Angina is more common than actual heart attacks and can progress over months,” says Dr. Ouchi. Indeed, increasing angina may signal an impending heart attack.
Pericarditis.
An infection, injury, cancer treatment, or medication reaction may inflame the pericardium (the protective sac around your heart). Pain is typically sharp and stabbing, located in the center or left side of your chest. It worsens when you take a deep breath or lie down.
Heartburn.
Sometimes stomach acid can back up into your esophagus, the tube connecting your mouth and stomach. Symptoms can include a fiery, tingly, tight, or stabbing pain in your chest; nausea; a sour taste in your mouth; a sore throat; and coughing.
Pulmonary embolism.
This is a blood clot that forms somewhere in your body (like a vein in your leg) and travels to a lung. It can be deadly.
Symptoms include chest pain or discomfort that worsens on taking in a deep breath, difficulty breathing, coughing up blood, a fast heart rate, sudden lightheadedness, or fainting.
Other lung problems.
Sharp, stabbing chest pain may occur in your lungs if you have pneumonia, bronchitis, asthma, or pneumothorax (a hole in the lung tissue that sends air between the chest wall and lungs; the condition is common in smokers).
Panic attack.
Sharp chest pain (along with shortness of breath, palpitations, and dizziness) can occur if you experience a sudden wave of anxiety. It usually doesn’t last long.
Costochondritis.
An overuse injury from sports or heavy lifting may inflame the chest wall between your ribs and the breastbone. The result: a stabbing chest pain. It goes away with time and rest.
Get specific about your symptoms
To help your doctor diagnose chest pain, be able to answer the following questions:
- When did the pain start, and how long did it last?
- Have you had pain like this before?
- Did anything seem to bring on the pain (such as physical exertion or anger), and did anything relieve the pain?
- Along with the pain, did you have lightheadedness, nausea, shortness of breath, or sudden sweating?
- What did the pain feel like: sharp and stabbing? squeezing? pressure? burning?
- Where did you feel the pain: in the middle of your chest? on one side?
Did the pain travel anywhere, like into your neck, arm, or back?
When to seek help
When chest pain is sudden and severe, call 911. “It’s the right thing to do,” Dr. Ouchi says. “Even if you call your doctor’s office and report sudden pain, they’ll tell you to go to the emergency department.”
But you don’t always have to call 911 if you’re experiencing chest pain. “If it’s been going on for months, it’s probably okay to be evaluated at your doctor’s office instead of the emergency department,” says Dr. Ouchi. If you’re unsure, he urges that you have your doctor make the decision. “Chest pain is common, and most of the time it’s not a heart attack,” explains Dr. Ouchi. “But we have to make sure it’s not life-threatening.”
