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  • Writer's pictureFarhad Nassiri Afshar

Chest Pain Urgent Care - Expert Doctor in Honolulu, Hawaii

Updated: Feb 18

Greetings, explorers! Chest pain is a common concern in primary care, prompting numerous visits. However, not all instances are cardiac in nature. Let's embark on a journey to understand the diverse causes of chest pain, unraveling its mysteries, and navigating the diagnostic landscape together. Join us in exploring the phenomenon of chest pain!

Decoding Critical Health Situations:

Acute Coronary Syndrome (ACS):

Swift evaluation and immediate transfer to an emergency center are crucial for chest pain at rest or sudden angina ( heart muscle pain due to lack of blood supply to it) due to acute heart ischemia with crushing mid-chest pain, which aggravates with exercise. This is especially true for high-risk patients with cardiac risk factors such as hyperlipidemia, hypertension, strong family history of coronary artery disease, diabetes, or people who are using any form of nicotine products by vaping or smoking.

Aortic Issues:

Aortic Dissection: An urgent situation marked by intense, sharp tearing chest or back pain, indicating potential aortic tearing (dissection).

Pulmonary Clots:

Pulmonary Embolism (lung clot) can manifest as shortness of breath (dyspnea) with painful breathing (Pleuritic chest pain). This is especially concerning for patients with underlying risk factors like cancer, recent long trips, prolonged bed rest, or recent orthopedic surgery.

Pneumothorax Drama:

Tension Pneumothorax can present as sudden, painful breathing (pleuritic chest pain) coupled with dyspnea (shortness of breath) and low blood pressure signals potential air trapping in the chest, compressing the lungs and compromising the heart's function as a pump.

Esophageal Issues:

Esophageal Rupture (Boerhaave Syndrome): Midline chest pain following spontaneous esophageal perforation during vigorous dry heaving or vomiting.

Cardiac Tamponade:

Sudden chest pain due to fluid buildup around the heart leads to squeezing of the heart and prevents the proper pumping of blood to vital organs such as heart muscle and brain.

Different Causes of Chest Pain in Detail:

Anginal Pain:

Myocardial Ischemic Pain (cardiac angina). Chest pain is linked to increased oxygen demand or compromised supply, influencing blood and oxygen supply to the heart (cardiac ischemia).

Nonischemic Cardiac Issues:

Heart failure (weak cardiac pumping function), pericarditis (Inflammation of the sac around the heart), myocarditis (Inflammation of the heart muscle), cardiomyopathy (disease of the heart muscle), and valvular anomalies (disease of heart valves) present diverse cardiac causes for chest pain.

Pulmonary (Lung) Diseases:

Pneumothorax (trapping air in the chest), lung infections (bronchitis, pneumonia), lung neoplasms (cancers), asthma, COPD (Chronic Obstructive Pulmonary Disease), and pulmonary hypertension (high blood pressure in lungs vasculature) can lead to chest pain.

Gastric Issues:

GERD (Gastroesophageal reflux disease), peptic ulcer disease (stomach or duodenum wound), Gastritis (inflammation of the stomach), esophageal spasms, and esophagitis (inflammation of the esophagus) can manifest as chest pain.

Musculoskeletal Source:

Ribcage pain, such as costochondral pain, rheumatic and inflammatory diseases, rib fractures, and chest trauma, can be musculoskeletal causes of chest pain.

Psychiatric Origin:

Panic attacks and depression can resurface as chest pain with no organ-related cause.

Pharmaceutical Impact:

Stimulants like cocaine and methamphetamine contribute to cardiac and pulmonary complications and lead to chest pain.

Referral Pain Mirage:

Illusory chest pain from extrathoracic organs like the liver or spleen.

Shingles Attack:

Chest pain preceding dermatomal eruptions, especially in the elderly.

Domestic Violence:

Chest pain within the context of psychiatric conditions, a somber note in the realm of domestic violence.

Diagnostic Approach:

Vital Sign Assessment:

All patients must undergo a thorough vital sign assessment, including oxygen saturation, blood pressure, and pulse rate measurements. Any abnormal or unstable vital sign readings require an immediate visit request with a physician.

Signs Requiring Urgent Attention:

Resting or progressive worsening crushing exercise-induced Chest Pain:

This is suggestive of unstable angina (imminent or in progress myocardial infarction), and an immediate visit to the emergency department is necessary.

Intense tearing Chest and Back Pain:

This concerns aortic dissection, which involves tearing a layer of the aorta with a potential for aortic rupture, and it requires urgent attention in the emergency department.

The presence of painful breathing (pleuritic chest pain), coupled with shortness of breath ( dyspnea), coughing, and the presence of deep venous thrombosis(leg clot):

It raises concerns about the possibility of a pulmonary embolism (lung clot). Swift action is needed.

Sudden onset of pleuritic chest pain, dyspnea, and low blood pressure ( Hemodynamic instability):

Consider the possibility of tension pneumothorax. Prompt medical attention is essential.

Retrosternal Agony Following Emesis:

Mid-chest pain after emesis (dry heave or vomiting) may signify esophageal rupture (Boerhaave syndrome). This requires immediate attention and investigation.

History and Physical Examination:

A thorough assessment by a physician to evaluate the probability of various causes.

