If you or someone near you has chest discomfort right now with sweating, breathlessness, or pain going to the arm or jaw: stop reading and call 108. Do not wait to see whether an acidity tablet works.
“It must be gas” is the most common thing people say in the first hour of a heart attack. Sometimes it is gas. This page explains how doctors think about the difference, and why, when in doubt, the safe choice is a hospital and an ECG.
Why the two get confused
The heart sits just above the stomach, and the body is poor at telling where pain inside the chest is coming from. A heart attack can cause a burning or full, bloated feeling in the upper stomach. The NHS lists “feeling like you have indigestion” among heart attack symptoms. Heart guidelines list upper stomach pain and “heartburn unrelated to meals” among the symptoms that can go with a heart attack.
So no one, including a doctor on the phone, can be sure from the description alone.
Signs that point towards the heart
- Pressure, squeezing, tightness or heaviness in the centre of the chest, more than a sharp pain
- Discomfort that is deep and hard to point to with one finger
- It builds up over a few minutes and lasts more than a few minutes, or goes away and returns
- It spreads to one or both arms, the neck, the jaw, the back or the upper stomach
- It comes with cold sweat, breathlessness, nausea or vomiting, or lightheadedness
- It comes on with walking, climbing or strain and eases with rest
Signs that make the heart less likely
Chest pain guidelines say the heart is a less likely cause when the pain is:
- sharp or stabbing, and lasts only a few seconds
- worse on taking a deep breath or on changing position
- in one small spot that hurts when you press on it
- moving from place to place
Less likely does not mean ruled out. If one of these pains comes with sweating or breathlessness, or you have diabetes, high BP, or a family history of early heart disease, get it checked.
Not everyone gets chest pain
In a large American study of over 430,000 people with heart attacks, one in three had no chest pain when they reached hospital. They were more often older, women, and people with diabetes. In another study, 42 in 100 women and about 31 in 100 men had a heart attack without chest pain.
In these groups especially, take seriously:
- sudden breathlessness
- unexplained sweating
- sudden unusual tiredness or weakness
- nausea, vomiting, or upper stomach discomfort that is not like their usual acidity
- lightheadedness or confusion
It happens earlier, and people come late
In a large international study, the average age at a first heart attack was 53 in South Asian countries, about six years younger than elsewhere. Being 40 is not protection.
And in a study of nearly 21,000 patients across 50 Indian cities, half took more than six hours from the start of symptoms to reach a hospital. The treatments that open a blocked artery work best in the first hours. Guidelines aim to open the artery within about 90 to 120 minutes of the first medical contact, and note that every 30 minutes of delay raises the risk of dying within a year.
Most of the delay is at home: waiting, trying an antacid, not wanting to trouble the family at night.
What to do in the first minutes
- Call 108 (the ambulance number in Andhra Pradesh and Telangana). 112 is the national emergency number.
- Stop all activity. Sit or lie down. Do not walk to the hospital or drive yourself.
- Do not wait for an acidity tablet, soda or home remedy to work.
- Aspirin: the ambulance staff or doctor may ask the person to chew one plain aspirin. Do not give it to anyone who is allergic to aspirin or has been told by a doctor not to take it. Do not delay the call to look for a tablet.
- Go to a hospital that can do an ECG at once, and preferably one with a heart unit (cath lab).
- Take along the list of regular tablets and any old ECG.
What happens at the hospital
Guidelines say an ECG should be taken and read within 10 minutes of arriving with chest pain. A blood test called troponin is done and repeated after one to three hours, because it takes time to rise.
One normal ECG does not close the question. Guidelines state that a normal first ECG does not exclude a heart attack. That is why you may be asked to stay for some hours even when the first tests are normal. Staying is not a waste of time: see ECG report words explained.
If it turned out not to be the heart
That is a good result, not an embarrassment. Doctors would much rather see ten people with gas than miss one heart attack.
If the discomfort keeps returning, especially with walking or climbing, ask whether further tests are needed even though the ECG at rest was normal. And if you are on heart tablets after a stent, see Tablets after a stent.
What an online consultation cannot do
Chest pain that is happening now cannot be handled on WhatsApp, by this clinic or any other. An online answer takes hours; a heart attack needs minutes. Send reports for an opinion only when the person is stable and the question is about what a report means or what to do next.