When your chest hurts, your brain screams heart attack. But not every ache means your heart is failing. In fact, most chest pain isn’t cardiac at all. Still, waiting too long can be deadly. Knowing when to call 999 and head to the emergency department isn’t just smart-it’s lifesaving.
What chest pain really looks like
Chest pain isn’t always a sharp stab or crushing weight. It can feel like pressure, tightness, or a dull ache. And it doesn’t even have to be in your chest. Many people feel it in their jaw, neck, back, shoulders, or even the upper belly. Some describe it like a heavy backpack strapped across their chest. Others say it’s like indigestion that won’t go away.
It’s not just pain. Look for the full picture: shortness of breath, cold sweat, nausea, sudden fatigue, or dizziness. These are the silent signs that often show up in women, older adults, and people with diabetes. They’re called anginal equivalents-symptoms that mean your heart isn’t getting enough oxygen, even if the chest pain is mild or absent.
When you must go to the emergency department
Don’t wait. Don’t text a friend. Don’t Google it. If you’re experiencing chest discomfort and any of these, call 999 right away:
- Pressure, squeezing, or tightness in your chest that lasts more than a few minutes
- Pain that spreads to your arm, neck, jaw, or back
- Breaking out in a cold sweat for no reason
- Feeling like you’re going to pass out
- Shortness of breath that comes with chest discomfort
- Nausea or vomiting along with chest pressure
These aren’t guesses. These are the red flags backed by the 2021 American Heart Association guidelines. If you have them, you could be having a heart attack-or another life-threatening condition like a pulmonary embolism or aortic dissection. Every minute counts.
What happens in the emergency department
When you arrive, the team moves fast. The first thing they do? Get an ECG within 10 minutes. That’s not a suggestion-it’s a strict standard. The ECG can show if your heart is in immediate danger, like a full blockage (STEMI). If it does, they’ll rush you to the cath lab. Door-to-balloon time? Less than 90 minutes. That’s the goal. And it saves lives.
Next, they’ll check your blood. High-sensitivity troponin tests are now standard. Troponin is a protein that leaks into the blood when heart muscle is damaged. Two tests, one hour apart, can rule out a heart attack in 70-80% of people within just two hours. That’s faster than ever before.
They’ll also check your vitals: heart rate, blood pressure, breathing rate. If you’re tachycardic (heart rate over 100), hypotensive (BP under 90), or breathing fast (over 20 breaths per minute), that’s a red flag. So is sweating, crackles in your lungs, or a new heart murmur. These aren’t random signs-they’re clinical markers that point to serious trouble.
Why you shouldn’t drive yourself
Some people think, “I’ll just drive myself.” Don’t. Transporting yourself by car increases your risk of a cardiac arrest en route by 25-30%. Ambulances aren’t just for transport-they’re mobile ERs. Paramedics can start oxygen, give aspirin, monitor your heart, and even deliver clot-busting drugs before you even hit the hospital. They can also send your ECG ahead, so the team is ready when you arrive.
Calling 999 isn’t dramatic. It’s the smartest thing you can do.
What if it’s not your heart?
Most chest pain isn’t heart-related. Muscle strain, acid reflux, anxiety, lung infections, even a rib injury can cause it. But here’s the catch: you can’t tell the difference on your own. That’s why doctors use tools like the HEART score-History, ECG, Age, Risk factors, Troponin. It’s a simple, evidence-based way to sort low-risk patients from those who need more testing.
If you’re low risk (HEART score 0-3), you might be sent home with follow-up. But if you’re intermediate risk (4-6), you’ll likely get a CT scan of your heart’s arteries (CCTA) or a stress test. High risk (7-10)? You’re going straight to the cath lab.
And yes, some people have ischemia with no blockages-called INOCA. It’s rare, about 5% of cases, but real. These patients need specialized care, not just a dismissal.
What to do if you’re unsure
Uncertainty is the enemy. If you’re asking yourself, “Should I go?”-you should go. The goal isn’t to avoid the ER. The goal is to avoid dying because you thought it was just gas.
Think of it like smoke in your house. You don’t wait to see if it’s a candle or a fire. You call the fire department. Same here.
And if you’re helping someone else? Don’t wait for them to “get better.” If they’re pale, sweaty, and saying their chest feels tight, call 999. Even if they insist it’s nothing. Your intervention could be the difference between life and death.
What’s changing in chest pain care
Emergency departments are getting smarter. By 2025, most U.S. hospitals will use AI to read ECGs. Early tests show AI spots subtle changes human doctors miss-like tiny ST-segment shifts that signal early heart damage. That means faster, more accurate decisions.
High-sensitivity troponin is now used in 90% of U.S. hospitals. In the UK, adoption is rising fast. These tests cut down unnecessary hospital stays by thousands every year. But they only work if you get them early-and that’s why timing matters.
The big takeaway? Chest pain evaluation isn’t about fear. It’s about precision. We don’t overtest anymore. We test the right way, at the right time, for the right people.
