• Heart Attack and Conditions That Mimic Heart Attack: Learn About Chest Pain


    There are many medical conditions that can mimic a heart attack. Some of these are a sign of something urgent, and others are not. Remember, if you are experiencing symptoms of a heart attack, dial 911. A few possible non-heart-attack causes of chest pain are described below. Your physician can help you identify the cause of any chest pain. There are other causes of chest pain that relate to the heart as well as non-heart-related causes of chest pain. You can learn about many of the causes of chest pain here, but first it is important to learn about heart attack and conditions that mimic it.

    What Is a Heart Attack?

    A heart attack happens when a complete blockage suddenly forms in an artery that supplies blood to your heart (a coronary artery). Blockages are caused by a disease process throughout the arteries in your body called atherosclerosis, in which plaque (a fatty substance) builds up in the arteries. This plaque narrows the arteries, leaving less room for blood to flow. A plaque can be topped with a thin, fibrous cap that ruptures. With rupture, exposure of atherosclerotic debris to the bloodstream can cause platelets (a component of blood that assists with clotting) and red blood cells to collect at the site of the rupture, cutting off blood flow to the artery. Alternatively, part of the plaque may break off and flow downstream in the blood. This piece of plaque can then lodge in a narrowed portion of the artery and blood will begin to clot around it. This blood clot (thrombosis) can partially or completely cut off blood flow through the artery. When blood flow is cut off, this is called ischemia.

    A heart attack is an emergency that requires immediate medical attention. Here's why:

    Your heart is a muscle. Blood carries vital oxygen and nutrients to the heart muscle, and without blood, the heart muscle begins to die. That is why every second counts when it comes to heart attack treatment. An extensive blockage, especially in a major blood vessel, such as the left anterior descending artery, can cause a large heart attack. Large heart attacks that are not treated early and aggressively can lead to heart failure. The risk of death within five years of being diagnosed with certain types of heart failure can be 50 percent or more, worse than many forms of cancer.

    It is better to go to the hospital and learn that you are not having a heart attack than to stay home and have one. That’s because the consequences of an untreated heart attack are so great. If your symptoms persist for more than 15 minutes, you are at more risk that heart muscle cells will die. It is critical for you and your heart that you receive immediate medical attention. To receive the best care, you have about 90 minutes from the onset of the heart attack for an interventional cardiologist or surgeon to restore the flow of blood to the heart before critical heart tissue dies or is damaged.

    Know that today your chances of surviving a heart attack – and surviving it well – are greater than ever, and that patients and physicians are a team working together for heart health. Recognition of the symptoms of a heart attack and seeking prompt medical attention are crucial in improving one’s odds of surviving a heart attack, so the first and probably most important link in the battle against CAD is seeking PROMPT medical attention when there is any suspicion of a heart attack.

    Symptoms of Heart Attack

    Many heart attacks involve discomfort in the center of the chest that lasts longer than a few minutes or that goes away and comes back. It can feel like -

    • Uncomfortable pressure,
    • Squeezing,
    • Fullness, or
    • Stabbing pain.


     Heart attack symptoms include -

    • Chest discomfort
    • Discomfort in other areas of the upper body:  one or both arms, the back, neck, jaw or stomach
    • Shortness of breath with or without chest discomfort
    • Pounding heart or changes in heart rhythm
    • Heartburn, nausea, vomiting, abdominal pain
    • Breaking out in a cold sweat
    • Dizziness or lightheadedness

    Heart Attack Symptoms May Be Different in Women

    These heart attack symptoms are more common in women. They may occur without chest pain.  

    • Sudden onset of weakness,
    • Shortness of breath
    • Nausea, vomiting, indigestion
    • Body aches
    • Overall feeling of illness
    • Unusual feeling or mild discomfort in the back, chest, arm, neck or jaw (Remember, these may occur without chest pain and still be a heart attack)
    • Sleep disturbance

    People who have diabetes or are elderly may also experience atypical heart attack symptoms.

    If you or someone you are with experiences any of the symptoms above, get help immediately. Don’t delay. 

    In a heart attack, every second counts. Dial 911 to get to the hospital as soon as possible.

    If you can, chew an uncoated aspirin tablet. This can help slow blood clot formation while you wait for emergency medical technicians (EMTs) to arrive in an ambulance.

    Unstable Angina

    Angina is chest pain caused by a lack of blood flow to the heart due to narrowed or blocked heart arteries. Most commonly it is the result of coronary artery disease (CAD). Angina occurs when the heart is not getting as much blood and oxygen as it needs to pump. Angina that occurs with increasing frequency, with decreasing levels of physical activity, at rest or that is not relieved with rest is called unstable angina. Unstable angina requires immediate attention because it can be the first sign of a heart attack. In unstable angina, blood work that assesses for damage to the heart muscle is negative, indicating no heart attack (yet). Generally, at rest, there is still some blood flow beyond a severe blockage, and so there has not been damage to the heart.

