Heart pain or just pain? How to tell the difference

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So recently there have been a lot of cases in my practice where the patient has presented with chest pain, of course the right thing to do is visit a doctor for any pain in your chest. But just to narrow it down for those wondering.

When you feel cardiac related pain, you will feel a deep pressure in your chest, a squeezing sensation if you like, the pain feels "crushing" this is usually the onset of a heart attack and medical attention is required as soon as possible. If you have irregular unexplained chest pain and you are generally healthy but they feel as described above, you may have a heart condition. If the pain feels like a tearing, sharp, stabbing, or more like an ache then the cause is more likely muscular or gastric. Of course as mentioned if you have any kind of pain near where your heart is, see a doctor and get a diagnosis. Doctors would rather you see them instead of googling your symptoms, in some cases time is in short supply.

Muscular pain in some cases can last years, but usually presents after demanding activity, for example you have just started going to the gym or after a long time have started having intercourse again. Both can be incredibly demanding on muscles that have been left to normal daily activities for the past several months/years. This can include tightness is your chest, aches and pains in arms, neck, chest etc.

I hope this helped anyone experiencing sudden chest pain.

Remember to always see a doctor regardless of what type of chest pain you or Google thinks it is.

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  • Posted

    Thank you this has helped me understand a little more i am just frustrated with how long things are taking in my case i was ill in April with pneumonia and a chest infection i was off my feet in bed or laid up for 3 weeks then very slowly began picking up and i mean slowly it was almost 6 weeks later middle of June i felt as though i was improving this lasted for aprox 1 week. I then felt as though i had hit a brick wall i couldnt walk as far as i had the week before was breathless on exhertion etc i had a tightness of chest and almost felt like someone was sat on my chest. I had a throbbing pain just under my left breast. i was referred to a cardiologist who examined me i had an ECG followed bey a heart scan 2 weeks ago. The cardiologist didnt say anything to me as to what it could be but had a report from the ecg i have heard nothing from the scan. I have attended A & E twice in the past 6 weeks with chest pains shortness of breath and a deteriation of my walking capacity. Nothing showed up from chest xray bloods were ok told me to keep appointments with cardiology and rest. i cannot possibly rest any more than i am i can hardly walk at all i go upstairs and am out of breath i walk around 30 40 yards and have to stop breathless bach aches chest pain and the throbbing under left breast starts. I was told if i get any worse to go to the hospital but i really cant constantly tie up emergency doctors i am worse every day i am going down hill all the time. I have appointments with GP when i can get in but they just smile and say wait for the cardiology to contact me. i am trying to eat sensible and less as with doing nothing i have gained weight in the past 6 months. Have you any ideas as to what i should do all i want is for someone to say its this or isnt and do more tests if need be i cant go on much longer it is depressing me now all i do some days is cry. i was walking 12 to 16 miles a day 2 or 3 times a week worked full time. please help x

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    • Posted

      The issue with pneumonia is if it was severe enough it can leave lungs in a very weak state for months. What you're describing sounds less cardiac and more respiratory. Pneumonia is an infection that causes fluid to build up in the lungs, the infection may clear in days/weeks but depending on severity the effects and damage can last up to a year or 2. You should talk to your GP about residual effects and damage to your lungs following the bout of pneumonia.

      I'm gathering you don't smoke or have any real heath issues but it sounds like you have asthma.

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  • Posted

    No i do not smoke anymore i did up until April. my GP said it could be heart not pumping properly causing water retention ( sorry forgot to mention this i have had swollen ankles legs and everywhere else in my body since June ) i am on freusemide and inhalers which does help a small amount I also had raised thyroid and had a repeat test 3 week ago which came back ok. I saw a nurse last week as i were breathless and had chest pains had an ECG at the surgery was told it looked like i had pneumonia again with the wheeze etc pain in my shoulder blades but they also said it couldn't be pneumonia as my oxygen level was 94 blood pressure was ok no temperature and told me to make an appointment to see the GP asap which i did but they couldn't fit me in until next Monday so said if i were to get worse go to A& E which like i said i am deteriorating every day i am so tired the whole time x

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    • Posted

      Heart related pain isn't always accompanied with shortness of breath. I honestly think you should focus less on your heart and more on your lungs. As an ex smoker there will be underlying damage, pneumonia may have caused scarring, scar tissue doesn't stretch like healthy tissue, this can easily cause shortness of breath and make it difficult to perform daily tasks like walking up the stairs. Scarring can easily be missed on x-rays, looks like cartilage in most circumstances or is small enough it goes unnoticed. Do you use e-cigs? If so the vapour can also damage the lungs, it's not water vapour it's oil, the thick substance can make it difficult for the lungs to evacuate the extra fluid.

