Every year, over 800,000 Americans suffer from heart attacks—and if you’ve ever experienced severe chest pain, you’re probably all too familiar with the fear of such a possibility. However, experts say that the vast majority of the time, chest pain is caused by something other than life threatening heart issues. In fact, a 2016 study published in the journal JAMA Internal Medicine found that just six percent of patients who arrived in the emergency with chest pain were later diagnosed with a heart attack. Many of their diagnoses were ultimately found to be of non-cardiac origin, caused by acid reflux, other gastrointestinal problems, lung conditions, stress, anxiety, and more.
Of course, you should never dismiss or downplay chest pain if it bears the hallmark signs of a heart attack, and it’s crucial to know these symptoms before they arise. Read on to learn three signs that your chest pain isn’t a heart attack, as well as the red flags that mean it’s time to call 911.
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Heart attacks often occur after bouts of heavy physical exertion, so if your pain subsides when you hit the gym, it’s most likely something else. Experts from the Cleveland clinic say that the most likely culprit for pain that lessens during a workout is acid reflux or another gastrointestinal problem. “An estimated 15 million Americans a day experience heartburn, which brings an uncomfortable burning feeling in your chest and a sour feeling in your throat,” notes the Clinic. “An over-the-counter antacid can help bring some relief,” they suggest.
That said, many people do experience exercise-induced reflux directly following their workout, so you should also not just assume you’re having a heart attack if your chest pain occurs during or after working out. Experts explain that this occurs when the lower esophageal sphincter is too relaxed, causing acid from the stomach to back up into the esophagus as you exercise.
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Experts explain that if your chest pain is intensely localized in one place, creating a “piercing” or “stabbing” sensation, it most likely has a cause other than heart attack. This is especially likely if the pain occurs when you breathe deeply, cough, or change positions, the Cleveland Clinic says. “If this describes your symptoms, odds are that you’re dealing with a lung-related issue,” their experts explain. “This is even more likely if the pain is focused on the right side of your chest, away from your heart,” they add.
Pleuritis, also known as pleurisy, is one such lung condition that can cause sharp chest pain. In patients with pleuritis, “the pleura—two large, thin layers of tissue that separate your lungs from your chest wall—becomes inflamed,” explains the Mayo Clinic. When this happens, “the two layers of the pleural membrane rub against each other like two pieces of sandpaper, producing pain when you inhale and exhale.”
However you may be able to determine whether pleuritis is to blame with a simple breath exercise. “The pleuritic pain lessens or stops when you hold your breath,” their experts note. Pain from a heat attack would persist regardless of your breathing.
Regardless of the intensity of your chest pain, experts say it’s less likely cause for serious concern if that pain fades quickly. The Cleveland Clinic explains that a heart attack “brings unrelenting pain that lasts several minutes,” while more brief pains will typically have another underlying cause. Injury is commonly to blame for these sharp, quick pains—in particular, bruised ribs or a pulled muscle in the chest wall. Others who experience this type of brief but intense pain are frequently diagnosed with inflammation in the rib cartilage, fibromyalgia, or shingles, the Clinic says.
Conversely, the Mayo Clinic notes that your chest pain likely has a cause other than heart attack if it persists for several hours without other symptoms developing. However, you should call for medical assistance for any severe chest pain that lasts longer than five minutes—especially if it is accompanied by any other signs of heart attack.
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While it’s true that just a small fraction of chest pain incidents are ultimately diagnosed as a heart attack, it’s important to call for emergency medical assistance immediately if you believe your heart could be in danger.
You should always dial 911 if your chest pain or pressure lasts for five minutes or more, especially if it radiates to the arms, back, jaw, neck, or upper stomach. Some people who experience heart attack display additional symptoms, including shortness of breath, cold sweat, nausea, fatigue, or lightheadedness.
If you’re at all unsure about whether you could be having a heart attack, call for help immediately. Many patients “don’t act quickly enough to make it to the hospital on time for help,” says the U.S. Department of Health and Human Services. “When a heart attack happens, delay in treatment can be deadly,” their experts warn.
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