Harvard Heart Letter

Understanding cardiovascular pain

What the location and severity reveals about your health.

If you're concerned about your heart, a sharp twinge in your chest may give you pause. If it's fleeting, it's probably nothing to worry about. But is that uncomfortable ache under your breastbone just heartburn—or a heart attack? It's often hard to tell. Understanding the underlying causes, symptoms, and duration of these two conditions—and others that cause similar sensations elsewhere in the body—can help you deal with the pain calmly and safely.

Early on, cardiovascular disease is silent and symptomless. But over time, cholesterol-laden plaque builds up inside your arteries. During times of exercise or stress, nearby muscles end up starved for blood, triggering pain—and causing the chest pain and pressure known as angina. If a clot completely blocks a heart artery, the result is a heart attack. If plaque builds up in your leg arteries, it may cause painful cramps with walking—a classic symptom of peripheral artery disease (PAD).

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