    Stable Angina

    Angina that occurs with exercise and is relieved with rest is called stable angina. In stable angina, the stimulus that causes the chest pain is relatively stable and reproducible. For instance, a patient with stable angina may report that he or she gets chest pressure with walking ten minutes on the treadmill, that the chest pressure is relieved with rest, and that the symptoms have been relatively stable for the past several months. Additionally, the patient may report that he or she can easily do some activities at home, such as walking one mile slowly, but that increasing the level of exercise by walking faster brings on chest pain.

    The chest pain is a sign that blood flow to the heart is being restricted by build-up of plaque (a fatty substance) in the coronary arteries that supply blood to the heart. While a patient with stable angina is not likely to be at immediate risk for a heart attack, the condition does need to be treated. Medications and lifestyle changes will be part of treatment. If the angina is very painful, the patient may consider angioplasty to reopen the narrowed arteries or cardiac bypass graft surgery to reroute blood flow around the blocked blood vessels.

    Broken Heart Syndrome (Takotsubo Syndrome)

    (A) Schematic representation of takotsubo cardiomyopathy
    (B) Compared to the situation in a normal
    person (B)
    The Japanese octopus traps after which Takotsubo Syndrome is named.

    Physicians know that there is something behind the folk idea of a broken heart. Occasionally, a person may arrive in the emergency room with the symptoms of a heart attack, including the presence of cardiac enzymes in the blood that indicate damage to the heart muscle, as well as abnormalities on an electrocardiogram (EKG or ECG). However, no blockages will be discovered in the arteries that supply blood to the heart. Instead, in these patients, the heart’s main pumping chamber, the left ventricle, contracts in an unusual pattern. With contraction, this ventricle will be shaped like a fishing pot used to trap octopuses, the tako-tsubo pot – an observation made by the Japanese physicians who were the first to identify the syndrome. In other words, the bottom of the heart does not squeeze well (akin to the base of the pot) while the top part of the heart does squeeze well (akin to the neck of the pot).

    While takotsubo syndrome is not well understood, researchers think the left ventricle may be “stunned” and unable to function because of a surge of stress hormones after the patient experiences a severe emotional or physical trauma, such as a death of a loved one or an automobile accident. The syndrome usually resolves quickly and without lasting damage to the heart, but it can, in very rare cases, be fatal. If you experience signs of a heart attack, dial 911 right away.

    You can learn more about Broken Heart Syndrome here.

    Esophageal Spasm, Gastroesophageal Reflux Disease (GERD)

    Gastroesophageal reflux disease (GERD) is a condition in which you have chronic heartburn. Esophageal spasm is when your esophagus, the pipe that carries food from your mouth to your stomach, strongly contracts. Either of these conditions can cause chest pain and can be hard to distinguish from a heart attack since the esophagus runs directly behind the heart within the chest. If the symptoms you experience are unusual for you, sudden, and severe, don’t be embarrassed to seek immediate medical attention. It is better to seek treatment and find out you have heartburn than to ignore a potentially fatal heart attack.

    Pulmonary Embolism (blood clot in the lung)

    Some forms of chest pain may originate from your lungs, rather than your heart. One lung problem, pulmonary embolism, can mimic a heart attack and is equally serious. A pulmonary embolism is a blood clot in an artery in the lungs. This clot cuts off blood flow, and the lung tissue begins to die. A pulmonary embolism is a life-threatening medical emergency that requires immediate treatment.

    Aortic Dissection (tear in the wall of the aorta)

    The aorta is the main artery that brings blood from the heart to the rest of the body. The wall of the aorta is made of three different layers. If there is a tear in the innermost layer, blood pumped from the heart may push under this flap and separate one layer from another. This separation causes a tearing chest pain that sometimes goes to the back. This tear in the aorta can extend up to the carotid arteries to the brain, back to the coronary arteries of the heart, or down to the arteries of the legs. Aortic dissection may cause stroke, heart attack and death. It is a life-threatening medical emergency that requires immediate treatment.

    Musculoskeletal Pain

    Sometimes chest pain may be something as simple as a pulled chest muscle. Inflammation in the cartilage that connects the ribs to the breastbone can also feel like a heart attack. If you have sudden chest pain that is causing you concern, you should seek immediate medical treatment to rule out a serious condition.

    Psychological Disorders That Can Cause Chest Pain

    Panic disorders, anxiety, depression, emotional stress or other psychological disordersmay also cause chest pain. In these psychological disorders, the chest pain is not related to angina or digestive causes but instead seems to be triggered by the emotional stress. Emotional stress is a relatively common cause of chest pain, but it is extremely important that you see your doctor to rule out coronary artery disease (CAD) before attributing your chest pain to psychological disorders, even if you do not have a history of coronary artery disease.