University of Iowa Health Science Relations and
Richard Kerber, MD
Professor of Internal Medicine
First Published: 2000
Last Revised: October 2004
Peer Review Status: Internally Peer Reviewed

If you're having chest pain and aren't sure whether it's heartburn from eating too much spicy chili or the first symptoms of a heart attack, don't wait around to find out.

It's important that you go to a hospital immediately, says a University of Iowa heart specialist.

"Although the classic symptom of a heart attack is chest pain, people describe it in different ways," says Dr. Richard Kerber, professor of internal medicine in the UI Carver College of Medicine.

The most typical description is a squeezing sensation or a pressure sensation in the chest. Sometimes people say it feels like there is an elephant sitting on their chests.

"Other people may feel the pain differently. They may say it's an aching sensation, a stabbing sensation, or a smothering sensation--the feeling that they aren't getting enough air.

"Occasionally the pain is not in the chest, but in the arms, usually the left arm. It may spread toward the neck or even the jaw."

Kerber says there usually are several brief periods of pain a few days or even weeks before the actual heart attack occurs. During the attack, the pain gradually builds. It can last from minutes to hours.

Heart attacks result from the long-term accumulation of cholesterol and other fatty materials causing deposits called "plaques" in the coronary arteries, blood vessels that nourish the heart muscle.

"When the coronary arteries build up these fatty deposits, they are similar to a rusty pipe," he says. "It's harder for water in the pipe or blood in the arteries to get through."

If the fatty deposits continue to build up, the blood passing through the coronary arteries may not be enough to meet the needs of the heart muscle. At this point, the person begins to feel pain.

"When the obstruction is complete or becomes so severe that virtually no blood can get through, that part of the heart muscle nourished by the artery actually dies." This is often caused by sudden expansion of a plaque, blocking the artery. This is what is called a heart attack, he says. The damaged muscle will be replaced by scar tissue within several weeks.

If you are having severe chest pain and think you may be having a heart attack, speed is very important. You should activate the emergency medical system by dialing 911. This will bring trained personnel--emergency medical technicians or firefighters with special medical training--who will take you to a hospital quickly and safely.