Is All Chest Pain Serious? How to Know If You Should Go to the ER
Key takeaways:
There are a lot of different causes of chest pain. And many of them are serious and potentially life-threatening.
Certain chest pain symptoms can be more worrisome for a serious condition. But even mild chest pain can be a sign of something life-threatening, like a heart attack.
If you are concerned about chest pain, it is best to go to the nearest emergency room for a medical evaluation. Healthcare providers can run tests to tell if your pain is a sign of something serious.
Chest pain is a common reason people go to the emergency room (ER). When something doesn’t feel right in your chest, it is natural to worry if something is seriously wrong with your heart.
The good news is that most cases of chest pain are not life-threatening. But that doesn’t mean you should wait to see a provider if you are having chest pain. It could be a sign of a serious condition in the heart, lungs, or blood vessels.
So, if you are experiencing chest pain and trying to figure out what to do, here’s some advice.
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Quiz: Should I go to urgent care or the ER?
What are the common causes of chest pain?
There are a lot of different conditions that can cause chest pain. These range from mild and harmless to severe and life-threatening. Let’s go through some of the common causes in both categories.
Causes of chest pain that are an emergency
Conditions affecting the critical organs of the chest — like the heart, lungs, or aorta — can be life-threatening. This includes:
Heart attacks: This is when blockages occur in the coronary arteries. These are the blood vessels that supply blood to the heart muscle.
Heart failure: Thiscan happen when someone’s heart muscle is weak or damaged. It can also occur when the heart valves are not working properly, if there is inflammation in the heart (myocarditis), or when there is fluid around the heart (pericardial effusion).
Aortic dissection: This occurs when there is a tear in the lining of the aorta. This is the large blood vessel that carries blood from the heart to the rest of the body.
Pulmonary embolism: Thisis a blood clot in the lungs. Large clots can be life-threatening because they can affect oxygen levels and the way the heart pumps blood.
Lung disease: Just like asthma or COPD (chronic obstructive pulmonary disease), lung diseases can cause chest pain when they flare up. And severe flares can be life-threatening when someone is struggling to breath.
Pneumothorax: This is a “collapsed lung” — when air builds up outside of the lungs and squishes the lungs inside the rib cage.
Pleural effusions: This is a condition in which fluid collects around the lungs. It is similar to a pneumothorax, but with fluid instead of air. This can happen with heart failure, infections like pneumonia, or cancer.
This is not a comprehensive list. There are other serious conditions that can also cause chest pain. But these are some of the more common ones that ER providers keep an eye out for.
Causes of chest pain that are not an emergency
The above list may make it seem like all chest pain is an emergency. But many of the common causes of chest pain are not dangerous — especially ones that involve the gastrointestinal (GI) tract, muscles, and bones in the chest. Some of these can be even more painful or uncomfortable than the conditions above.
Causes of chest pain that are not an emergency include:
Acid reflux: Also known as GERD (gastroesophageal reflux disease), reflux can feel like a heart attack in some people.
Esophageal spasm: An overactive esophagus can squeeze too hard and cause chest discomfort.
Costochondritis: More common in younger people, this occurs when the cartilage in the rib cage can get inflamed. It can be quite uncomfortable but isn’t dangerous.
Chest wall injuries: These can include bruised or broken ribs as well as muscle strains around the rib cage. Injuries can happen with obvious trauma to the chest, like a fall. They can also happen with more minor incidents, like a cough or hard workout.
Stress and anxiety: It can feel exactly like some of the more serious causes of chest pain listed above.
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How to know if you should go to the ER for chest pain
There are a lot of different medical conditions that can cause pain. So, without medical testing, it’s not always easy to tell if it is serious. People and healthcare providers have a hard time figuring out the cause of chest pain from symptoms alone.
But there are some clues that can point toward a potentially serious cause of chest pain. Pain is more worrisome when it:
Is severe, worsening, or unrelenting
Feels like it is tearing or ripping
Travels to the arms, neck, back, or jaw
Gets worse with exertion
Worsens when taking a deep breath or occurs along with shortness of breath
Causes a cold sweat
Causes nausea or vomiting
Occurs with leg swelling
Chest pain is also more likely to be serious when someone has other high-risk medical conditions. This includes:
Coronary artery disease
A history of prior heart attacks
Heart failure
A heart valve condition, like aortic stenosis
Aortic aneurysm
Prior blood clots in the legs or lungs
Any blood clotting disorder
It is important to keep in mind that these are just rough guidelines. Even if none of the above circumstances are true for you, your chest pain could still be a sign of a life-threatening condition. So when it feels like your body is sending you warning signs, it is important to take them seriously.
Should you go to the ER or urgent care for chest pain?
If you have new chest pain — especially if you have any of the other symptoms above — you should call 911 or have someone take you to the nearest ER. It’s best not to drive yourself if you are not feeling well. ERs are a better option than urgent care for chest pain. An ER can run more tests and has treatment available if your chest pain turns out to be serious.
What does the ER do for chest pain?
When you go to the ER for chest pain, your healthcare provider will likely run several tests to look for any serious conditions. Common tests are:
An electrocardiogram (ECG): This is a quick and easy test that can diagnose a heart attack.
Blood work: This can include blood counts, electrolytes, and blood tests to check if the heart is under any sort of strain. It may also include a D-dimer if your provider thinks you may have a blood clot.
A chest X-ray: This is an easy way to get a picture of the heart and lungs. Your provider may also recommend a CT scan of the chest, which can detect an aortic dissection or pulmonary embolism.
While you are getting these tests done, you may also get some medications if your provider suspects a heart condition. This varies from person to person, but some examples are:
Aspirin: This helps to prevent any blockages in the coronary arteries.
Nitroglycerin: This medicine opens up the coronary arteries, so it can also be helpful if your chest pain, or angina, is coming from coronary artery disease.
IV (intravenous) pain medication: There are several different types of pain medication that can help chest pain. It depends on the most likely cause of someone’s pain.
If testing shows a serious cause of chest pain, you may be admitted to the hospital for additional testing or treatment. But the tests often do not give a clear answer about what is causing the pain.
If you are at high risk of having heart problems, you might still end up staying in the hospital to get more testing done. People with lower risk for heart disease are often discharged home. But they often need close follow-up with their primary provider or a heart specialist for more testing.
The bottom line
Chest pain can be a sign of serious or even life-threatening illnesses. And it can be really hard to figure out how serious your chest pain is based on just your symptoms. What’s more, some serious causes — like a heart attack — may cause only mild symptoms. And less dangerous causes — like a strain in the chest wall — can feel very painful. At the end of the day, don’t second guess yourself if you are having chest pain. Go to the emergency room where they can diagnose and treat any serious conditions.
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References
American Heart Association. (2021). Angina (chest pain).
Centers for Disease Control and Prevention. (2022). Heart attack symptoms, risk and recovery.
