Is Your Chest Pain a Sign of a Heart Attack or Something Else?

Chest pain can be a frightening symptom, and it can be difficult to know whether it’s something serious such as a heart attack or a more benign issue. Whether you’re feeling tightness, discomfort, or sharp pain, it's essential to understand the underlying causes — some of which may be life-threatening.

One of the most alarming causes of chest pain is a heart attack. This occurs when the blood flow to part of the heart muscle is blocked, typically by a buildup of plaque in the coronary arteries. The common and well-known symptoms of a heart attack include severe chest pain, pressure or tightness in the chest, and difficulty breathing. But there are also other warning signs that are often overlooked.

Jonathan Fialkow, M.D., cardiologist, chief medical executive of Integrated Services and Precision Care, and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute, points out: “Some of the symptoms that people in general develop with heart attacks include chest pain, chest pressure or tightness. But in addition to that, women may also experience some other less obvious symptoms, like shortness of breath or nausea, which can sometimes be mistaken for something else.”

Women, in particular, may experience more subtle heart attack symptoms compared to men. While men are more likely to experience the typical chest pain, women are more likely to have a heart attack without chest pain. And their symptoms may often be dismissed or misinterpreted. “Women in general are very quick to dismiss their symptoms as being concerning, sometimes even at the expense of their own health,” explains Dr. Fialkow. “They say: ‘Oh, it's nothing. It'll go away.’”

Chest pain or discomfort might not be the only warning to seek immediate medical attention. Difficulty breathing — feeling like you've just climbed several flights of stairs when you haven’t — should never be ignored. This can signal a heart-related issue.

Pericarditis: A Less Common, But Serious Condition

Another possible cause of chest pain is pericarditis, which is inflammation of the lining around the heart. While pericarditis can mimic a heart attack, the pain tends to be sharper and may worsen with deep breaths or lying down. It’s often more localized, unlike the generalized chest pressure experienced during a heart attack.

“There are concerning causes of chest pain like heart attacks, pericarditis, aortic syndrome, and other forms of chest pain which may not be cardiac-related, such as GI (gastrointestinal)-related conditions and musculoskeletal causes," said Andrea Vitello, M.D., cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

Though pericarditis itself is not always as dangerous as a heart attack, it requires medical treatment to reduce inflammation and prevent further complications.

Aortic Syndromes: Life-Threatening Tears in Blood Vessels

Aortic syndromes, particularly a dissecting aortic aneurysm, represent another dangerous cause of chest pain. This condition involves a tear in the aorta, the body's largest blood vessel. Aortic dissection can lead to severe internal bleeding and is often fatal if not treated immediately. The pain from an aortic dissection is typically described as a sudden, sharp pain that radiates from the chest to the back. It’s critical to seek emergency care if you suspect an aortic tear.

Dr. Vitello emphasizes the seriousness of this condition: “Aortic syndromes, where there may be a life-threatening tear in the aorta, require immediate medical intervention. It’s a very large blood vessel, and any damage to it is a medical emergency.”

Gastrointestinal Causes: Less Dangerous, But Still Troubling

Not all chest pain signals a heart-related issue. In fact, some of the most common causes of chest discomfort are gastrointestinal. Acid reflux (GERD) or an esophageal spasm can cause a sensation of burning or pressure in the chest that may resemble heart attack symptoms. Although these conditions are not life-threatening, they should still be addressed, as chronic acid reflux can lead to other complications like esophageal ulcers or difficulty swallowing.

Anxiety and Panic Attacks: Often Misinterpreted, But Still Worth Attention

Sometimes chest pain may be linked to anxiety or panic attacks, especially when all other physical causes have been ruled out. In these cases, the chest pain is typically accompanied by a sense of dread, rapid breathing, and a racing heart. While anxiety is not a life-threatening condition, it's important to get a full evaluation to rule out serious causes of chest pain.

Dr. Vitello explains that anxiety is something that needs to be considered after other, more serious causes have been excluded: “There are other symptoms that can mimic a heart attack, but these are more of a diagnosis of exclusion once everything else has been more completely evaluated.”

When to Seek Help: Trust Your Instincts

If you experience severe chest pain, especially if it's accompanied by shortness of breath, nausea, dizziness, or pain radiating down your arm, these are clear signs that you should seek immediate medical attention, as they may indicate a heart attack or another life-threatening condition.

While less urgent causes like acid reflux or anxiety should still be addressed, delaying care in the event of a potential heart attack can have serious consequences. Women, in particular, are advised to pay close attention to unusual symptoms.

Dr. Fialkow warns: “Women tend not to think of themselves as at risk for coronary artery disease and heart attacks, which leads to delays in seeking care. Roughly 24 percent of women in emergency rooms with chest pain are found to have coronary artery disease.”

Chest pain can be caused by a wide range of issues, some of which may not be serious and others that require immediate attention. While conditions like heart attacks and aortic syndromes are clearly life-threatening, it’s essential to take all chest pain seriously until your primary care physician or cardiologist can rule out more dangerous causes.

If in doubt, don’t hesitate to seek medical care. Doctors say to trust your instincts, and don’t ignore symptoms that could point to a heart issue, especially if you're experiencing them for the first time.

Jonathan Fialkow, M.D., cardiologist, chief medical executive of Integrated Services and Precision Care, and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute.

 

 

Andrea Vitello, M.D., cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

Do You Know Your Coronary Calcium Score?  As part of Heart Month this February, many Baptist Health diagnostic imaging locations will be participating in our heart scan promotion. You may be eligible for a CT calcium scoring if you are 40-75 years old and meet certain cardiac risk factors. To learn more and request an appointment visit BaptistHealth.net/HeartScan.