Chest pain: causes, symptoms and when to call 999

The NHS says chest pain has many different causes, and in most cases it is not caused by a heart problem. It advises you not to self-diagnose: see a GP if you are worried. The NHS table below shows how symptoms can point towards a cause.

The NHS says the most common heart problems that cause chest pain include pericarditis, which usually causes a sudden, sharp, stabbing pain that gets worse when you breathe deeply or lie down, and angina or a heart attack, which have similar symptoms but a heart attack is life-threatening. The BHF also lists myocarditis, where parts of the heart are inflamed, usually following a virus.

You are more likely to have heart problems if you are older or at risk of coronary heart disease. The NHS says you may be at risk if you smoke, are living with obesity, have high blood pressure, diabetes or high cholesterol, or have a history of heart attacks or angina in family members under 60 years old.

On angina, the BHF says that if you have not been diagnosed with angina and have chest pain that stops after a few minutes of rest, you should get an urgent doctor's appointment. If the pain does not stop after a few minutes of rest, call 999 immediately because you could be having a heart attack.

The BHF says people experience pain differently. Chest pain may feel like tightness, squeezing, a dull ache, or pressure like someone sitting on your chest, or you may just feel uncomfortable, as if something is off. It can be on the left side, the right side, at the centre or behind the breastbone, and it can stay in one place or spread to the shoulder and arm, neck and jaw, or stomach and back. It may be constant or come in waves.

Triggers may suggest the cause. The BHF gives examples: chest pain after lunch may be a sign of indigestion, and chest pain only in a specific position may be muscular. It also says it can be hard to tell the cause of chest pain, so if you are unsure, seek medical help.

The NHS says to call 999 if any of the following apply, because you could be having a heart attack and need immediate treatment in hospital:

• You get sudden pain or discomfort in your chest that does not go away. It can feel like squeezing or pressure inside your chest, or like burning or indigestion.

• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.

• You have chest pain and you feel sweaty, sick, light-headed or short of breath.

The NHS says to see a GP if you have chest pain that comes and goes, or chest pain that goes away quickly but you are still worried. It stresses that it is important to get medical advice to make sure it is nothing serious.

The BHF also says that if you have been diagnosed with angina and it feels worse, happens more often or changes in any way, you should talk to your doctor as soon as you can.

The BHF says that less common but serious causes include aortic dissection, pulmonary embolism and spontaneous coronary artery dissection (SCAD), and that if you have symptoms associated with these you should phone 999 immediately. It also says it is better to wait for an ambulance than to take yourself to A&E, as paramedics can start helping as soon as they arrive.

NICE guideline CG95 on recent-onset chest pain of suspected cardiac origin says that when an acute coronary syndrome (such as a heart attack) is suspected, management starts immediately and a resting 12-lead ECG is taken as soon as possible. On arrival in hospital, it says to take a resting 12-lead ECG and a blood sample for high-sensitivity troponin measurement.

The guideline says high-sensitivity troponin tests should not be used for people in whom an acute coronary syndrome is not suspected. If chest pain has another suspected cause, tests are chosen to match it, for example a chest X-ray for a chest infection. Your own clinician decides what you need.

Yes. The NHS lists anxiety, depression or panic attack as a possible cause of often sharp, continuous chest pain triggered by worries or stress. The BHF says anxiety-related chest pain may feel similar to heart-related chest pain and is common: the chest may feel squeezed and the heart may feel as if it is racing or skipping beats.

The BHF says that medication, breathing techniques and psychotherapy can help you cope with or control the symptoms over time. Because it can feel identical to a heart problem, new chest pain should still be assessed first.

On the NHS, sudden chest pain is an emergency handled through 999, ambulance and A&E. Chest pain that comes and goes is assessed by your GP, who may arrange tests or a referral to a cardiology or rapid-access chest pain service.

Private cardiology services can offer ECGs, scans and specialist review for people who are not in an emergency. Do not delay a 999 call to arrange a private appointment, and ask how any test results will be shared with your GP.