Chest Pain: What to Do and Where to Go
Not all chest pain is a heart attack — but knowing the difference could save your life. A guide to causes, red flags and the right response.
Chest pain is always worth taking seriously
Chest pain is the number one reason people call 999 in the UK, and rightly so — it can signal a heart attack, where minutes matter. But chest pain has dozens of causes, ranging from life-threatening cardiac events to harmless muscle strain. The challenge is telling them apart, and the stakes for getting it wrong are high.
This guide is not a substitute for medical assessment. If you have chest pain right now and are worried it could be your heart, stop reading and call 999. If your chest pain has settled and you want to understand what might have caused it and when to seek help, read on.
When to call 999 immediately
Call 999 without delay if you have:
- Central chest pain that feels like pressure, squeezing, tightness or heaviness — as though something is sitting on your chest
- Pain that radiates to the left arm, jaw, neck, back or stomach
- Chest pain with breathlessness — struggling to get air in, even at rest
- Chest pain with sweating — cold, clammy sweat, not related to exercise or heat
- Chest pain with nausea or vomiting
- Chest pain with dizziness, light-headedness or feeling like you might pass out
- Chest pain with a racing, irregular or pounding heartbeat
- A feeling of impending doom — this sounds vague but is a recognised symptom of heart attack
While waiting for the ambulance:
- Sit down in a comfortable position, leaning slightly forward
- Chew a 300 mg aspirin tablet if you have one and are not allergic — chewing gets it into the bloodstream faster than swallowing whole
- If you have a GTN (glyceryl trinitrate) spray prescribed for angina, use it as directed
- Do not walk around or exert yourself
- Unlock the front door so paramedics can get in
Our general guide on when to call 999 covers emergency decision-making across all conditions.
Heart attack — what is actually happening
A heart attack (myocardial infarction) occurs when a blood clot blocks one of the coronary arteries — the blood vessels that supply the heart muscle itself with oxygen. Without blood supply, the affected heart muscle begins to die. The faster blood flow is restored — through clot-busting drugs or emergency surgery to open the artery — the more muscle is saved.
This is why time matters. "Time is muscle" is the phrase cardiologists use. Every minute of delay increases the amount of permanent heart damage.
Heart attack symptoms in women
Women are more likely than men to have atypical heart attack symptoms:
- Pain in the back, jaw or arm without typical central chest pain
- Nausea, indigestion-like symptoms or stomach pain
- Breathlessness without chest pain
- Unusual fatigue for days before the event
- Dizziness or light-headedness
These atypical presentations mean heart attacks in women are more often missed or dismissed. If you are a woman with any combination of these symptoms, do not wait — call 999.
Other serious causes of chest pain
Pulmonary embolism (blood clot in the lung)
Sharp chest pain that worsens when you breathe in, often accompanied by breathlessness and rapid heart rate. Risk factors include recent surgery, long flights or car journeys, cancer, pregnancy, and being on the contraceptive pill. This is a 999-level emergency.
Aortic dissection
Sudden, severe, tearing pain in the chest or between the shoulder blades. Extremely serious and requires immediate emergency care. Call 999.
Pneumothorax (collapsed lung)
Sudden sharp chest pain on one side with breathlessness. More common in tall, thin young men and in people with lung disease. Needs A&E assessment.
Pericarditis
Inflammation of the sac around the heart. Causes sharp chest pain that worsens when lying flat and improves when leaning forward. Often follows a viral infection. Needs medical assessment but is not usually immediately life-threatening.
Less serious causes of chest pain
Many causes of chest pain are uncomfortable but not dangerous:
Musculoskeletal pain
The most common cause of chest pain in younger adults. Muscle strain from exercise, heavy lifting or awkward movements causes pain that worsens with movement, deep breathing or pressing on the chest wall. It does not radiate to the arm or jaw and is not associated with breathlessness or sweating. Rest, over-the-counter painkillers and gentle stretching usually resolve it within a few days.
