Chest pain is a common discomfort in daily life and serves as the chief symptom of more than 30 clinical illnesses, many of which relate to cardiovascular diseases. Delayed medical treatment may lead to life-threatening complications. The onset pattern and duration of chest pain provide vital clues for identifying root causes.

Pain lasts several minutes, rarely over ten minutes

Coronary heart disease is the leading cause of chest tightness and chest pain, categorized into stable angina, unstable angina and acute myocardial infarction based on severity and attack duration.

• Stable angina: Dull pain in the precordium or back, sometimes radiating to the left arm or even the teeth. Triggers include physical exertion, emotional excitement or overeating; symptoms ease rapidly with rest or sublingual nitroglycerin.

• Unstable angina: May flare up at rest, with slightly longer pain duration. Relief after rest or nitroglycerin takes more time compared to stable angina.

Pain persists for over one hour

Acute myocardial infarction is a severe progression of coronary heart disease. Under stress, atherosclerotic plaques rupture and form acute thrombi that completely block coronary arteries. Patients suffer severe, unrelenting chest pain lasting three to four hours in some cases; nitroglycerin loses efficacy, accompanied by profuse sweating or fever.

Critical reminder: Seek emergency care immediately once chest pain lasts more than 20 minutes, even if it has not stretched for hours.

Variable pain duration

Pulmonary embolism is a life-threatening emergency caused by thrombus blockage in the pulmonary artery and its branches, mostly originating from dislodged deep vein thrombi in the lower limbs. Typical manifestations include dyspnea, syncope, chest pain, hemoptysis and a sense of impending doom. The dull chest pain resembles angina yet does not improve after rest or nitroglycerin. Rush to hospital if chest pain comes with breathing difficulty or fainting spells.

Uninterrupted, unrelieved chest pain

Aortic dissection forms a false lumen between the layers of the aortic wall filled with blood, thinning the vessel wall drastically. Sudden spikes in blood pressure may trigger arterial rupture, massive hemorrhage and hypovolemic shock. Patients with long-standing hypertension must stay alert to sudden severe pain in the chest and back that fails to subside with rest or medication.

Brief sudden pain

Pneumothorax arises from pleural rupture due to trauma, tumors or medical procedures, allowing air to accumulate in the thoracic cavity. Attacks may occur at rest or during heavy lifting, breath-holding and strenuous exercise. Patients experience sharp stabbing or cutting pain on one side of the chest, quickly followed by chest tightness, dyspnea and an irritating dry cough. Medication barely relieves symptoms; hospital diagnosis and treatment are mandatory.