Chest pain is one of the most anxiety-provoking symptoms in medicine — and rightly so. It sits at the intersection of harmless muscle strain and life-threatening cardiac events.

Emergency medicine guidelines stress that chest pain must be assumed cardiac until proven otherwise. This is not fear-mongering; it is risk management.

What heart-related pain often feels like

Classically, cardiac pain is described as pressure, heaviness, squeezing, or tightness in the chest, sometimes spreading to the arm, jaw, neck, or back. It may come with sweating, nausea, shortness of breath, or extreme fatigue.

Why people misjudge danger

Heart attacks do not always present dramatically. Some people — especially women and people with diabetes — experience vague discomfort, breathlessness, or unusual exhaustion rather than crushing pain.

Non-cardiac causes that still need evaluation

• Acid reflux and oesophageal spasm
• Muscle strain or costochondritis
• Anxiety and panic attacks
• Lung conditions such as pneumonia or pulmonary embolism

The rule doctors use

If chest pain is new, unexplained, worsening, or associated with breathlessness, dizziness, or collapse, emergency evaluation is required. Reassurance comes after exclusion — not before.

Bottom line: It is safer to be told “it’s not your heart” by a clinician than to decide that yourself and be wrong.