Chest Pain: A Quick Self-Assessment
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Oct 18, 2024
- 10 min read
Updated: Jul 5
If you are reading this page because you are having chest pain, you need to do a very quick self-assessment. Here are a few things to ask yourself:
Chest Pain: A Quick Self-Assessment
Symptoms
Everyone’s symptoms can be different, but if you have:
Pressure, tightness, fullness, pain, a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw, shoulders, back or arms (especially left-sided).
Nausea, indigestion, heartburn, or possibly abdominal pain
Shortness of breath
Cold sweat
Sudden Fatigue
Lightheadedness or sudden dizziness
Rapid or irregular heartbeat
If you are having a sudden onset of these symptoms, do not read on, call 9-1-1
These are “typical” symptoms of a heart attack but remember, everyone is different; that is, not everyone experiences these "classic" symptoms.
Cardiac symptoms can develop over hours to days, weeks, or, sometimes, longer. The pain may be constant or intermittent, and may come and go. Heart attacks (also called MIs or myocardial infarctions) occur more commonly in early morning hours (before or when a person just wakes up), during stressful times or with an increase in activity (the pain often decreases after resting). If symptoms are coming on fast, call 911 (It's no skin off their backs, that's their job, they are there to do it, and they are happy to help. And, in most places, it's free if EMS comes to evaluate your problem). If symptoms develop over time, call your healthcare provider or, better yet, go to an urgent care clinic or ER if you are having a bout of pain. A heart attack is best treated early.
Note: According to the American Heart Association, "The most common symptom of heart attack for both men and women is chest pain or discomfort. However, women are more likely than men to experience some of the other symptoms, such as jaw or back pain, shortness of breath, and nausea or vomiting". Some people have NO symptoms at all (a “silent” heart attack) and just keep going about their business!
Risk Factors For a Heart Attack
Chest Pain: A Quick Self-Assessment is more than just assessing symptoms. Let's look at some other symptoms and risk factors for cardiac events (please, if you are in acute pain and think you need medical help right away, please do not take time to read this, call 9-1-1)
Does the pain increase when you take a deep breath? (if so, it is usually NOT cardiac/heart pain)
Do you have a history of stomach problems like ulcers or a hiatal hernia? (Chest pain or back pain is often related to your stomach, but do not assume this). If the pain is relatively new, accompanied by the above symptoms, or becoming severe, get it checked out right away - it is always better safe than sorry.
Have you been more short of breath recently without a history of asthma, COPD, emphysema, or other lung problems? Yes=Risk
Do you have swelling in your ankles? Yes=Risk
Are you a male older than 65 years or a woman 72 (or older)? Yes=Risk.
Most people who have heart attacks are older. However, one in five people who have heart attacks is under 40 years old (and the incidence is increasing). So it is not impossible. Especially if you have risk factors (hypertension, high cholesterol, diabetes, family history, and so on).
Do you have a family history of sudden death or heart attacks/death at an early age? Genetic factors – especially in first-degree relatives - can put you at about a 50% greater risk of having a heart attack. However, many of the risk factors at play here are modifiable with lifestyle changes (for example, smoking and excessive drinking).
Do you have uncontrolled high cholesterol? Yes=Risk
Uncontrolled “bad” cholesterol (LDL, triglycerides) places you at a great risk for cardiovascular disease and a heart attack. Cholesterol builds up in your arteries and coats the inner lining of your blood vessels, creating plaques, clots, and occlusion of an artery. When blood vessels get occluded, the blood cannot get to important places (like your heart or your brain). This can cause a heart attack or stroke (respectively).
So, be sure to get your cholesterol checked regularly (this can also be hereditary) I see this far too often).
IF IT IS HIGH, GET IT TREATED. If you are not getting along with your cholesterol medicine, ask your doctor to recommend a different approach - DON'T JUST LET IT GO.
Let me tell you a story (if you want to read it) – Over the last three days when I worked at the clinic, I had three people (out of about 20) patients who told me they had a history of high cholesterol but were not treating it:
1) A 29-year-old with high cholesterol, diagnosed as a teen (“inherited”). Her father died at 46 from a heart attack. This patient had not addressed it since it was diagnosed several years ago because she did not think it was important.