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  • Posted

    My husband has heart failure, diagnosed by a cardiologist, after local GP did ECG's and said nothing wrong with him, I disagreed, and demanded he see a cardiologist, against GP's advice, did his best to discourage us from seeing cardio, told we would be wasting our money.

    Cardio was shocked and carefully explained to me the ECG, looked normal at first glance, but then the arch was extended and stretched out, sorry not medically trained, so don't know the correct terms, he had EF 23% that same afternoon echo confirmed dialated cardiomyopathy. His blood pressure was normal, and no swollen ankles, but very breathless. With medication and walking his EF came back to 45%.

    How did I know, talked to my sister who's a very senior nurse, and she laughed and said you lived your entire life with it, in fact when you were born your father had dialated cardiomyopathy, so you knew what it looked and felt like, she was right, same breathlessness.

    Husband has gone on to have 100% branch bundle blockage, again happened at home, after months of complaining about left bicep pain and weakness in left arm that was dismissed by cardiology dept outpatients, as rotator cuff, arthirits of shoulder, torn muscle in arm, and even when his heart was beating at 30BPM, pinched nerve in his neck, I lost it at that point and told the junior Dr, he had better go back to medical school, and wasn't very polite about it, he then went on to withdraw some of his heart meds, and heart dropped to 23BPM, at that point we got to see the senior consultant, told him our story about bicep pain, and falling EF, echo confimed, over previous year, he growled at junior and ordered him to his office in front of us, came back some time later and said pacemaker and defib to be installed that afternoon.

    Interesting that after pacemkaer installed he said to us he could breathe, he also started peeing, and passed about 2 kilos of fluid over the following 24 hours, and over the following few months, his very slow peeing, enlarged prostrate seems to have improved as well, improved blood supply.

    I still try to watch his fluid balances, weight himself every morning on a regular basis, and record in school notebook, (hospital has photocopied a number of times), take his blood pressure and heart rate (omron), and generally keep one eye on him, still no swollen ankles, and no fruusemide required although we do have a bottle of tablets if and when we need it. 

    Has never had any chest pain.

    Last time he was in hospital a few weeks ago, he was put on a drip and a jug of water was given to him, I arrived for visiting time, took one look and said he is in fluid overload, married 45 years, so I know my husband, demanded of nurses they remove the drip, refused, and I took out of his reach the jug of fluid. 4 hours later a Dr finally arrived and agreed with me, weighed him which was again refused for me, 2 kilo's difference from 7am to 4pm in the afternoon, GRRRRR.  also pointed out to visiting Dr, from another ward, that should his panadol be at Max dose, when his liver functions were that high, and pointed out to him the results as I understood them to be very high, panadol halved immediately and congratulated again that I knew what I was talking about.

    Why oh why do I have to be the one recognizing in the first place he had a heart issue, secondly recognised that the bundle block was failing, and did fail, and again when he had a virus that the Dr's had ordered up a drip and not taken into consideration that he had heart failure and was very prone to fluid overload, nurses constanly checking his ankles, and me pointing out that he has NEVER got swollen ankles even during the period of 23% EF, yes skin felt wet, as if he had be sweating, but in air-conditoned room he should not be sweating and feeling wet on his forearms, and shins, but thats where I can touch and feel if he is in fluid overload. GRRRRRR, I can and do get really hostile with Dr's NOT DOING THEIR JOB CORRECTLY.

     

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    • Posted

      the water retention i have is very weird it feels at times like water is running down my legs on the outside i nearly always touch them to see before i realise it must be inside it is a real funny feeling.I ave been on 80mg freusimide for over 3 months now some days hardly use toilet so drink more but if i drink more carry more i have put almost 3 stone on in 6 months but am sure most is still water x 
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    • Posted

      You local GP, if he reffered you to the cardio, should have a report from the cardiologist.

      You do know I assume that the person who does the echo is only the driver of the machine they will not tell you anything, its more than their job is worth to comment.

      The cardiologist then reads the results of the echo and writes a report to you local GP, so unless you see them immediately after the echo as we did, maybe at her request, and she explained to us exactly what was wrong with husbands heart, GP Dr got that same report a couple of days later. We got a copy when husband collapsed at home, and when we got to the hospital and staff asked had we seen a Dr in the last few days, yes, and gave the Dr's name and where she was, nurses later that night handed me a copy of the letter she sent to the hospital, same letter she had sent to the local GP, as it had his name at the top of the letter.

