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If you are having pain in your chest and you're short of breath, you might wonder whether you are having a heart attack. It's always a good idea to see a doctor so you will know for sure, but here are some of the possible explanations of these symptoms.

Many different health conditions are on the list of causes of chest pain and shortness of breath. Shortness of breath treatment has to be based on a medical diagnosis. You can't diagnose yourself from information you get on the Internet. But here are some of the possible diagnoses you can expect.

Typical and not so common symptoms of heart attack 

Intense pressure pain and shortness of breath often indicates heart attack or a heart problem such as angina [1]. You can have a kind of early warning about heart problems several days or even several weeks before you actually have a heart attack. Maybe you will get out of breath more easily when you are going up and down stairs, or you will break out in a sweat on a cool day even with little exertion. You might have a passing sensation as if someone reached into your chest and squeezed your heart. [2

If you have these potential early warning signs of a heart attack, don't wait until you keel over in pain to see a doctor. There are many things your doctor can to prevent a heart attack: blood pressure control, high-dose statins (not so much to lower cholesterol as to stop inflammation)[3], and nitroglycerin pills to open your arteries [4]. If you are diabetic, keeping your blood sugar levels under control can help prevent heart attack [5].

If you are at the point of experiencing the symptoms of a heart attack, the sweating, chest pain, and shortness of breath usually (but not always) increase, and there may also be pain radiating to the left arm or neck. When there isn't a feeling of crushing or burning pain, there may be a feeling of fullness in the chest. There can be nausea, vomiting, dizziness, and confusion. Shortness of breath may be severe after physical exertion, but improve after a few minutes rest. 

Not everyone who has a heart attack will have chest pain

 Women, diabetics, and people over the age of 80 often do not have chest pain when they have heart attacks [6]. There are people who have pain on the "wrong" (right) side of the chest, and there are people who get leg pain [7] or headaches [8] instead of chest pain. When it doubt, see a doctor right away.

Another common cause of chest pain is heartburn, also known as gastroesophageal reflux disease or GERD. When acid coming up from the stomach causes chest pain, it is more likely to be a burning pain than a crushing pain. There is more likely to be a sense of fullness in the stomach than in the center of the chest. There will probably also be:

  • A sour taste in the mouth.
  • Trouble swallowing.
  • Throwing up in your mouth.
  • Pain that gets better or worse when you change body position.
  • Pain that intensifies when you breathe deeply or cough.
  • Pain that is worse after you eat, but not worse after you exercise.

The kind of shortness of breath that comes with GERD is not a symptom that responds to the usual, natural ways of treating dyspnea. It's higher in your chest than the shortness of breath that accompanies heart attack or angina. There is a sensation of burning more than of pressure. It won't get worse with physical exertion. It may be recurrent, getting worse in pregnant women [9], or in either men or women after weight gain [10], improving after weight loss [11]. And entirely unlike a heart attack, symptoms of GERD can be improved by taking an antacid.

Angina, heart attack, and GERD are only three of the conditions that can cause shortness of breath with chest pain. These symptoms also occur in abdominal compartment syndrome, acute aortic dissection, acute cholecystitis (gallbladder inflammation with or without gallstones),acute gastritis, acute mitral regurgitation, acute pericarditis, anxiety attacks, aortic dissection, aortic regurgitation, aortic stenosis, asthma,  biliary colic, biliary disease, cardiogenic shock, cholelithiasis (gallstones), chronic obstructive pulmonary disease (COPD), depression, dyspepsia, esophageal spasm, esophagitis, heart rupture, infective endocarditis, mitral valve prolapse, myocarditis, myopericarditis, pleurodynia, pneumonia, pneumothorax, pulmonary hypertension, pulmonary embolism, and shingles. None of these diseases is a condition you should try to diagnose on your own. So how do you know when you need to see a doctor?

  • When chest pain and shortness of breath are new, or
  • When chest pain and shortness of breath are unexplained,

See a doctor right away. All of the causes of chest pain with shortness of breath are serious. Some are immediately life-threatening. Guessing your diagnosis on the basis of things you read on the Internet, even if you read them here, is never a good plan. Once you have a diagnosis of the cause of your chest pain and shortness of breath, you may not need to see a doctor every time they flare up. But always see a doctor in person to get the diagnosis that truly matches your symptoms.

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