Gastro-oesophageal reflux (heartburn)
Acid from the stomach rising into the oesophagus causes a burning sensation behind the breastbone. It often worsens after eating, when lying down, or when bending over. Antacids provide quick relief. Reflux pain can mimic cardiac pain, and even experienced clinicians sometimes cannot tell them apart without tests — which is why chest pain should always be assessed if there is any doubt.
Anxiety and panic attacks
Panic attacks commonly cause chest tightness, rapid breathing, pounding heart and a feeling that something terrible is happening. The physical sensations are real and can be genuinely frightening. If you have recurrent panic attacks with chest pain, it is still worth having a one-off cardiac assessment to rule out a physical cause, after which you can be confident that future episodes are anxiety-related.
Our mental health crisis guide covers panic attacks and anxiety in the context of A&E attendance.
Costochondritis
Inflammation of the cartilage connecting the ribs to the breastbone. Causes localised chest pain that worsens with pressing on the affected area, deep breathing or twisting. It resolves on its own over weeks with anti-inflammatory medication.
Making the decision
If you are unsure whether your chest pain is serious, ask yourself these questions:
- Is the pain central, crushing or pressure-like? → Call 999
- Does it spread to the arm, jaw, neck or back? → Call 999
- Is it accompanied by breathlessness, sweating, nausea or dizziness? → Call 999
- Did it come on suddenly and severely? → Call 999
- Is it sharp, localised, and worse when you press on it or move? → Likely musculoskeletal. Try painkillers and rest. See your GP if it persists.
- Is it a burning sensation related to eating? → Likely reflux. Try antacids. See your GP if it recurs.
- Are you also feeling panicky, tingling in your hands, and breathing fast? → Likely anxiety. Try slow breathing. But if this is the first time, get checked.
When in doubt, call 999. No paramedic will criticise you for calling with chest pain that turns out to be muscular. The alternative — ignoring cardiac symptoms — is far more dangerous.
What happens at A&E for chest pain
If you arrive at A&E with chest pain — whether by ambulance or self-presenting — you will be triaged as high priority. The standard workup includes:
- ECG (electrocardiogram) — a tracing of your heart's electrical activity, done within minutes of arrival. It can immediately show whether you are having a heart attack.
- Blood tests — including troponin, a protein released when heart muscle is damaged. Initial results take about an hour; a second troponin is often taken 3–6 hours later.
- Chest X-ray — to check for lung problems
- Clinical assessment — history, examination, medication review
- Monitoring — continuous heart rhythm monitoring while results are awaited
For the full process, see our A&E walkthrough. Our what to bring guide covers what to have with you — your medication list is particularly important for chest pain presentations.
After the visit
If cardiac causes are ruled out, your discharge advice will depend on the suspected diagnosis. Our after discharge guide covers general follow-up. For musculoskeletal and reflux-related chest pain, your GP can manage ongoing treatment. For anxiety-related chest pain, ask about talking therapies and panic management strategies.
If a cardiac cause is found, your treatment will be more intensive — potentially including emergency procedures, medication changes, cardiac rehabilitation and lifestyle modification. The cardiology team will manage this pathway.
Preventing future episodes
Once a cardiac event has been ruled out, understanding your risk factors helps prevent future scares and genuine problems. The main modifiable risk factors for heart disease are smoking, high blood pressure, high cholesterol, diabetes, obesity and physical inactivity. Your GP can arrange a cardiovascular risk assessment — an NHS Health Check is free for adults aged 40–74. For non-cardiac chest pain, identifying triggers is equally important: reflux responds to dietary changes and medication timing; musculoskeletal pain responds to posture correction and physiotherapy; and anxiety-related chest pain responds to cognitive behavioural therapy and breathing techniques.
Bottom line
Chest pain is a symptom, not a diagnosis. Some causes are life-threatening and time-sensitive; others are benign. You cannot reliably tell the difference yourself, which is why the rule is simple: if you think it could be your heart, call 999. Fast treatment saves lives. For chest pain that is clearly muscular, reflux-related or associated with anxiety, manage at home and see your GP. Live A&E wait times are useful context, but for chest pain, speed of arrival matters more than queue length — call 999 and let the paramedics decide.