      It makes for very tough reading, even though it had been explained to us in the cardio's office, having it in writing really makes it hit home.

      I keep a copy of that letter in a brief case along with all his other letters and reports, from echo's, x-rays, cat scans, GP's notes, I ALWAYS ASK FOR A COPY. and have used this briefcase a number of times when he has presented at the hospital for other issues, even in outpatients cardio appt, and the young Dr said to me, oh we have only been sent his old file, threw the briefcase up on the desk and said what would you like, I have copies of everything incl his last outpatients appt report to our local GP, his face fell, making excuses NOT GOOD ENOUGH, we went though the case together, with me producing the letters he asked for.  I read these letters and try to get an understanding of what they are saying, use the dictionary, to understand the new words and get myself educated about what these medical words mean.

      You need to bluntly ask the Dr, do you have a heart issue, YES OR NO, and make sure you understand what they are saying, and TAKE THEIR ADVICE, ask questions, until you do understand, Dr's seem to like you taking an interest in you own health and issues, I certainly have found that out, and the few that have taken offence, changed Dr's, from our first who said their was nothing wrong with husband, I was offended.

      Husband is only alive because we took their advice, even though he was very ill when he first left the hospital, I insisted he walk, 20 steps, 3 x times a day for a start, which he was struggling to do in the hospital, and then slowly slowly, every 10 days or so adding another 20 -30 steps, by 18 months walking 3 miles a day, still doing it 6 half years after his estimated death date, we even have a copy if that letter, we can laugh at it now.

      Water intake for heart failure patients is very important, you can overload on water very easily, he only drinks 1 & 1/2 litres a day on cool days, if he is walking and sweating, we have to estimate how much he has sweated out, and add that amount to his fluid, I even weigh his t-shirts sometimes when they are very wet, to see how heavy they are compared to dry weight, I have a very good set of balance scales, old fashioned scales but very accurate.

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    • Posted

      the cardiologists receptionist said the concultant had not had a good look at all my tests together when i phoned last tuesday she said as soon as he does a report will be sent to me and my GP i keep telling myself no news is good news but makes me anxious all the waiting the only thing the lady said at scan was she couldnt see anything major and the doctor will be in touch. i am seeing a GP on Monday so i will ask questions again hopefully we will have results and can have other tests to rule things out the sooner the better though x

       

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    • Posted

      I do apologise for the treatment you received, without actually seeing a patient all I can do on this forum is speculate. I wish I could have people on here send me their ECGs then I would get a clearer picture of what is happening. If you ever feel like a doctor is not doing his best to help then tell them. We are all trained to do what we can to diagnose, treat/cure. I myself have been studying cardiology since 2002, I currently work as a GP. On these forums you should not expect a diagnosis of any kind, I will say what I believe the problems may be but never will I say "you have" as mentioned above, heart related pain usually presents with a particular type of pain, but you are very correct in that you don't need to have chest pain to have a cardiovascular disorder. The junior doctor you saw sounded like he didn't do a consultation with a senior. How is your husband doing now?

      The extended arch you describe sounds like a P-R interval or perhaps an inverted T wave, this is usually an instant red flag as it means there is evidence of a blockage depending on the lead. Has your husband always suffered from bradycardia? (Slow heart rate)

      Also curious as to why that wasn't spotted on the ECG... This case is definitely something that needs looking into.

      Mark.

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    • Posted

      No, bradycardia was a complication I believe of his dialated cardiomyopathy, although never had it directly confirmed by the consultant, it came on very suddenly about a year and half ago, at 6am in the morning feeling weak in the legs, and dizzy, I used our little omron, BP normal, heatbeat 30BPM., I wasn't even dressed, started throwing clothes on, and he disappeared, lying across back seat of car, semi-concious, drove him to heart hospital, they had him on monitoring in ER, with external de-fib, and then transfered him to ward with monitoring, during the night heartbeat dropped to 23BPM, BP still normal.

      I believe they came very close to losing him, even though his heart dropped to 23 BPM, they continued to say while his BP remained normal he was OK, I disagreed, his hands and feet were white, and he wasn't peeing, nor were his feet swelling, but could not sit up, lying flat he was concious, and could talk to me, but sitting up lapsed into semi-concious, not with us.

      Post instalation of pacemaker he was discharged the following morning, I notice his bowel did not operate for about 10 days, starting to get very concerned, but he was not running a temp, still peeing like horse, and then everything seemed to just come right.

      Left branch bundle block was picked up when Dr's doing a prostrate biopsy under sedation, apparently scared them to see a patient so unwell under sedation.

