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Chest Pain: What Does It Mean?

Cardiac, digestive, musculoskeletal — how to tell the difference

Chest pain is one of the most anxiety-provoking symptoms — and rightfully so, because some causes are life-threatening. But the majority of chest pain seen in Nigerian clinics is not cardiac. Knowing how to recognise the pattern, associated features, and red flags helps distinguish a heart attack from heartburn or a pulled muscle — without dismissing something that could be serious.

Signs and Symptoms

✓ Cardiac (heart attack / angina): pressure, tightness, or squeezing in the centre or left chest; may radiate to left arm, jaw, or back; associated with sweating, breathlessness, nausea; often at rest or with exertion
✓ GERD (acid reflux): burning, usually after eating; in the centre of the chest; moves toward the throat; relieved by antacids
✓ Musculoskeletal: sharp, localised pain; worsens when you press the chest wall; related to movement or breathing; no radiation to arm or jaw
✓ Pleurisy (lung covering inflammation): sharp pain, worse with breathing or coughing; often with fever or cough
✓ Anxiety/panic attack: chest tightness, palpitations, dizziness, feeling of impending doom; may occur at rest
✓ Costochondritis: tenderness over the cartilage where ribs meet the sternum — reproducible on pressing
✓ Pericarditis: sharp central chest pain, better sitting forward; worse lying down; may follow viral illness

Risk Factors

When to Seek Help

New central chest pain with radiation to jaw or armTreat as a heart attack until proven otherwise. Call for help, rest, and seek emergency care immediately.
Chest pain with breathlessness, sweating, or collapseEmergency — possible heart attack, pulmonary embolism, or aortic dissection.
Chest pain at rest lasting more than 20 minutesNot typical of musculoskeletal or GERD — requires urgent cardiac assessment (ECG, troponin).
Sharp chest pain worse with breathing + feverPossible pleuritis or pulmonary embolism — requires assessment within hours.

Tests & Diagnosis

🧪 ECG (electrocardiogram)
First-line test for chest pain — shows heart attack, ischaemia, arrhythmia, or pericarditis within minutes.
🧪 Troponin I or T (blood test)
Released by damaged heart muscle. A rising troponin 3–6 hours after onset confirms heart attack. High-sensitivity troponin can exclude heart attack within 1–2 hours.
🧪 Chest X-ray
Looks for pneumonia, pneumothorax, widened mediastinum (aortic dissection), and pulmonary oedema.
🧪 D-dimer
If pulmonary embolism is suspected — a negative result in low-risk patients effectively excludes PE.
🧪 CT pulmonary angiography
If pulmonary embolism is suspected and D-dimer is positive — confirms or excludes PE definitively.
🧪 Exercise stress test / CT coronary angiogram
For stable angina — identifies coronary artery disease.

Treatment Options

1
Heart attack (STEMI/NSTEMI)
Aspirin 300 mg immediately. Nitroglycerin if available. Emergency hospital transfer. Reperfusion (primary PCI or thrombolysis) within 12 hours is the standard of care.
2
Angina
Sublingual GTN for acute attacks. Beta-blockers, nitrates, and calcium channel blockers for prevention. Investigate for coronary artery disease. Revascularisation (stenting or bypass) for significant disease.
3
GERD
Proton pump inhibitors. Lifestyle modification. Antacids for acute relief.
4
Musculoskeletal chest pain
NSAIDs (ibuprofen 400 mg three times daily with food). Rest. Local heat or ice. Resolves within days to 2 weeks.
5
Pericarditis
NSAIDs (ibuprofen or aspirin). Colchicine for 3 months to prevent recurrence. Rest — avoid exercise until symptom-free.
6
Panic attack
Reassurance after cardiac causes are excluded. Controlled breathing. CBT for recurrent attacks.

Frequently Asked Questions

How do I know if my chest pain is serious?
Features suggesting cardiac emergency: central or left-sided pressure or tightness; radiation to jaw, left arm, or back; associated sweating, breathlessness, or nausea; onset at rest or during minimal activity; lasting more than 20 minutes; in a person with cardiac risk factors. When in doubt, seek emergency care — a troponin and ECG take 30 minutes and will reassure or diagnose.
Can young Nigerians get heart attacks?
Yes — hypertension and diabetes are increasingly common in young Nigerians (30s–40s). Cocaine use, which is increasing in urban Nigeria, causes coronary spasm and heart attack in young people. Young adults with cardiac risk factors can and do have heart attacks.
Is chest pain from anxiety real?
Yes — anxiety and panic attacks cause genuine physical chest tightness, often indistinguishable from cardiac pain by description alone. The diagnosis is made by exclusion of cardiac causes after appropriate tests. Anxiety-related chest pain should be taken seriously and treated — it significantly impairs quality of life.
If the ECG is normal, does that mean my heart is fine?
A normal resting ECG does not exclude coronary artery disease or future heart attack. A normal ECG during chest pain significantly lowers the probability of a heart attack, but troponin levels at 0 and 3 hours are still needed to exclude NSTEMI. For stable chest pain, a stress test or CT coronary angiogram is needed.
Should I chew aspirin during a suspected heart attack?
Yes — if you suspect you are having a heart attack, chew (not swallow whole) 300 mg of aspirin immediately. This partially inhibits the clot forming in the coronary artery. Do not take aspirin if you are allergic to it. This is a well-established first-aid measure.

Related Pages

Heart Attack Warning Signs in NigeriaAtrial Fibrillation in NigeriaCoronary Artery Disease in NigeriaHeart Failure in Nigeria

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