When to Go to the Emergency Room for Chest Pain

If you are having chest pain now, call 911. Do not drive yourself. Paramedics begin treatment on the way and can tell the emergency room you are coming.

Chest pain that lasts more than a few minutes, or that goes away and comes back, is a 911 call — and so is chest discomfort that arrives with shortness of breath, a cold sweat, or pain spreading to an arm, shoulder, jaw, neck or back. You do not need to be sure it is your heart. That is the part we work out.

This is the one page on this site where the advice is not “decide carefully”. It is “call now and let somebody else decide”.

Why chest pain is treated differently from almost everything else

Most symptoms give you time to think. Chest pain does not, because the thing you are ruling out damages heart muscle while you deliberate — and the amount of damage is a function of how long it goes untreated.

The Centers for Disease Control and Prevention puts it plainly: the chances of surviving a heart attack are better the sooner emergency treatment begins, and the sooner you reach an emergency room, the less damage there is to the heart muscle.

So the arithmetic people do at the kitchen table — is this bad enough, will I feel foolish, what will it cost — is arithmetic with a clock attached, and the clock is the only part that matters.

What the warning signs actually are

The CDC lists these as the major signs of a heart attack:

• Chest pain or discomfort that lasts more than a few minutes, or that goes away and comes back. It is often described as uncomfortable pressure, squeezing or fullness rather than as sharp pain
• Shortness of breath
• Pain or discomfort in one or both arms or shoulders
• Pain or discomfort in the jaw, neck or back
• Feeling weak, light-headed or faint, sometimes with a cold sweat

And it notes that women more often have unusual or unexplained tiredness, and nausea or vomiting — which is part of why heart attacks in women get attributed to something else for longer.

Anything on that list is a 911 call. You are not expected to have several of them, and you are not expected to be certain.

The word “pressure” is doing a lot of work

A great many people describe what turned out to be a heart attack as pressure, tightness, heaviness, fullness, or a band around the chest — and then say afterwards that they did not call because it was not really pain.

If your chest feels wrong in a way you would struggle to describe, that counts. “I cannot describe it” is a symptom, not a disqualification.

Call 911 rather than driving

Three reasons, and the third is the one people have not usually thought about.

Treatment starts in the ambulance. Paramedics can give medication, monitor your heart rhythm, and act immediately if that rhythm changes. A car cannot do any of that.

They can tell us you are coming. An emergency room that knows a possible cardiac patient is two minutes out is a different room from one that finds out when you walk through the door.

And if the worst happens on the way, you want to be in the vehicle with the defibrillator. That is the blunt version, and it is the reason nobody in emergency medicine will tell you to drive.

Do not drive yourself. If you are the only adult present and cannot call, that is a reason to call 911, not a reason to drive.

Other reasons chest pain lands in an emergency room

Chest pain is not only a heart question, and several of the other answers are also emergencies. The National Library of Medicine’s guidance on recognising medical emergencies puts significant chest pain lasting more than a few minutes in the call-911 category outright, alongside an inability to breathe.

Pain that is worse when you breathe in, pain with a cough and a fever, pain after an injury, pain with a swollen or painful leg, sudden tearing pain in the chest or back — all of those have answers that need imaging and blood work rather than a conversation. Both of our emergency rooms have CT, X-ray and a full laboratory in the building, staffed around the clock, which is why the answer usually arrives during the visit rather than later in the week.

What happens when you arrive with chest pain

Chest pain is triaged high. That is not a promise about a wait — it is a statement about the order things happen in, and it is why a chest-pain patient who arrives after you may be taken back before you.

Expect an ECG early, blood work, and a physician assessment. If it is not your heart, finding that out is the point of the visit and it is a good outcome, not a wasted trip.

Coming in and being told it was not your heart

That is a success. It is the outcome in most cases, and the people who most need to hear it are the ones who will hesitate the longest.

Being evaluated for chest pain and sent home with an explanation costs you an evening. The other way of being wrong costs considerably more, and it cannot be undone afterwards. The two are not the same size.

And on the cost question, because it keeps people at home: ability to pay is not a barrier to assessment and access to care in our emergency rooms, and by law. If cost is the obstacle, tell us when you arrive.

Questions people actually ask

It went away. Do I still need to be seen? Yes. Chest pain that comes and goes is specifically on the CDC’s list. Going away is not reassurance.

I am young. Can it still be my heart? It can. Age changes the odds; it does not change what you should do about chest pain.

It is probably heartburn. Should I wait and see? Heartburn and cardiac pain are genuinely hard to tell apart from the inside, which is the whole problem. Call.

Can I drive myself if the hospital is close? No. Treatment starts in the ambulance, and they can alert us before you arrive.

What if I am wrong? Then you were checked. Nobody here will think less of you, and it is the outcome we expect most of the time.

---

If you are having chest pain, call 911. For anything else that is sudden, severe or getting worse, both of our emergency rooms are open 24 hours a day, every day of the year — walk in, no appointment and no referral, with CT, X-ray and a full laboratory in the building. Find your nearest emergency room →

Related reading: which door do you need · what our emergency rooms can do

Sources

1. About Heart Attack Symptoms, Risk, and Recovery — Centers for Disease Control and Prevention. https://www.cdc.gov/heart-disease/about/heart-attack.html
3. Recognizing medical emergencies — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/001927.htm

This article is general information, not a diagnosis, and it cannot account for your history or your medications. If you are unsure, come in — this list is not exhaustive and you are not expected to diagnose yourself. If it might be an emergency, treat it as one and call 911.