Chest pain — your questions answered
Chest pain is the most common reason patients are referred to a cardiologist, and most cases turn out not to be a heart attack. The hard part is knowing which symptoms warrant urgent attention and which can wait for a planned assessment. On this page I answer the questions I am asked most often in my London cardiology clinic.
About chest pain assessment at One Heart Clinic
Chest pain is one of the most important symptoms in cardiology — and one of the most misunderstood. Not all chest pain is cardiac, but distinguishing cardiac from non-cardiac causes requires careful clinical assessment, often with same-day investigations.
- Same-day ECG and echocardiogram available
- CT coronary angiography arranged rapidly when indicated
- Coronary physiology (iFR) for precise assessment
- No GP referral required for private appointments
Dr Nijjer at One Heart Clinic, 68 Harley Street
When chest pain is an emergency — call 999 immediately
Do not drive yourself. Chew one 300 mg aspirin if you are not allergic. Call 999 if your chest pain is:
- Severe, central, crushing or heavy — lasting more than 15 minutes and not relieved by rest
- Spreading to the jaw, neck, shoulder or arm
- Accompanied by breathlessness, sweating, nausea or feeling faint
- New and unfamiliar, especially with heart disease risk factors
Paramedics can begin treatment on the way to hospital, which significantly improves outcomes.
Questions on this page
- What does heart-related chest pain feel like?
- How do I tell a heart attack from anxiety?
- Can chest pain be caused by indigestion or reflux?
- Why does my chest hurt when I breathe in?
- Is left-sided chest pain always serious?
- How long does angina chest pain usually last?
- What is the difference between angina and a heart attack?
- Can chest pain come and go and still be serious?
- Why do I get chest pain when I exercise?
- Can stress or panic attacks cause real chest pain?
- What tests will a cardiologist do for chest pain?
- Should I see a cardiologist privately for chest pain?
What does heart-related chest pain feel like?
Heart-related chest pain typically feels like a heavy pressure, tightness, squeezing or band-like discomfort in the centre of the chest, rather than a sharp or stabbing pain. Many patients describe it as "an elephant sitting on my chest" or "a tight belt" — rather than what most people picture as pain at all.
The discomfort often radiates to the left arm, jaw, neck, back or upper abdomen, and is usually brought on by exertion, emotional stress or a heavy meal. Importantly, cardiac chest pain is rarely affected by breathing in deeply or pressing on the chest wall — if your pain changes with either of those, a non-cardiac cause is more likely, though it does not exclude heart disease entirely.
How do I tell the difference between a heart attack and anxiety?
A panic attack and a heart attack can feel uncannily alike, but several features help separate them. Panic attacks usually peak within ten minutes and ease with calming techniques, while heart attack pain tends to build, persist beyond fifteen minutes and worsen with exertion.
Panic-related chest pain is more often sharp, localised to one spot, and accompanied by tingling in the fingers or around the mouth from over-breathing. Heart attack pain is more often central, pressure-like, spreads to the arm or jaw, and comes with cold sweat or nausea. If you are unsure, treat it as cardiac and call 999 — only an ECG and blood tests can reliably tell them apart.
"Chest pain is the most common reason patients are referred to me, and the vast majority of cases turn out to have a reassuring explanation. What I always say is: the time to worry about chest pain is before we investigate it. Once we've done the right tests, most patients leave with genuine peace of mind — and the small number who do have something treatable are in exactly the right place."
— Dr Sukhjinder Nijjer, Consultant Cardiologist, Harley Street
Can chest pain be caused by indigestion or reflux?
Yes — gastro-oesophageal reflux (GORD) is one of the most common causes of chest pain seen in clinic, and it can mimic angina very closely. The oesophagus and the heart share nerve pathways, so acid irritation can produce burning, tightness or even a crushing sensation behind the breastbone.
Clues pointing towards reflux include a burning quality, relief with antacids, a sour taste in the mouth, symptoms worse when lying flat or after eating, and a long history of similar episodes that have never escalated. That said, the overlap with cardiac pain is significant enough that new or changing chest pain should always be properly assessed before being labelled as reflux.
Why does my chest hurt when I breathe in?
Pain that sharpens when you breathe in — called pleuritic pain — usually points to the lining of the lungs, the chest wall or the pericardium (the sac around the heart), rather than the heart muscle itself. Common causes include muscle strain, costochondritis (inflammation of the rib cartilage), a chest infection, or pericarditis.
Pericarditis can feel very alarming because the pain is often severe and central, but it characteristically eases when you lean forward and worsens when you lie flat. A pulmonary embolus (blood clot in the lung) is a more serious cause of pleuritic pain and needs urgent assessment — especially if combined with breathlessness, a fast heart rate or a recent long flight or surgery.
Dr Nijjer's clinical perspective
Consultant Cardiologist · Lead, Cardiac Catheter Labs, Hammersmith Hospital
Chest pain is never something I dismiss without a thorough assessment. I have had patients come to me who had been told their pain was anxiety for months — only to find significant coronary artery disease on CT scanning. Even when the heart turns out to be perfectly healthy, which is frequently the case, having that confirmed provides genuine peace of mind.
My approach combines clinical history, a resting ECG, and almost always an echocardiogram at the same visit. Where coronary disease is suspected, I arrange CT coronary angiography and, if needed, coronary pressure wire assessment (iFR) to determine exactly whether a vessel is causing symptoms. Exercise-related chest pain, in particular, should always be assessed by a cardiologist — a stress echocardiogram can be highly informative in these cases.
Chest pain: when to call 999 immediately
These features suggest a possible heart attack — do not drive yourself. Call 999.
