Your first step is urgently sorting out about coronary artery disease.



Do you have chest pain right now?

No history of coronary artery disease? Chest pain something new for you, or different to usual? Your safest option is to attend a hospital emergency department, to check for a heart attack.

A quarter to a half of deaths from heart attacks happen in the first hour from the start.Heart pains can be anywhere from the pit of the stomach ( just under the ribs, in the mid line,) to under the jawbone in the front and sides of the neck. In the chest it will be in the mid line mostly. In the back it can be between the shoulder blades. It can be anywhere in the arms, right down to the wrist.


You may not have any other symptoms during a mild heat attack, but it is still very important to check urgently. 51% of people with sudden cardiac arrest in one study had chest pain or breathlessness before the event.

Modern heart attack treatment is very effective in saving lives.

Half an asprin or a teaspoon of cayenne pepper² in water are emergency treatments before you leave for the hospital - but don't delay leaving waiting for one of them.

Any other symptoms?

Pain is not the only heart attack symptom, and particularly in diabetes, heart attacks may have no pain at all (silent ischemia.)

If you also feel faint, breathless, weak or nauseous, these could also be heart attack symptoms. They can also occur with a lot of other conditions, however, particularly with severe chest pain. These range from serious conditions such as a split in your major blood vessel (dissecting aneurysm of the aorta,) or a blood clot traveling up from the leg and lodging in the lung (pulmonary embolism,) to much less dangerous such as acid burns in the gullet (gastroesophageal reflux disease – gerd.)

A lot of pulmonary embolism goes undiagnosed, so being knowledgeable pays - you can ask your doctor about the possibility.

(See note 3 at the end of this page.)


If your central chest pain is affected by posture, is worse on deep breathing and you recently had a respiratory infection, think of pericarditis - inflammation of the sac surrounding your heart, which is nothing to do with coronary artery disease.

Remember always that common things will occur together some of the time. They will coincide purely by chance. If you have ischemic heart disease, you can still get chest pain from muscles. Even if you have gastro esophageal reflux disease already, you can still have a heart attack.

You've already been for a check re: coronary artery disease?

After you have been assessed by a cardiologist, you will probably be asked to undertake a test involving exercise plus either nuclear medicine testing with a radioactive isotope, electrocardiogram (EKG) or ultrasound ( ECHO.)

You may be asked to undergo angiography, where pictures of the coronary arteries are taken with dye introduced via a fine tube inserted in the groin or arm.

One of these tests usually answers whether or not coronary artery disease is present. You will know whether or not you have clogged coronary arteries, but negative tests do not rule out coronary artery spasm. In this condition a test would only have been positive if the coronary artery was in a state of spasm at that time.

Article on this.

Angiography does not show microvascular coronary disease either, only disease of the bigger coronary arteries.
Many women with coronary microvascular syndrome also have a high risk for heart attack.

The "Women’s Ischemia Syndrome Evaluation"(WISE¹) study investigators found that the majority of women with “clear” angiography who are not diagnosed will continue to have symptoms, a declining quality of life, and repeated hospitalizations and tests.



Recurring coronary artery disease chest pains?

next page of this website, about angina pain in coronary artery disease

Angina can be aggravated and prolongued by anxiety.

Cleared of cardiac pain , but thinking about the future?

Looking at modifying your cardiovascular risk?

Non cardiac chest pain pages.

Pointers to chest muscle pain rather than heart pain.

More on finding the muscles and joints involved in your musculoskeletal chest pain

Is your pain out at the side of your chest?
As well as musculoskeletal causes, a pulmonary infarct (venous thrombo embolism - a clot from your leg lodging in your lung,) , pleurisy or pneumothorax are possibilities. Medical check is still essential as these definitely need treatment.



Do you suspect acid reflux is a problem for you?

Does it hurt in your chest as food goes down your gullet?

Diagnosed with eosinophilic oesophagitis?



Zinc nutrition in GERD and many more conditions.


Is the pain in your breasts?



Central retrosternal pain (immediately behind your breastbone,) can be caused by tracheitis or pericarditis.

These are inflammation of your windpipe and covering of heart respectively. Trachea inflammation is caused by acute infection, and you have either a croaky voice or a cough to go with it. Breathing in hurts.

Pericarditis has lots of causes. The pain may be altered by reclining backwards compared with sitting forwards, and is also worse on deep inbreath.



References, notes, for coronary artery disease

1. http://clinicaltrials.gov/ct2/show/NCT00000554

2. Book "Left For Dead" by R. F. Quin (ISBN: 0963283901 / 0-9632839-0-1)

3. Clots in deep veins in the leg muscles are more common in cancer, during immobilization, long flights or bus trips and in the fortnight or so after childbirth or surgery.

Prevention is by blood thinning (asprin, cayenne pepper, long term vitamin E,) exercise and compression garments.

The exercise in a plane or bus, is periodically to sharply fully lift your heel, leaving your toes on the floor. This contracts your calf muscles, pumping blood out of your leg.

Compression works by flattening your veins, so the blood speeds up, like a river in a narrow canyon.

In the above circumstances, sudden breathlessness, with racing pulse, faint feeling or any sort of chest pain, may be due to VTE. A sore swollen calf is likely to come days after this.



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