Chest pain: First aid

The specific cause of chest pain is often difficult to interpret. Causes of the pain can vary from minor problems, such as indigestion or stress, to serious medical emergencies, such as a heart attack or pulmonary embolism.

As with other sudden, unexplained pain, chest pain may be a signal for you to get medical help. Use the following information to help you determine whether your chest pain is a medical emergency.

Heart attack

A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack generally causes chest pain for more than 15 minutes. But a heart attack can also be silent and produce no symptoms.

About half the people who suffer a heart attack have warning symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain that's triggered by exertion and relieved by rest.

The American Heart Association lists these warning signs and symptoms of a heart attack. Be aware that you may not have all of them and that these signs and symptoms may come and go.

Uncomfortable pressure, fullness or squeezing pain in the center of your chest lasting more than a few minutes.

Pain spreading to your shoulders, neck or arms.

Lightheadedness, fainting, sweating, nausea or shortness of breath.

If you or someone else may be having a heart attack:

-Dial 911 or call for emergency medical assistance. Paramedics can begin treatment as soon as they arrive, even before you get to the hospital. If you live in a rural or large metropolitan area, emergency medical assistance personnel may advise you that it's faster for you to drive the person suspected of having a heart attack to the hospital. If you think you're having a heart attack, never drive yourself.

-Chew aspirin . While you're waiting for emergency assistance, take one regular-strength aspirin and chew it to speed absorption.

Begin CPR. If the person suspected of having a heart attack is unconscious, a 911 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR). Even if you're not trained, a dispatcher can instruct you in CPR until help arrives.

Pulmonary embolism

An embolus is an accumulation of foreign material — usually a blood clot — that blocks an artery. Tissue death occurs when the tissue supplied by the blocked artery is damaged by the sudden loss of blood. Pulmonary embolism describes the condition that occurs when a clot — usually from the veins of the leg or pelvis — lodges in an artery of the lung.

Signs and symptoms of pulmonary embolism include:

-Sudden, sharp chest pain that begins or worsens with a deep breath or a cough, often accompanied by shortness of breath

-Sudden, unexplained shortness of breath, even without pain

-Cough that may produce blood-streaked sputum

-Rapid heartbeat

-Anxiety and excessive perspiration

-As with a suspected heart attack, dial 911 or call for emergency medical assistance immediately.

A frequent symptom of pneumonia is chest pain accompanied by chills, fever and a cough that may bring up bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes that surround the lung (pleura), you may have considerable chest discomfort when inhaling or coughing. This condition is called pleurisy.

One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This is not true of a heart attack. See your doctor if a cough and a fever or chills accompany your chest pain. Pleurisy alone, however, isn't a medical emergency.

Chest wall pain

One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It consists of pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).

Often, placing pressure over a few points along the margin of the sternum results in considerable tenderness limited to those small areas. If the pressure of a finger duplicates your chest pain, you probably can conclude that a serious cause of chest pain, such as a heart attack, isn't responsible.

Other causes of chest wall pain include:

-Strained muscles from overuse or excessive coughing.

-Muscle bruising from minor trauma.