What should I do with chest pain?

The following are concerning signs that require you to call the emergency services for an ambulance – chest pain that:

• causes the chest to feel heavy, with pressing or crushing pain
• comes on suddenly
• continues for at least 15 minutes
• spreads to the arm, back, neck or jaw
• is also causing difficulty in breathing or feeling short of breath
• is causing other symptoms such as nausea, sweating or coughing up blood

Risk factors for an MI include:

• obesity
• smoking
• high blood pressure
• high cholesterol
• diabetes

Men over 45 and women over 55 are generally at greater risk than those who are younger. If any of these are present alongside symptoms, suspicion of an MI is increased.

Diabetes can sometimes cause a “silent MI”, so if you are diabetic and have a mild version of any of these symptoms, have a low threshold for seeking urgent medical attention.

If the person experiencing chest pain is conscious, have them sit on the floor, a sturdy chair, or a bed, and reassure them that you’re there to help. Stay with them and call the emergency services, where they will ask about your location and symptoms and provide a reference for you to call them back if the situation changes.

If you think an MI is possible and you have aspirin on hand, give them a 325 mg regular tablet to chew and swallow. This helps keep the blood flowing in the heart vessels.

If unconscious, lay them on the floor or a bed and call 911. The call handler will talk you through the next steps, which include giving chest compressions or cardio-pulmonary resuscitation (CPR) if there is no pulse or they are not breathing and if you feel confident.

You do not have to give mouth-to-mouth if you don’t feel confident or there’s no mouthpiece on hand, but CPR can save a life. Press hard on the center of their chest – put the heel of one hand on their breast bone, in the center of their chest, and the heel of the other hand on top, arms straight and leaning over the patient. Press rapidly, less than a second per press, and allow the chest to come fully up.

Depending on where you are, there may be a defibrillator nearby, where the call handler may ask you to put stickers on the patient’s chest and turn it on, as using this may save their life, depending on what the machine finds.

Do not try to give any medications by mouth if they are unconscious.

An MI means that one of the blood vessels to the heart is blocked, depriving the heart muscle of oxygen. These vessels sometimes get temporarily blocked or restricted in a condition called angina, which can give similar symptoms of chest pain, shortness of breath, and feeling sick and sweaty. This often occurs during physical activity or emotional stress – the key difference is that this improves with rest. If you’ve had an episode of this, even if it improved, you should see your doctor or go to the Emergency Department with urgency. If you get this repeatedly, keep regular aspirin nearby and call an ambulance if the pain is not resolving after 15 minutes or if it occurs at rest. Tell your doctor if you’re getting more frequent attacks or if it happens at rest.

An MI and angina are causes for concern. Other conditions can mimic these symptoms, such as heartburn or gastroesophageal reflux disease (GERD); panic attacks; a pulled or strained muscle in your chest wall or a painful inflammatory condition called costochondritis; lung conditions such as pneumonia or pleurisy; an inflammatory heart condition called pericarditis; a pulmonary embolism where a blood clot blocks a blood vessel to the lung; shingles, which can cause nerve pain across a part of the chest; aortic dissection, which is an emergency where a major blood vessel develops a leak; or problems with the stomach such as ulcers, gastritis or gall bladder inflammation.

Any of these are reasons to see your doctor or the Emergency Department, depending on the severity of your symptoms, your risk factors, and your level of concern.