Below are just a few essential thoughts that are not exhaustive but give some insight into the complexity of this symptom.
You have to dial 999 as you could be having a heart attack if you experience severe chest pain with the feeling of chest tightness, feeling of heaviness or breathlessness which lasts more than 15 minutes. The above symptoms could also be accompanied by sweatiness, nausea or a feeling of panic. The pain in the chest may radiate to the arms, neck, or jaw.
Very similar symptoms can occasionally be caused by two other life-threatening conditions: aortic dissection or pulmonary embolism.
In non-acute cases a Cardiologist needs to establish whether the chest pain is of heart origin.
The most common chest pain of cardiac origin is angina. Angina is a feeling of chest pain or chest tightness that usually has a relation to physical activity and subsides when a patient stops the physical activity. Usually, the patient experiences a feeling of chest pain in the middle of the chest or left side with possible radiation to the arms, neck or jaw. The main cause of angina is Atherosclerosis, a process that can last many decades before causing symptoms.
As Atherosclerosis develops, there is the deposition of blood fat called cholesterol into the wall of arteries. Once the cholesterol penetrates an artery, it starts to attract other substances, including calcium, and this leads to gradual plaque formation. With time, plaque gradually grows and replaces the typical structure of the arterial wall. It also infringes the lumen, causing the narrowing of the lumen of the artery.
When narrowing reaches 60%-70% the natural flow to the heart might be compromised especially during increased demand in oxygen (exercise). The heart, through its vast network of small nerves, starts to issue warning signs that result in a sensation of angina. The heart in itself does not have pain receptors; however, it is still able to find a way to signal alert. Even after practising Cardiology for more than 25 years, I find this fascinating!
Atherosclerosis can start at a very young age. The best pre-emptive measure to avoid Atherosclerosis is a healthy lifestyle, according to leading scientists as early as possible. A healthy lifestyle implies a diet with low amount of saturated fats, a lot of fruit and vegetables plus regular exercise.
Science does not know one exact cause of Atherosclerosis. However, we know major risk factors that contribute or accelerate Atherosclerosis: smoking, fat-rich diet, lack of exercise, overweight, diabetes, hypertension and unfavourable family history.
There are other causes of chest pain that are not related to the heart, such as reflux, stomach or duodenum ulcer, gallbladder stones, pancreatitis and lung problems. Muscle or bone structures of the chest wall can cause musculoskeletal pain. Sometimes chest pain can even be due to severe anaemia, when there is relative undersupply of the oxygen to the heart muscle. Also, shingles can cause severe chest pain.
Cardiac pain can be caused also by valve problems (most commonly, narrowing of the Aortic valve – Aortic Stenosis), acute or chronic inflammation (pericarditis) of the sac around the heart called (pericardium), inherited heart conditions resulting in increased thickness of the heart muscle (Hypertrophic Cardiomyopathy or an increase in blood pressure (Hypertension)…
If you experience chest pain, it is best to discuss this with your GP or Cardiologist
After discussions and assessing your risk profile, you may need further tests. From the heart point of view, this is usually an ultrasound scan of your heart, assessment of heart arteries with computed tomography coronary angiography (CTCA), invasive coronary angiogram of the nuclear scan.