Chest pain can be hard to judge. It may come from something relatively minor, such as heartburn or a strained chest muscle. But it can also be a warning sign of a heart attack, blood clot in the lungs, stroke, or another medical emergency.

The difficult part is that serious and less serious causes can feel surprisingly similar. You don't need to figure out the cause yourself before deciding what to do.

If chest pain is new, severe, unexplained, or happening with other concerning symptoms, call 911 rather than waiting for an appointment or driving yourself to the ER.

TL;DR: Key Takeaways

  • Chest pain when to worry: Call 911 for sudden, severe, or unexplained chest pain, especially if it lasts more than a few minutes or comes and goes.
  • Pressure, squeezing, tightness, or pain that spreads to the arm, back, neck, jaw, shoulder, or upper abdomen can be a heart attack warning sign.
  • Chest pain with shortness of breath, fainting, cold sweats, nausea, dizziness, or severe weakness needs emergency evaluation.
  • Sudden chest pain with trouble breathing, coughing up blood, or fainting can be a sign of a pulmonary embolism.
  • Sudden severe chest or upper-back pain can also signal an aortic emergency.
  • Stroke symptoms can be remembered with B.E.F.A.S.T.: Balance, Eyes, Face, Arms, Speech, Time.
  • If you think you're having a heart attack or stroke, call 911 instead of driving yourself

Chest pain can be a medical emergency. If you have sudden or unexplained chest pain, trouble breathing, fainting, severe weakness, or possible heart attack or stroke symptoms, call 911 or your local emergency number now.

Don't use an online symptom checker or telehealth visit to try to diagnose potentially serious chest symptoms. Every minute matters when it comes to heart attack and stroke treatment. Emergency medical services can begin care during transport and alert the hospital that you're coming.

Chest pain when to worry

The most important question isn't whether your chest pain feels exactly like a heart attack. Heart attack symptoms can vary, and some people have mild or unusual symptoms.

Call 911 if you have new or unexplained chest pain that is sudden, severe, lasts more than a few minutes, or goes away and returns.

Chest discomfort may feel like:

  • Pressure
  • Squeezing
  • Tightness
  • Fullness
  • Aching
  • Burning or pain

Chest pain becomes more concerning when it happens with other symptoms, including:

  • Shortness of breath
  • Cold sweats
  • Nausea or vomiting
  • Lightheadedness or sudden dizziness
  • Fainting or loss of consciousness
  • Unusual weakness or fatigue
  • A rapid or irregular heartbeat
  • Pain spreading to the arm, shoulder, back, neck, jaw, or upper abdomen

These symptoms can happen with a heart attack and other serious conditions. You can't reliably determine the cause based on how the pain feels alone.

When chest pain may mean a heart attack

A heart attack occurs when blood flow to part of the heart muscle becomes blocked. Chest discomfort is a common warning sign, but symptoms don't always look like the classic severe or crushing pain people expect.

Heart attack symptoms can include pressure, squeezing, fullness, aching, or pain in the center of the chest. The discomfort may spread to one or both arms, the back, neck, jaw, shoulders, or upper abdomen.

Shortness of breath can occur with or without chest discomfort.

Some people also experience nausea, cold sweating, unusual tiredness, dizziness, or lightheadedness. Symptoms may be mild or come and go, which can make it tempting to wait and see if they improve.

If you think you could be having a heart attack, call 911. Don't wait to see whether the pain disappears. Emergency medical services can begin care while you're being transported and alert the hospital that you're coming.

For more information, see the American Heart Association's warning signs of a heart attack.

Heart attack symptoms can be different in women

Women can experience the same classic heart attack symptoms as men, including chest pain or pressure.

They may also experience symptoms such as:

  • Shortness of breath
  • Nausea or vomiting
  • Unusual tiredness
  • Pain in the back, shoulder, or arm
  • Lightheadedness

These symptoms don't automatically mean you're having a heart attack. But when they occur with chest discomfort or other concerning symptoms, they shouldn't be dismissed.

If your symptoms could indicate a heart attack, seek emergency medical care rather than trying to determine the cause at home.

When to go to the ER for chest pain

New, unexplained, or severe chest pain deserves prompt medical evaluation, particularly when other emergency symptoms are present.

Call 911, your local emergency line, or go to the ER immediately if chest pain occurs with:

  • Severe or worsening shortness of breath
  • Fainting or near-fainting
  • Confusion or a sudden change in alertness
  • Cold sweats or severe weakness
  • Pain spreading to the arm, back, neck, jaw, shoulder, or upper abdomen
  • Sudden severe upper-back or neck pain
  • Coughing up blood
  • Sudden weakness or numbness
  • Trouble speaking
  • Sudden vision changes

These symptoms can occur with a heart attack, pulmonary embolism, aortic dissection, or stroke. These conditions require urgent assessment and can't be safely ruled out through an online visit.

Chest pain and stroke symptoms: know B.E.F.A.S.T.

Chest pain isn't usually the main symptom of a stroke. But sudden neurological symptoms require emergency care just as quickly.