2) Another patient was a woman in her early 40s with three young children. She had diabetes-her last A1C a year and a half ago was 9.1, she weighed about 220 pounds and was 5'4", and had a history of high cholesterol but was not treating it because the medicine did not agree with her. She had three small children with her. I asked her why she did not go to her PCP to follow up on her cholesterol and glucose, and she told me she did not have time (even though she is a stay-at-home mom and her kids are in school in the morning). I spoke to her and felt sad for her and for the future of her children because she will become very ill - and likely disabled - if she continues to neglect herself.
3) The third patient with high cholesterol was a middle-aged, big, burly male who also felt that it was just not important. He has a family.
What is wrong in this picture?
This breaks my heart because things can be done about this problem and need to be done before these people get very sick, or maybe even die. Plenty of things can be done - from lifestyle changes to medicines. There are many options.
I will say this more than once – “if I knew then what I know now, I would have done some things differently”. It catches up with you. Don't become a person in my story.
Is your blood pressure usually over 120 -130/80? Yes=Risk
High blood pressure makes your heart work harder and can damage arteries that feed your heart with blood and oxygen it needs to beat. This makes you more at risk for a heart attack.
If you take blood pressure medicine and your blood pressure is still high, talk to your healthcare provider. Why bother taking medicine if it is not going to work very well? Take the right med instead.
If you have “white coat syndrome” (temporary high blood pressure 130/90 but <160/100 when anxious at the healthcare provider’s office) be sure to check it at home so, if it stays elevated, you will recognize it and get it treated. If your blood
pressure rises in stressful circumstances, it may become elevated at other places too (city traffic? Work?) Think about learning ways to manage your stress. (I love the patient who - aware that he had white coat syndrome, told me he was "deep breathing" for relaxation before he came in for his appointment so his blood pressure would not be elevated. He is a guy who worries, but also a guy who cares.)
Do you have diabetes or prediabetes? Yes=Risk
Diabetes wreaks havoc on small blood vessels in your heart, kidneys, and eyes, among
other organs. It will put you at risk for a heart attack because you need those little vessels to get oxygen to your heart muscle. Keep your blood sugar under control, or you will be sorry later. Can I tell you about my diabetic brother-in-law who is on dialysis? He used to do what he wanted and eat what he wanted without a care in the world. Now he's miserable and very regretful.
Do you smoke? Yes=Risk
Smoking also leads to a build-up of plaque in your arteries (see cholesterol above), which can cause clots to form and break off or can narrow and block the arteries that "feed" your heart. When your heart muscle does not receive oxygen, part of the muscle dies, and a heart attack ensues. Smoking also “thickens” your blood, which can cause more platelets or clotting factors (clots go to your heart and cause a heart attack by cutting off blood to the heart). Ask to see your labs sometime- your CBC. Some people get away with it (I don't know how), but many people don't. Want to quit?
Do you drink too much alcohol? Yes=Risk
Chronic alcohol use or even just binge drinking can contribute to several things that can cause a heart attack. Alcohol can cause arrhythmias (irregular heartbeats); it can cause weakened heart muscle (alcoholic cardiomyopathy), and it can cause a rise in your blood pressure, which is bad for your heart. Alcohol overuse can also increase platelets, which are responsible for clotting of the blood. Blood clots can block the blood flow of arteries, causing a heart attack or a stroke.
How much is too much? The number of alcohol servings per day changes now and then and varies with the source you read. The Alcohol Research Group is fairly lenient with its recommendations compared to other sites:
They recommend that you do not exceed 14 drinks per week for men and seven drinks per week for women. The daily guideline is no more than four drinks on any day for men, and three drinks on any day for women.
There is a great expression: "Everything in moderation". You just don’t need to “party” all the time.
