Read this bit first

If you have chest pain right now that feels heavy, tight or crushing — or pain spreading into your arm, jaw, neck or back — put your phone to better use than reading: dial 999. A wrong guess in the cautious direction costs an ambulance crew an hour. A wrong guess in the other direction can cost heart muscle, or a life. Nobody in the NHS will think less of you if it turns out to be indigestion; call handlers and paramedics deal with exactly this uncertainty all day and would always rather come.

If your pain has passed, or you are reading on someone's behalf, carry on.

The symptoms that mean phone, now

Treat chest pain as a possible heart attack — and call 999 — when it comes with any of the following:

  • A sensation of weight, squeezing or a tight band across the centre of the chest, rather than a pinpoint stab
  • Pain travelling into either arm (not just the left), the jaw, the throat, the back or the upper belly
  • Breathlessness, even sitting still
  • Skin gone grey, clammy or drenched in cold sweat
  • Feeling sick, light-headed or close to fainting
  • A thumping, racing or chaotic heartbeat
  • An overwhelming, hard-to-describe sense that something is badly wrong — clinicians take this symptom seriously, and so should you
  • Pain lasting more than 15 minutes, or coming on during rest or minimal effort

While the ambulance is on its way

  1. Stop all activity and sit down — on the floor, propped against a wall with knees bent, is a good position
  2. If there is aspirin in the house, you are not allergic, and you have never been told to avoid it, chew one adult tablet (300 mg) slowly — chewing speeds absorption
  3. Anyone with a prescribed GTN spray for angina should use it as they have been taught
  4. Unlock the door, put pets away, and if possible have someone stand outside to flag the crew down
  5. Do not eat, do not have a cigarette, and do not let the person talk you into driving them — a cardiac arrest in a moving car helps no one

What a heart attack actually is

A clot blocks one of the coronary arteries feeding the heart muscle, and the muscle beyond it starts to die for lack of oxygen. Modern treatment — clot-dissolving drugs, or a wire-and-balloon procedure that reopens the artery — is remarkably effective, but its benefit shrinks with every passing minute of blockage. That is the entire logic behind the "call first, wonder later" rule: the treatment works, and it works best early.

One thing worth knowing about women: heart attacks in women more often skip the textbook chest-clutching presentation. Unexplained breathlessness, nausea that feels like a stomach bug, aching in the jaw or between the shoulder blades, and profound unusual tiredness in the preceding days are all recognised patterns. Women wait longer, on average, before calling for help — and are more likely to be sent home undiagnosed. If the combination feels wrong, say the words "I think this could be my heart" and let the professionals prove you wrong.

Other emergencies that announce themselves in the chest

The heart is not the only serious possibility. Three others deserve a mention:

  • A clot on the lung (pulmonary embolism): sharp pain that catches when you breathe in, with breathlessness and a fast pulse. Think of it especially after recent surgery, a long-haul flight, a plastered leg, during pregnancy, or on the combined pill. 999.
  • A tear in the main artery (aortic dissection): abrupt, ferocious pain often described as ripping, felt in the chest or between the shoulder blades. Rare, but a true emergency. 999.
  • A collapsed lung (pneumothorax): sudden one-sided sharp pain plus breathlessness, classically in tall slim young men or people with lung conditions. Needs emergency assessment.

The reassuring end of the spectrum

Most chest pain seen in general practice is not cardiac. The common benign culprits have recognisable fingerprints:

  • Chest-wall pain. A gym session, a coughing fit or an awkward lift strains the muscles and cartilage of the ribcage. The giveaway: pressing on the sore spot reproduces the pain, and twisting or deep breaths make it worse. Painkillers and patience fix it.
  • Acid reflux. A burning behind the breastbone after a big meal, worse lying flat or bending, often with a sour taste. An antacid usually settles it within minutes. Be aware that reflux and cardiac pain can genuinely mimic each other — persistent doubt still deserves assessment.
  • Panic attacks. A pounding heart, tight chest, tingling fingers and racing breath, often with a terror of dying — the symptoms are physically real, not imagined. If it has never happened before, get checked once; a normal cardiac work-up then becomes powerful reassurance for future episodes. Our mental health emergencies guide covers where to turn if panic attacks keep recurring.
  • Shingles. One-sided burning or stabbing chest-wall pain a few days before a stripy rash appears. See a GP promptly — early antivirals help.

A rough decision guide

  • Crushing, spreading, or paired with sweating, sickness or breathlessness → 999, now
  • Sudden, severe and unlike anything before → 999
  • Sharp, one small spot, worse on pressing or moving → likely muscular; painkillers, GP if it drags on
  • Burning after food, eased by antacids → likely reflux; GP if it keeps returning
  • First-ever episode of anything you cannot confidently place → get assessed today, via 111 if you are genuinely unsure it is an emergency

Notice what is missing from that list: "wait and see how it is in the morning" does not appear anywhere next to possible cardiac symptoms.

What A&E will do with chest pain

Chest pain jumps the queue. At triage you will be moved quickly to have an ECG — a five-minute heart tracing that can show a major heart attack immediately. Blood is taken to measure troponin, a protein that leaks from injured heart muscle; because it takes time to rise, a second sample a few hours later is standard, which is why chest-pain visits often involve several hours of monitored waiting even when everything is heading towards good news. A chest X-ray, blood pressure in both arms and a detailed history round out the work-up. Bring your medication list — our packing checklist is worth a skim before any visit.

If the heart is cleared, you leave with an explanation and a plan; if not, you are in exactly the right building, and the cardiology pathway takes over. Either way, our guide to life after discharge covers the follow-up steps. It is also worth asking your GP about a free NHS Health Check (ages 40 to 74) — blood pressure, cholesterol and diabetes screening quietly deal with the biggest heart risks before they ever cause pain.

The short version

  • Heavy, tight or spreading chest pain, or pain with sweating, sickness or breathlessness: call 999 — sit down, chew 300 mg of aspirin if available, unlock the door
  • Speed of treatment determines how much heart muscle survives; hesitation is the real risk
  • Women's heart attacks are more often atypical — breathlessness, nausea, jaw or back ache, crushing fatigue
  • Pressable, movement-related or food-related pain is usually benign — but a first, unexplained episode always deserves same-day assessment
  • For chest pain, do not shop around on waiting times — ambulance-borne chest pain is prioritised the moment it arrives