Chest Pain
What Your Emergency Department Evaluation Does and Does Not Show
General information from an emergency physician. It adds to your discharge papers and does not replace them or your own doctor. What this site is and isn’t
Key Takeaways:
- An ECG and blood tests help check for an active heart attack. They may not find the cause of your pain.
- About half of people with chest pain go home without one clear cause.
- Low-risk patients do not always need a stress test.
About Your Diagnosis and ED Workup
The emergency department may use an ECG and troponin blood tests. These tests look for an active heart attack. The care team also looks at your symptoms, age, and heart risk factors. Together, this information helps estimate your short-term heart risk. People judged to be at low risk can often continue care through follow-up instead of staying in the hospital for more tests. Low risk does not mean no risk. It also does not explain every cause of chest pain.
About half of people with chest pain go home without one clear cause. The pain may come from the chest wall, acid reflux, or anxiety:
| Typical Cause | What is Physically Happening |
|---|---|
| Chest Wall Strain (Costochondritis) | Inflammation of the cartilage that connects your ribs to your breastbone. It accounts for 15% to 45% of non-cardiac chest pain and typically causes a sharp pain that is reproduced when you bend, stretch, or press directly on your rib joints. |
| Acid Reflux (GERD) | Stomach acid washing up into the food pipe (esophagus), causing a burning sensation behind the breastbone that can closely mimic heart pain. |
| Anxiety or Panic | Stress and anxiety can trigger a “fight-or-flight” reflex, causing rapid breathing, chest tightness, and a racing heart. While abnormal anxiety is present in up to 47% of low-risk chest pain patients, it is formally diagnosed in only about 5% of cases. |
First Steps and Evidence-Based Home Care
Follow the plan in your discharge papers. Do not choose a treatment based only on how the pain feels.
- If chest-wall pain was suspected: Use heat and avoid heavy lifting or movements that worsen the pain. Take an anti-inflammatory medicine only if your discharge plan says it is safe for you.
- If reflux was suspected: Follow the reflux plan you were given. Your doctor may recommend a trial of acid-reducing medicine.
- If anxiety or panic was suspected: Follow-up counseling, including cognitive behavioral therapy, can reduce repeated chest pain.
If no cause was named, do not choose one yourself. Follow your discharge plan. Discuss possible causes at follow-up.
Timeline and Expected Recovery Course
Recovery depends on the cause. These timelines cannot tell you what caused your pain. Use only the timeline that matches the suspected cause in your discharge plan.
- If chest-wall pain was suspected: Most people recover within about 3 weeks.
- If reflux was suspected: Improvement may begin within 1 to 2 weeks. Symptoms can return after treatment stops.
- If anxiety or panic was suspected: Counseling may reduce symptoms over about 3 months.
Your short-term heart risk: For low-risk patients, the chance of a serious heart event within 30 days is less than 1%. The risk is low, not zero. Follow-up is still part of the plan.
Emergency Red Flags: Return Immediately
Return to the emergency department for any of these signs. This list does not cover everything. Return for anything else that worries you:
- New, recurrent, or worsening chest pain or pressure
- New or worsening shortness of breath
- Passing out (syncope) or feeling like you are about to collapse
- Heavy, unexplained sweating (diaphoresis)
- Pain that spreads (radiates) to your arm, shoulder, jaw, neck, or back
Return if these signs occur with activity, nausea, feeling faint, or sudden fear.
Medical Disclaimer: This guide is for educational purposes following your Emergency Department evaluation and does not replace direct care from your physician. Return to the emergency department if you feel you are experiencing a medical emergency.
Reviewed August 27, 2026