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Sometimes it's hard to tell whether the pain you're having is from a heart attack or something else. Here's a guide to some of the differences. Remember, if you have any sort of chest pain and you think you could be having a heart attack, call 911 immediately.

Angina is the name that doctors use for a pain in your chest that you get when your heart isn't getting enough oxygen. You usually get angina because not enough blood is reaching your heart. The pain you have with angina is similar to the pain of a heart attack. If your angina seems to be getting worse, it may be a warning sign that you're going to have a heart attack.

Like a heart attack, angina usually happens when the vessels that carry blood to your heart (your coronary arteries) get narrower because of a condition known as atherosclerosis (which is also called "hardening of the arteries"). The main differences between angina and a heart attack are:¹

• Angina often comes on during exercise and goes away when you rest
• Angina usually goes away if you take medication, such as nitroglycerin
• The pain of angina is usually not as bad as the pain of a heart attack, and it doesn't last as long. Angina goes away in about 10 minutes.

A severe attack of angina can feel a lot like a heart attack. If you have any doubts about what is causing your pain, get medical help right away.

Indigestion is any discomfort you feel after eating. Acid reflux happens when acid from your stomach flows back into your throat or into the tube (esophagus) leading from just behind your tongue to your stomach. Indigestion causes pain in the middle of your chest. But the pain of indigestion usually is not as bad as the pain of a heart attack. Patients describe it as "burning," rather than "crushing" or "restricting." The pain of indigestion does not usually spread down your arms or into your jaw. It usually goes away if you take medications, such as antacids.

Chest infections can cause pain. But it's usually much sharper than the pain of a heart attack. You're more likely to have pain on one side of your chest, not in the middle. If you have an infection, breathing in or coughing makes the pain worse. And the pain usually doesn't spread to your arms or jaw. If you're having a heart attack, breathing in and coughing usually won't make the pain worse.

It can be hard to tell the difference between the pain of a heart attack and something less serious. Studies of people who went into the hospital when they had chest pain found that you're probably not having a heart attack if the pain:²

• Feels sharp like a knife
• Gets worse when you breathe in
• Is brought on by a doctor examining you
• Changes when you move.

You probably are having a heart attack if the pain:

• Spreads out from your chest to your arms or jaw
• Goes down both arms.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.