Writings
Not Every Chest Pain Is a Heart Attack
Originally published on Substack.
I still remember the patient who apologized for “bothering” us.
He’d had pressure in his chest for two days. Not crushing. Not cinematic. Just a weight under the sternum when he walked to the car. He waited because he didn’t want to make a scene. By the time he arrived, we were no longer talking about discomfort. We were talking about muscle that had already been hurt.
I also remember the opposite: the panicked ER visit for pain that turned out to be reflux, muscle strain, anxiety — real suffering, not a heart attack. Both people were trying to do the right thing. Both deserved better information.
So let’s make this plain.
When chest pain is an emergency
Call emergency services (dont drive yourself) if pain is:
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Pressure, squeezing, or heaviness in the chest
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– Spreading to the arm, jaw, neck, or back
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– Paired with shortness of breath, cold sweat, nausea, or a sense that something is deeply wrong
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– New, severe, or worse with exertion
Women, people with diabetes, and older adults sometimes get quieter versions of this — more shortness of breath, fatigue, or indigestion-like discomfort than Hollywood chest-clutching. “Atypical” does not mean “safe.”
When its often not the heart
Many chest pains are musculoskeletal (you can poke the spot and it hurts), reflux, panic, or lung-related. That doesn’t make them imaginary. It means the pathway is different — and still worth sorting out with a clinician if they’re recurrent or frightening.
A useful rule I give patients: one scary episode gets checked. Repeated milder episodes get a plan, not endless Googling.
What I want you to take from this
The goal isn’t to live terrified of every twinge. The goal is to recognize the signals that protect the life you’re building — work that matters, people you love, faith that steadies you when the room gets loud.
Your heart is not a machine you ignore until it fails. It’s part of how you keep a meaningful life going.
If something feels urgent, treat it as urgent. If it doesn’t, still take it seriously enough to ask. Listening to your body isn’t weakness. It’s stewardship.
