Call 000 now if
- The pain is severe, crushing or pressing, lasts more than 10 minutes, or comes with sweating, nausea, breathlessness or light-headedness
- It spreads to the arm, jaw, neck or back
- It comes on at rest, or wakes you from sleep, and you have known heart disease or several risk factors
Paramedics can record an ECG in your home and start treatment on the way. A heart attack is treated by opening the artery, and every hour of delay costs heart muscle.
See a cardiologist within days to weeks if
- Pain or tightness comes on with exertion, such as walking uphill or hurrying, and settles within minutes of resting. This is the classic pattern of angina.
- Breathlessness on exertion is new or worsening, even without pain
- Chest pain comes with palpitations, fainting or near-fainting
- You have chest pain and diabetes, high cholesterol, high blood pressure, a smoking history, or a parent or sibling who had heart disease before 60
Your GP can arrange an urgent referral; Adelaide Specialist Clinic triages referrals on the day they arrive, and we will call to arrange an early appointment when the referral describes exertional symptoms.
Pain that is usually not the heart
Sharp pain that lasts a second or two, pain you can point to with one finger, pain that is worse when you press on the chest or twist, and pain that changes with breathing or position are more often from the chest wall, the lungs' lining or the oesophagus. Burning pain after meals or when lying flat is usually reflux. These still deserve a GP visit, but rarely a cardiologist.
What the cardiologist will do
Take a careful history, examine you, record an ECG and, depending on the pattern, arrange a CT coronary angiogram, a bulk-billed echocardiogram or a stress echocardiogram. For most people with new chest pain the CT is the most useful test because it shows whether plaque is present at all. Sharp chest pain after a viral illness in a younger person is more often pericarditis or myocarditis, where cardiac MRI rather than CT makes the diagnosis. Many patients leave the follow-up visit reassured; those with plaque leave with a treatment plan that substantially lowers their risk.
Women and chest pain
Women more often present with breathlessness, fatigue, jaw or back discomfort and nausea rather than classic central chest pain, and are more likely to have their symptoms attributed to something else. If exertion reliably brings on any of these symptoms, ask for a cardiology assessment.