CARDIAC CHEST PAIN

As I talk to people about heart problems it appears there is confusion about what constitutes “heart” pain or chest pain of cardiac origin.  As a result an impending heart attack may not be recognized by the patient and getting medical help is delayed.    Heart pains also vary from patient to patient making recognition even more difficult for the patient as well as the doctor.  I will try to provide some guidelines to help with this problem.

In general, any kind of chest pains or chest distress should make the patient think about a possible heart problem.  First, if that chest distress comes on with exertion such as climbing stairs, vacuuming, running, cycling, snow shoveling, etc, and then subsides with rest, should certainly raise the question of a cardiac origin of the pain.  Second, the heart is a midline, not a left chest structure, so heart pain will be in the middle of the chest.  The most common description is a dull, heavy, pressing, squeezing type of distress, “like an elephant on my chest.”  Sometimes it is described as an expanding ball of fire.  The pain may radiate up into the neck and jaws, and/or down the left arm.  The presence of sweating, particularly if sitting or lying down, in association with this type of chest pain, is heart in origin until proven otherwise by a physician.  Sharp, stabbing, fleeting, knife-like pains in the left chest beneath the left breast, are rarely an  indication of heart disease.   The most important thing for the patient to do is to maintain a high index of suspicion for possible heart disease and then get medical care if there is any question.  Let the physician sort through the various symptoms that are present.

Summary:   The typical chest pain associated with an impending heart attack is often described as a dull, heavy pain located in the middle of the chest, but there are many variations that only the physician can sort out.  The most important thing for the patient is to think of possible heart disease and get an evaluation.  Sharp, stabbing, fleeting pains in the left chest beneath the breast are rarely heart pains.