Electrocardiogram (ECG):

Doctors will order an ECG for all patients with new onset yet unidentified chest pain. It helps diagnose by showing specific electrical patterns in serious conditions like cardiac ischemia, pericarditis, or lung clot (pulmonary embolism).

Radiographic Tools:

If your physician suspects issues with the lungs, heart, skeletal or chest structure, a chest radiograph provides a revealing picture.

Sorting Out Myocardial Ischemia:

Identifying typical symptoms and risk factors using a systematic approach by doctors. Using risk calculators to categorize the different factors for diagnosis and planning the treatment

Identifying the Other Culprits Beyond Heart Ischemia:

Delving into potential causes beyond the heart, such as issues with the digestive system, lungs, muscles and bones, and mental health. Examining skin nerve areas (Dermatomes), spinal routes, and pain patterns from internal organs (referral pain) helps uncover the final diagnosis.

Navigating the Chest Pain Maze:

Understanding chest pain is like deciphering a complex code. Urgent cases need swift attention, while many can be managed in primary care. Don't delay seeking help for chest pain—prompt, professional guidance ensures thorough evaluation and proper care. Remember, specific symptoms like new or severe pain, breathlessness, or ongoing discomfort should signal an immediate call for ambulance assistance.

Curious Minds Unleash Inquiries:

Should I call for an ambulance if I have chest pain?

  • If you experience chest pain, it's crucial to call for an ambulance by calling 9-1-1 under the following circumstances:

  • If the pain is new, severe, or lasts more than a few minutes.

  • If it occurs with shortness of breath.

  • If it worsens during physical activity or is accompanied by fear or worry.

While chest pain doesn't always indicate a heart attack, it's essential not to take any chances. Many cases are due to less severe issues like muscle pain, heartburn, or anxiety. Despite this, prompt action is advised, as delaying seeking help for a potential heart attack can lead to lasting heart damage or even be life-threatening.

Can a heart attack cause other symptoms besides chest pain?

Absolutely! While chest pain or discomfort is the primary symptom of a heart attack, it's crucial to note that other symptoms may also be present. Surprisingly, some individuals might not experience any pain and still have a heart attack. This scenario is more common in women, those with diabetes, and individuals aged 60 and above. Symptoms of a heart attack may include chest pain or discomfort, pain in various upper body parts, shortness of breath, nausea, vomiting, sweating, irregular heart rate, and dizziness. It's crucial to recognize these symptoms, especially if they persist more than a few minutes or recur. If you suspect a heart attack, call for an ambulance immediately by calling 9-1-1 rather than attempting to reach the hospital independently.

Is a heart attack the only cause of chest pain?

No, chest pain is not exclusively caused by heart-related issues, as various conditions can contribute. These include heart infection (infective endocarditis), muscle soreness post-physical activity (Rhabdomyolysis), diseases like arthritis, shingles with its associated painful rash, chest injuries or surgeries, digestive issues such as heartburn or ulcers, lung problems like pneumonia or blood clots, mental health disorders like panic disorder or depression, and weakening of the aorta lining (Aortic dissection). It's essential to consider a range of factors when assessing the cause of chest pain.

What happens in the Emergency Room?

Your visit to the ER involves a series of tests, including ECGs, blood analyses, X-rays, stress tests, cardiac catheterization, echocardiograms, and CT scans. These timely evaluations guide the course for suitable management and treatment.

What if I have a heart attack?

In the event of a heart attack, prompt medical intervention is crucial. Doctors will provide treatments to minimize heart damage and alleviate pain. The effectiveness of these treatments significantly improves with early intervention, emphasizing the importance of seeking immediate medical attention. Every minute plays a critical role in preserving the health of your heart muscle. Cardiologists say, “Time Is Muscle,” which means the longer you wait to get someone in for treatment, the more damage can occur to the heart muscle, and the less likely the chances for recovery.


Chest pain is a complex symptom with various causes. Seeking prompt medical attention ensures timely diagnosis and appropriate management. If you experience chest pain, especially with associated symptoms, call for an ambulance or seek emergency care immediately. Early intervention is crucial for favorable outcomes.

In the realm of chest pain and cardiac symptoms, prioritizing your heart health is crucial. Irys Medical Clinic, your trusted Honolulu chest pain expert, stands ready as your dedicated partner in comprehensive cardiac care in Hawaii. Our team of expert doctors in Honolulu is committed to understanding the unique aspects of your health, providing personalized guidance, and guiding you through a journey to well-being.

Recognizing the diverse causes of chest pain, it's essential to address any concerns promptly. If you've experienced chest pain or related symptoms, we encourage you to take the next step towards a healthier heart by making an appointment with our Honolulu chest pain expert doctors at Irys Medical Clinic. Our expertise ensures a thorough evaluation of your condition and the development of a personalized plan for your cardiac well-being.

Your heart deserves the best care. Schedule an appointment with Irys Medical Clinic, your Honolulu chest pain expert doctor, today. Embark on a path to a healthier, heartier you, knowing that your well-being is our top priority. We look forward to being your trusted partner in your cardiac health journey.


This guide provides general information and is not a substitute for professional medical advice. It is essential to consult healthcare professionals for personalized guidance based on individual health conditions.

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