      His Ecg looked like to the best of my memory, normal at first glance, except for the big spike of the LBBB, but apparently the arch, is suppolsed to cover about 4 squares of the background micro graph, all being well, and it covered 14 squares, that what the cardio showed me to the best of my memory, and she smiled at me and said the GP should not have missed that.

      He is doing amazing well, walks about 3 - 4 km's a day, spends 15 minutes a day on a stationery bike on our deck, his last echo came back at 45%, cardio team very pleased they told us, that was am improvement on his previous echo of 34% when they installed his pacemaker, told unlikely we will get further improvement.

      He keeps himself really busy, fixes lawmowers for all our neighbours at cost, mows our lawn, we run air-con on very humid days and nights, as he does start to get really breathless with high humidity, he is very driven, and cannot just sit still, does not understand the meaning of the word.  He would have swum in the 1972 olympics if he could have afforded the costs at the time, held all sorts of records when he was much younger, would have been up against Mark Spitz, I once asked him could he have beaten him, he thinks he would have given him a run for his money.

      His lung function is still astounding, the little local GP's lung function test, goes to the top of the graph and bounces along the max setting, GP laughed when I asked was it good, better than good I was told.  The hospital I remember did an enclosed pod test so they would know exactly what his lung function was, but that was 6 years ago.

      He is in the care of the Russell Denman team at Prince Charles Hospital, Brisbane, very very good team even if I have had issues occasionally.

      I find it interesting that he does not get swollen ankles, his sister also has a heart issue, electrical, and from what I understand the Dr's have said both husband and husband sister both have no plaque in their arteries, or very little, and that has been a big bonus in his survival.

      Have just found out the last few weeks, that there is a genetic issue with the family, nephew has lost multiple children prior to birth, found to have heart issues, suggested it may be marfans.

      Is their a genetic test for marfans, need to talk to Dr's, as this could affect our children and grandchildren I suspect.

      Also have thought about NO PLAQUE, cannot husband and sister in law give to university study because isn't plaque the biggest killer of them all, I know husband would be willing to give blood, or tissue to help, or are as we told by Dr's no one is interested as all studies are funded by drug co's, and why would they want to discover why a few do not have plaque and can it be found why genetically.

       

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  • Posted

    no i stopped without any help at all i had no choice i wasnt a heavy smoker but i couldnt justify smoking when i couldnt breathe so stopped it hasnt bothered me at all but i think thats because im not ok still . can it just come on like that it was as though i hit a brick wall back in June one minute picking up the next wham struggled ever since . the lady who did the echo cardiogram reccomended i ask for a 24hr ecg and the treadmill . i too think it is more lungs and not heart it was and still is doctors that are focusing on the heart at moment as i had a spirometer test and was ok 92 they originally told me to stop the inhalers but another doctor put me back on them x

     

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    • Posted

      Yes, a 24 hour ECG will definitely open a door to what the issue is. If anything it may even rule out a heart problem. Perhaps get a bronchoscopy if you can. Physically seeing the lungs might be the way to go.
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    • Posted

      Thank you yes i agree apart from the bronchoscopy it terrifies me the thought of having that done im sure my mum had it done 12 year ago and she said the experience was awful she felt like a little bird gasping for air x
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  • Posted

    my ecg and cardiology report was pulse 74 bpm blood pressure 133/ 93 mm hg bilateral pedal oedema was told to continue with Broncho inhalers and water tablets. referred for echo cardiogram to assess left ventricular functions and rule out significant valvular disease. ECG sinus rythm 64 bpm QRS duration 76 milliseconds QTC 400 recent thyroid functions show increased levels of TSH like i said this test was repeated and was told it was ok x I did phone the hospital spoke to cardiology nurse and asked if results of scan were back i was told the doctor will be in touch and she asked if i had someone with me as i needed not to be on my own at any time this did worry me and i think i did have a few anxiety attacks i have never had them before and again were awful feelings x

     

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    • Posted

      Your results sound normal but obviously I can't see the results so that's all I can say... in regards to them advising you to have someone with you it is a simple precaution when waiting for results from heart related tests.

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    • Posted

      Helen - I can assure you that when results are a worry to the echo operator, and or cat scan have a worrying issue.

      For example husband had a cat scan about 8 weeks ago, late in the afternoon, about 4pm, told the results would come in about 3 days.

      Husband collapsed later the same afternoon, and hospital was interested in the results of the cat scan, asked where it was done, I suggested the clinic was closed, and told not to worry about that.

