There are no hard and fast rules here.  Sometimes even minor chest symptoms can turn out to be due to coronary artery disease (evidenced by the fact that up to 30% of heart attacks are accompanied by symptoms so trivial that the patient does not notice them).  And you should tell your doctor about any chest pain you experience. But here are some general guidelines that are useful for deciding whether you need to go to the emergency room.

Chest pain is relatively likely to represent a dangerous cardiac disorder - and should be treated as an emergency - if any of the following are true:

-         You are 40 years old or older, and have one or more risk factors for coronary artery disease (family history, smoking, obesity, sedentary lifestyle, elevated cholesterol, diabetes).

-         You are any age and have a very strong family history of early heart disease.

-         The pain can best be described by the terms tightness, squeezing, heaviness, or crushing.

-         The pain is accompanied by weakness, nausea, shortness of breath, sweating, dizziness or fainting.

-         The pain “radiates” to the shoulders, arms, or jaw.

-         The pain is more severe than any you have had before.

-         The pain is accompanied by the uncontrollable feeling that something is horribly wrong (this is often called by doctors, “a sense of impending doom”).

-         The pain gets continually worse over the first 15 or 20 minutes.

-         The pain is new – you have never experienced anything like it before.

On the other hand, chest pain is relatively unlikely to represent a dangerous cardiac disorder - and probably is not a medical emergency - if any of the following are true:

     -         The pain changes with changes in body position.

    -          The pain worsens with a deep breath or with coughing.

-          You have had similar pains in the past, and a cardiac disorder was ruled out.

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