Causes of Chest Pain - Myocardial Infarction (Heart Attack)

Senior with Chest Pain
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Cause of the Chest Pain:

The pain that usually accompanies a myocardial infarction (heart attack) is caused by an acute blockage of one of the coronary arteries, usually due to coronary artery disease (CAD). This sudden blockage is the result of a ruptured atherosclerotic plaque in wall of the artery.

When the coronary artery becomes obstructed, the heart muscle supplied by that artery immediately becomes severely ischemic (oxygen starved), and if the ischemia persists heart muscle cells begin to die.

The death of heart muscle is what defines a heart attack.

Heart attacks usually produce significant symptoms. Chest pain, or chest discomfort, is typically a prominent part of these symptoms.

Characteristics Of the Pain

The pain accompanying a heart attack is usually similar to classic angina, but tends to be more severe and longer lasting. The pain classically is described as a pressure-like, squeezing, crushing, or tight pain. The pain often radiates to the jaw, shoulders or arms.

However, heart attack pain can often be “atypical.” Sometimes it does not involve the chest at all, but instead may be centered in the back, one or both arms, or in the stomach area. Furthermore, it may not be perceived by the victim as “pain” at all, but rather as a discomfort.

In addition to pain (or discomfort) people having heart attacks will often experience dyspnea (shortness of breath), as well as nausea, sweating, dizziness, weakness, or unexplained fatigue.

Unlike with angina, the symptoms tend to persist, and often builds for at least the first 15 or 20 minutes.

These symptoms often develop quite suddenly - but this is not a rule. The symptoms of a heart attack can build slowly, over a period of hours or even days.

The symptoms of a heart attack is often accompanied by a feeling of intense fear - classically described as a "sense of impending doom."

What To Do

Anyone experiencing symptoms resembling a heart attack needs immediate medical assistance. If it is a heart attack, minutes can make the difference between a long and happy life, or permanent disability or death. Call 9-1-1.

When you arrive in the emergency department, the doctor’s evaluation will include a careful medical history and physical examination, which often point to the diagnosis, and an ECG, which often clinches the diagnosis. Cardiac enzymes (heart proteins that leak into the bloodstream when cardiac cells die) are measured in blood tests to confirm the diagnosis. Evaluation of suspected heart attacks must occur rapidly and expeditiously, because early and aggressive therapy can preserve heart tissue and greatly improve the chances of your disability-free survival.

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O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.

Svavarsdottir, AE, Jonasson, MR, Gudmundsson, GH, Fjeldsted, K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician 1996; 42:1122.

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