      I don't know quite what happened, but results through by 8pm that evening, faxed to the hospital on the cat scan clinics letterhead, given a copy by the hospital staff.

      I assume the radiologist was called in to the cat scan clinic and or the cat scan was forwarded to the hospital, but it was read that afternoon/evening, so if its deemed urgent, they get the reading done ASAP, so in your case, not urgent enough to rate a few days wait is good news I would think.

      Similar happened may years ago with daughter, asked to wait for results, radiologist came out and said I don't want to frighten you, but you need to go straight to the hospital, here is the MRI Scan, and report, they must have rung the hospital while we were on the road, because as soon as we arrived and gave our names we were seen immediately, and daughter admitted for assessment, consultant seen with his big team of juniors, saw surgeon the same day, end result in-operable brain tumor, and or damage to get it out would be catastrophic, that explained her headaches, but it has never grown any more, she still sees consultant on a regular basis, and they MRI her every so often, she is very well and touch wood has not had any more problems, even had two children with consultant's cautious approval.

       

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    • Posted

      I think one of the reasons i was told to make sure someone was with me was my breathing was very bad  i was wheezing really badly and probably sounded worse over the telephone. I agree i dont think there is going to be any problem at all with my heart i would just like the results so we can look into what actually is wrong x
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    • Posted

      I have attended an appointment with my GP today still no results from the heart scan but GP said he will chase them up as my health is deteriorating rapidly my ankles are really swollen so increased water tablets now on 12mg daily to have inhaler as much as i need. He said i will be admitted to hospital soon and things will go faster if my condition deteriorates much more i am breathless all the time but even more so when going upstairs etc so was told to rest as much as i can its a viscious circle if i sit feet swell and i become stiff if i move about i get chest pain breathless i cannot cope with much more feel dreadful GP said hang in there but how much longer x
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    • Posted

      I am very sorry to hear your condition is worsening. Water retention is not fun at the best of times, something that may help.. When you go to bed sleep with your feet elevated, use pillows or something to raise your feet a bit. Gravity will help reduce swelling and excess water will be absorbed and evacuated naturally. Also see if you can get hold of a vitamin B6 supplement. All the above plus your medication should help reduce water retention. I am just curious.. have you been tested for or diagnosed with diabetes?
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    • Posted

      I do have feet elevated the whole time when resting. that was supposed to say 120mg frucemide. I have today received letter from the cardiologist saying no heart problems basically but due to increased shortness of breath to look at respiratory causes also with the oedema in ankles fee tto look at vascular causes so this is reassuring in the fact it isnt my heart at all. no i dont think they have looked at Diabetes this time they ruled out Thyroid after second test was ok Thank you for your advice x
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    • Posted

      i am a little confused as if its vascular does that mean lung. if so i dont understand i had a spirometry test at the surgery and they said it was fine 92% so took me off the inhalers this is when i went down hill breathing plummeted also mobility they put me back on the inhalers and i have more or less remained stable mobility is getting less as shortness of breath has increased. x
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    • Posted

      Hi,

      vascular conditions refer to the arteries, in your case this could well be the thickening of the artery walls, or an autoimmune disease... You may wish to get checked for vasculitis, specifically "takayasu arteritis" I hope I spelt that correctly... So yes it will not explain the water retention to a point but it's a place to start to finding some answers and hopefully ruling out arterial deterioration.

      Also I mentioned it sounds a lot like you have asthma, This and water retention can go hand in hand especially for women, definitely look into getting this checked out.

      Ask your doctor about the above for a second opinion as I may have missed something (can't be too careful)

      Do let me know and I wish you all the best.

      Mark

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    • Posted

      Thank you i am really getting tired now i am unable to walk more than a few steps so tired i cant eat properly now as i cant breathe and eat i am wheezt and out of breath just sat if i go upstairs i am worse and need to rest a few minutes before coming back down. i talked to a doctor last week but because my regular GP was not there they were reluctant to do anything just saying she had put a not for him to telephone me Monday if i were to get worse they would see me at Aan E I AM WORSE EVERY DAY I HAVE REVILLAR INHALER EVERYDAY AND BLUE VENTOLIN WHEN NEEDED I DARENT TAKE IT ALL TIME SO LIMIT TO 3/4 times a day when need it most i feel like i have a tight corset on constantly and niggly chest pains tomorrow cant come quick enough i am just hoping he is able to give me something else while waiting to have lung tests if thats what he has decided to do if not i will have to take a trip to the hospital emergency something i am reluctant to do i dont like tying the emergency doctors up but cant go on like this x

       

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