Chest pain and coronary artery disease
Some chest pain does not come from the heart, but some needs emergency help. This page explains the difference between sudden, lasting pain and pain that comes with effort and eases with rest, and describes the usual assessment and treatment of angina.
Know this first
Sudden, lasting chest pain does not wait. The UK’s National Health Service (NHS) says that if you have pain that started suddenly and does not go away, that feels like squeezing, pressure, burning or indigestion, or that spreads to the arm, neck, jaw, shoulder, stomach or back, or that comes with sweating, nausea, dizziness or shortness of breath, call 115 (the emergency number in Iran). If you are outside Iran, call your local emergency number. Do not book an appointment and do not drive yourself.
These signs may mean a heart attack. The rest of this page is for when you are not in an emergency and want to understand chest pain.
Where does chest pain come from?
The NHS also lists several causes that are not the heart: heartburn and indigestion (pain after meals, sour taste), a pulled chest muscle (after a knock or exercise, worse with a deep breath), anxiety and panic attacks (sharp pain linked to stress), a chest infection (pain on breathing, fever and phlegm) and shingles. There are heart causes too: angina, a heart attack and inflammation of the lining of the heart. The NHS advises against diagnosing yourself. Pain that feels like indigestion, or comes with sweating and a racing heart, may come from the heart, so do not put it down to your stomach or to anxiety.
One more cause is less well known: a blood clot in the lung. If chest pain gets worse with a deep breath, comes with sudden shortness of breath or coughing up blood, or appears a few days after leg swelling and pain on one side, call 115 (the emergency number in Iran) straight away.
Angina: when the heart does not get enough blood
Angina is pain or pressure in the chest that, the NHS says, may spread to the neck, shoulder, jaw or arm and may come with shortness of breath, dizziness or nausea. Common triggers are physical effort, stress, excitement and cold weather. An attack usually lasts less than ten minutes and eases with rest or with the medicine a doctor has prescribed.
The usual cause is coronary artery disease: fatty deposits build up in the walls of the heart arteries and narrow the path for blood. The NHS lists these risk factors: age (men 45 or over, women 55 or over), smoking, high blood pressure and high cholesterol, being overweight, diabetes, kidney disease and a family history of heart disease.
If a doctor has already told you that you have angina, follow that doctor’s instructions. If the pain does not ease with rest and your prescribed medicine, the NHS says to call the emergency services: 115 in Iran. If attacks become worse, more frequent or longer, or come at rest, see a doctor or go to the emergency department the same day.
Assessment
A careful history is usually the first step: where the pain is, what brings it on, how long it lasts and what eases it. Then comes an examination, blood pressure and an ECG. For angina the NHS also names blood tests and imaging (angiogram, CT or MRI).
Which tests you need depends on your history and examination. Not everyone needs every test.
Treatment
Treatment is chosen according to the cause and how severe it is. For angina the NHS names several groups: medicine to stop an attack, medicine to prevent attacks, medicines that lower the risk of a heart attack or stroke, and, for some patients, opening or bypassing the narrowed artery (angioplasty or bypass). Only your treating doctor decides the medicine and the amount. Do not start, stop or change a medicine on your own.
Alongside treatment, the NHS recommends: stopping smoking, a healthy weight, a balanced diet, activity within your ability, and always carrying your prescribed medicine.
The heart and the leg veins
The heart arteries and the leg veins belong to the same circulation and share some risk factors, such as smoking and being overweight. Varicose veins on their own are not a sign of heart disease, but leg swelling sometimes comes from the heart. If you have both chest pain and a leg problem, mention both at the examination.
When to get urgent help
- Sudden, lasting pain that is pressing, burning or like indigestion
- Pain that spreads to the arm, neck, jaw, stomach or back
- Pain with sweating, nausea, dizziness or shortness of breath
- Pale skin, or lips and skin turning blue or grey
- Chest pain with a racing heart or fainting
For any of these: 115 (the emergency number in Iran), and do not drive yourself. If you are outside Iran, call your local emergency number. If someone does not respond and is not breathing, the NHS says to start CPR. Ask the emergency operator for guidance too.
Frequently asked questions
Does every chest pain mean a heart problem?
No. The NHS also lists other causes such as heartburn, a pulled chest muscle, anxiety and panic attacks, a chest infection and shingles. But the pain alone cannot tell you for certain. If it is sudden and lasting, or comes with sweating, nausea, dizziness or shortness of breath, call 115 (the emergency number in Iran) straight away. If you are outside Iran, call your local emergency number.
My chest pain comes and goes. Should I be worried?
The NHS says that chest pain that comes and goes should be checked by a doctor even if it passes quickly. So see a doctor the same day. If the pain comes back and stays, or comes with sweating, nausea, dizziness or shortness of breath, call 115 (the emergency number in Iran; outside Iran, your local emergency number).
Is angina the same as a heart attack?
No, but the symptoms are similar. Angina happens when the heart does not get enough blood, usually because the heart arteries have narrowed. The NHS says an angina attack usually lasts less than ten minutes and settles with rest or a prescribed medicine. Pain that carries on may be a heart attack: call 115 (the emergency number in Iran; outside Iran, your local emergency number).
What tests are done to check the heart?
For suspected angina the NHS lists an ECG, blood tests and, if needed, imaging such as an angiogram or CT scan. Which of these you need is decided by the doctor after your history and examination.
Talk through your concern with a specialist.
Go to the booking page or talk to support. If you have a warning sign, do not wait for an appointment.