The CDC recommends using B.E.F.A.S.T. to recognize common stroke symptoms:

  • B — Balance: sudden loss of balance, coordination, or difficulty walking
  • E — Eyes: sudden vision changes or loss of vision
  • F — Face: one side of the face droops or feels numb
  • A — Arms: sudden weakness or numbness in one arm
  • S — Speech: slurred speech, difficulty speaking, or difficulty understanding speech
  • T — Time: call 911 immediately

Other possible stroke symptoms include sudden severe headache, dizziness, confusion, or difficulty seeing.

If you can, note when the symptoms started. That information can help the medical team determine which treatments may be appropriate.

Even if the symptoms disappear, emergency evaluation is still important. A temporary episode can be a transient ischemic attack, which may be a warning sign of a future stroke.

Chest pain with trouble breathing can be another emergency

Not every dangerous cause of chest pain involves the heart.

A pulmonary embolism, for example, occurs when a blood clot blocks an artery in the lungs. Symptoms can include:

  • Sudden shortness of breath
  • Chest pain that may worsen with a deep breath or cough
  • Rapid breathing
  • A rapid pulse
  • Dizziness or fainting
  • Coughing up blood

A swollen or painful leg can also be a clue to a blood clot, particularly when it occurs with sudden breathing problems or chest pain.

If you have sudden chest pain with significant difficulty breathing, don't wait for an appointment. Seek emergency medical care.

What if the chest pain feels like heartburn?

Heartburn and other digestive problems can cause burning or discomfort in the chest. Chest pain can also come from muscle strain, inflammation, or other non-cardiac causes.

The problem is that these symptoms can overlap with serious conditions.

A burning sensation doesn't automatically mean acid reflux, and a heart attack doesn't always cause severe crushing pain.

If chest pain is new or unexplained, especially if it occurs with shortness of breath, sweating, nausea, dizziness, or pain spreading to another part of the upper body, don't assume it's heartburn. Get emergency medical help.

Should you drive yourself to the ER?

If you think you're having a heart attack or stroke, call 911 instead of driving yourself.

Emergency medical services can begin care before you reach the hospital and alert the emergency department that you're coming. This can be especially important if your condition changes during transport.

If emergency medical services aren't available, have someone else drive you if possible. Driving yourself should be a last resort because your condition could worsen suddenly.

What if the chest pain isn't an emergency?

Not every episode of chest pain requires an ambulance. But new or unexplained chest pain still deserves medical attention.

Depending on your symptoms, a healthcare professional may need to perform an examination, ECG, blood tests, imaging, or other testing to determine what's causing the pain.

If the pain has stopped and you're not experiencing emergency symptoms, contact a healthcare professional for guidance rather than trying to diagnose yourself.

For more information about distinguishing emergency symptoms from problems that may be appropriate for urgent care, see our guide on urgent care vs ER: how to decide in 60 seconds.

Conclusion

Chest pain is hard to judge. Serious and less serious causes can feel similar, and even physicians rely on tests to sort them out.

That's why new, sudden, severe, or unexplained chest pain deserves prompt medical attention, especially when it comes with shortness of breath, fainting, cold sweats, severe weakness, nausea, dizziness, or pain spreading to the arm, back, neck, jaw, shoulder, or upper abdomen.

Call 911 for possible heart attack or stroke symptoms, severe breathing problems, coughing up blood, or sudden severe chest or upper-back pain. Don't wait for an online appointment. Don't drive yourself if emergency medical services are available.

With chest pain, getting evaluated quickly matters more than figuring out the cause yourself.

Frequently Asked Questions

Call 911 if you have symptoms that could indicate a heart attack or stroke.

Emergency medical services can begin care during transport and notify the hospital that you're coming. If your condition suddenly worsens, trained responders can also provide emergency assistance.

If EMS isn't available and someone else can drive you, that's preferable to driving yourself.

When chest pain is new, unexplained, or accompanied by other concerning symptoms, it's safer to seek emergency evaluation.

Serious conditions such as heart attack, pulmonary embolism, and aortic dissection can overlap with less dangerous causes. Waiting to see whether the pain goes away can delay treatment.

If you're unsure and the symptoms could be an emergency, call 911 and describe what you're experiencing.

Yes.

Heart attacks are more common in older adults, but they can happen at any age. Risk factors can include a family history of heart disease, high cholesterol, diabetes, smoking, high blood pressure, and certain drug use, including cocaine.

Age alone shouldn't be used to rule out a heart attack. If a younger person has chest pain with heart attack warning signs, emergency evaluation is appropriate.

Follow the instructions given by the 911 dispatcher.

If you're able to do so, sit or rest somewhere comfortable, unlock the door if you're alone, and keep your phone nearby. Don't spend time trying to diagnose the cause of the pain or searching for an answer online.

If you become unconscious and someone is with you, they should follow the dispatcher's instructions, including CPR guidance if needed.

Still get evaluated.

Chest pain that resolves doesn't necessarily mean the underlying problem is gone. Some serious conditions can cause symptoms that come and go.

Tell emergency responders what happened, including how long the pain lasted and whether you experienced other symptoms. They can determine whether you still need hospital evaluation.