Crushing central pressure
Heavy, tight, or squeezing sensation in the centre or left of the chest lasting more than 15 minutes
Pain spreading to arm or jaw
Radiation to the left arm, both arms, neck, jaw, or upper back — a classic warning sign
Cold sweats and nausea
Chest discomfort accompanied by cold sweats, nausea, vomiting, or a sense of impending doom
Breathlessness with chest pain
Sudden breathlessness alongside chest pain, or severe breathlessness at rest — call 999 now
Is left-sided chest pain always serious?
No — left-sided chest pain is not always cardiac, and very localised "pin-point" left-sided pain that you can reproduce by pressing on the chest wall is usually musculoskeletal. The heart is positioned slightly left of centre, which is why people associate the left side with cardiac problems, but cardiac pain is more often central than purely left-sided.
That said, left-sided pain that is dull, heavy, exertional or radiates into the left arm or jaw deserves prompt cardiac assessment. The reassuring features are: short stabs lasting seconds, reproducible by pressing or twisting, and no associated breathlessness, sweating or faintness.
"One of the things I find most important in clinic is listening carefully to how a patient describes their pain. The quality and character — whether it's pressure, burning, stabbing — tells me a great deal before I've even examined them. But I never rely on description alone. The tests are there to confirm what the history suggests, and sometimes to surprise us."
— Dr Sukhjinder Nijjer
How long does angina chest pain usually last?
Stable angina typically lasts a few minutes — usually 2 to 10 — and eases with rest or with a glyceryl trinitrate (GTN) spray within five minutes. Episodes brought on reliably by the same level of exertion and relieved by the same rest pattern are the hallmark of stable disease.
Pain that lasts longer than 15 minutes, comes on at rest, or is more severe than usual is a red flag for unstable angina or a heart attack and is a 999 call. A new pattern of more frequent, more easily triggered or longer-lasting episodes is also a reason to seek same-day specialist review.
What is the difference between angina and a heart attack?
Angina is chest pain caused by a temporary shortage of blood supply to the heart muscle, usually from a narrowed coronary artery — the muscle is starved but not damaged. A heart attack (myocardial infarction) occurs when blood supply is cut off long enough to kill heart muscle, almost always because a plaque has ruptured and triggered a clot.
The symptoms can feel identical at first. The key differences are duration and response to rest: angina settles within minutes, while a heart attack does not. A heart attack also produces a rise in the blood marker troponin, which is how it is confirmed in hospital. Both deserve urgent attention, but a heart attack is a 999 emergency — every minute counts.
Can chest pain come and go and still be serious?
Yes. Intermittent chest pain is exactly how stable angina presents — short episodes triggered by exertion that resolve with rest. It is also how unstable angina behaves in the days or weeks before a heart attack, with episodes becoming more frequent or occurring at rest.
A pattern of repeated short episodes — even if each one settles — is a reason to be assessed promptly. Pain that comes and goes for hours, particularly if accompanied by sweating, nausea, breathlessness or radiation to the arm or jaw, should be treated as a heart attack until proven otherwise.
"I always tell patients: if you've had the same chest discomfort reliably for years and it hasn't changed, it's very different from something new. It's the change in pattern — pain coming on more easily, lasting longer, waking you at night — that worries me clinically. Please don't dismiss a new pattern because the old one was harmless."
— Dr Sukhjinder Nijjer
Why do I get chest pain when I exercise?
Exertional chest pain that eases with rest is the textbook presentation of angina and means a coronary artery is likely narrowed by atherosclerosis. The heart muscle needs more oxygen during exercise; if a narrowing limits supply, the muscle protests.
Not every cause is cardiac — asthma, exercise-induced bronchoconstriction and chest wall strain can all do the same — but exertional chest pain should always be investigated. A CT coronary angiogram is usually the first-line test under NICE guidance for new exertional chest pain in the UK and gives a definitive answer about whether your arteries are narrowed.
Can stress or panic attacks cause real chest pain?
Yes — the chest pain of a panic attack is genuine, not imagined, and it can be intense enough to send people to A&E. It is driven by hyperventilation, muscle tension and a surge of adrenaline, producing a tight, sharp or burning sensation, often with tingling in the hands, dizziness and a sense of doom.
Chronic stress can also worsen genuine cardiac disease and is increasingly recognised as a cardiovascular risk factor. The safe approach is: if the pain is new, atypical, or you have heart disease risk factors, get a cardiac assessment first. Once the heart is cleared, the psychological component can be addressed properly.
What tests will a cardiologist do for chest pain?
The standard work-up usually begins with an ECG and blood tests including troponin and cholesterol, followed by a CT coronary angiogram if NICE criteria are met — this is the first-line imaging test for new chest pain in most UK patients.
Depending on what those tests show, further investigations may include an echocardiogram, a stress echocardiogram or cardiac MRI to look for ischaemia, or an invasive coronary angiogram if a significant blockage is suspected. You can read more about all these tests in the cardiac tests FAQ.
Should I see a cardiologist privately for chest pain?
Private cardiology assessment makes sense when you want a rapid, joined-up review — consultation, ECG, blood tests and imaging arranged within days rather than weeks. New or changing chest pain is a clinical priority and should not wait.
You can be seen privately while remaining under NHS care, and you do not always need a GP referral, although one is helpful. If your pain is severe or escalating, the right route is A&E first, with cardiology follow-up afterwards. See When should I see a cardiologist? for more on the private pathway.
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See Dr Nijjer for a chest pain assessment
Dr Nijjer runs a dedicated chest pain pathway across his London locations, with same-week appointments, on-site ECG and echocardiography, and rapid access to CT coronary angiography where indicated. You do not need a GP referral to book privately.
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This page provides general information for educational purposes and is not a substitute for personalised medical advice, diagnosis or treatment. Always seek the advice of your GP or a qualified medical professional with any questions about a medical condition. In a medical emergency, call 999. Last reviewed ; next review due .