Do you exercise? No=Risk
Sedentary behavior (sitting a lot) and lack of exercise contribute to cardiovascular risk. Moderate exercise strengthens the heart muscle and allows more oxygen to flow to your heart. It can also help lower blood pressure, decrease stress hormones that place more demand on the heart. Overall, exercise helps decrease many of the risk factors that contribute to heart disease, like high cholesterol and high blood pressure
Are you overweight? Yes=RISK
Being overweight places more stress on your heart: Your heart has to pump harder to get the blood where it needs to be. The heart muscle overworks, so the muscle becomes enlarged and less efficient. Arrhythmias and heart failure can occur. Moreover, obesity puts you at risk for high blood pressure, high cholesterol, and higher blood sugar. It can cause venous stasis (less movement of the blood in blood vessels), so there is more opportunity for blood to clot (when blood just "sits", it tends to clot). Those clots are sent to your heart, which causes a heart attack. Additionally, obesity can increase the clotting factors in your blood (these factors cause blood to clot). This creates an additional risk for the formation of even more clots, heart attacks, and strokes.
Do you take street drugs? (not including marijuana) Yes=RISK
Among many other cardiac and vascular problems, cocaine and methamphetamines can cause an irregular heartbeat which can lead to a heart attack because the heart needs more oxygen than is supplied. Some other resulting vascular problems include cardiomyopathy - a heart muscle problem that causes the heart to pump inefficiently, high blood pressure, decreased blood flow to the heart, endocarditis, aneurysms and other problems.
Do you eat a reasonably healthy diet? No=RISK
It stands to reason that the food you eat can impact your overall heart health. What in your diet causes heart problems?
Sodium can cause high blood pressure, which ultimately can harm your heart.
Saturated fats raise your cholesterol, which ultimately harms your heart
(fatty meats, cheese, butter, some oils)
Too much sugar, carbohydrates (the “white foods”-white bread, pasta, white rice)
Soda (1 can of regular soda contains 10 teaspoons of sugar!)
Trans Fats
Processed Meats (the “greasy” meats), Bacon
Margarine, butter, cheese, dairy - Whole milk, flavored yogurt
Red meat (a lot of cholesterol) – if you eat this, eat lean meat!
Baked goods (“cholesterol” holds those crumbs together!)-try whole wheat products
Pizza (sodium, fat, and calories)
Fried foods (saturated fat)
Canned soups (loaded with sodium)
Potato Chips (saturated fat and loaded with salt)
And, if you think that those vegetarian "plant-based meats" are good substitutes, think again. Many are full of salt and saturated fat.
You say, "That’s just not fair," but sometimes, life is a tradeoff. (You can “cheat” once in a while). Become a label reader (or scanner - Load Yuka on your phone, then scan a barcode on a label and read about the contents of the food. You can then figure out the risks and benefits of the foods you are buying and eating; you might be surprised. (This is not an advertisement - it is one I use; there are others).
Do you have a lot of anxiety and stress? Yes=RISK
Increased cortisol caused by stress and anxiety can cause an elevated heart rate and blood pressure, as well as arrhythmias. Sometimes, it is even hard to tell the difference between anxiety (i.e., panic) and a heart attack. A person’s medical history (above) and a history of anxiety and panic attacks might help determine whether or not a person is having an actual heart attack but a “better safe than sorry” approach - especially if you have not been checked out for this in the past – it would be prudent to dial 911 or go to an ER.
If you are having chest pain and answered "yes" to some of the above questions, you have a greater risk of a heart attack. If you suspect a heart attack, dial 911. No symptoms but have a lot of "RISKS" marked above, you really should talk to a healthcare provider who can help you get and stay well (If you haven't already).
Chest Pain Q+A
Q: When is the most common day of the week in the US to have a heart attack (MI)?
A: Monday: "MI Mondays". Many people say this is because Monday is the start of the stressful work week, although others believe that it may be due to people’s natural circadian rhythms (sleep-wake cycle)
Q: When is the most common time of the year to have an MI?
A: During the winter-especially around holidays.
Q: When is the most common hour of the day to have an MI?
A: In the morning from 4 am -10 am (some say between 6 am and noon). There are a lot of physiological changes going on during those hours (increased adrenaline, increased cortisol, and increased platelets, which are responsible for blood clotting).
