Chest Pain: When to Worry and When to Wait
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Chest Pain: When to Worry and When to Wait
On JustGospel's Medical Monday with Carlett, Dr. Matla demystified chest pain—covering everything from muscle strains to heart attacks, and when to rush to emergency versus when to relax.
Not Always a Heart Attack
"More than 10 conditions cause chest pain beyond heart attacks," Dr. Matla explained. "Panic attacks, anxiety, acid reflux, peptic ulcers, muscle inflammation from exercise, lung infections, or blood clots in lungs."
Critical Warning Signs—Go to Hospital Immediately
Rush to emergency if chest pain is:
Sudden and severe crushing sensation (not burning or stabbing)
Central upper chest, more on left side
Feels like something heavy sitting on your chest
Radiates to neck, back, or left arm
Affects heart rate (faster or slower than usual)
Causes breathing difficulty
Doesn't go away after 5 minutes of rest
"Don't drive yourself. Should it be a full-blown heart attack, you might not make it on your own."
When It's Probably Not an Emergency
Muscle strain: Pain during exercise that resolves after 1-2 minutes rest. You know the pattern.
Acid reflux: Burning going up into front of neck, worse lying flat, better sitting upright.
Muscle inflammation: Stabbing or sharp pain—not crushing.
If you're used to pain patterns that resolve with rest, monitor them. But if intensity changes or doesn't resolve as usual—go to hospital.
The 6-Hour Window
"The heart needs its own oxygen supply," Dr. Matla explained. Heart attacks occur when arteries supplying the heart become blocked. "We have less than six hours to unblock before heart muscle dies completely and can't be recovered. Any body tissue has 4.5-6 hours without blood supply before it dies."
Treatment must start within that window—not just running to hospital, but treatment initiated.
Other Emergencies
Aortic dissection: Biggest artery ruptures—sudden severe pain radiating to back and neck, shortness of breath. Surgical emergency; many don't survive.
Ruptured ulcer: Mild pain suddenly intensifies, emergency when vomiting blood.
Large pulmonary embolus: Clot blocking major lung arteries—can be fatal without immediate treatment.
Non-Emergencies: Pneumonia or TB causing chest pain while coughing—if breathing normally, can wait for clinic/GP. Inflammation of cartilage or muscles—treatable over time.
Public Healthcare Reality
"That's the million-dollar question." Rural areas with only level 1 hospitals lack emergency drugs to open blood vessels. Patients need referral to level 2/3 hospitals hours away.
The system should work from ambulance call: alert hospital so teams prepare medication, ICU beds, and senior doctors. Ambulances should divert to level 2 hospitals when level 1 can't provide thrombolysis (clot-dissolving medication).
Location matters: Vanderbijlpark residents reach Seboke in 10-15 minutes. Parys or rural areas travel two hours to Kroonstad or Bloemfontein.
From Mind to Muscle
"Chest pain ranges from psychological (panic attacks) to abdominal to cardiac to musculoskeletal—sometimes fractures after accidents."
The Bottom Line
"Listen to your body. If you're used to certain pains that resolve, monitor them. But if anything worries you or changes intensity—rather safe than sorry. But don't rush to emergency shouting you're dying when it's just muscle strain from exercise."
On JustGospel's Medical Monday with Carlett, Dr. Matla demystified chest pain—covering everything from muscle strains to heart attacks, and when to rush to emergency versus when to relax.
Not Always a Heart Attack
"More than 10 conditions cause chest pain beyond heart attacks," Dr. Matla explained. "Panic attacks, anxiety, acid reflux, peptic ulcers, muscle inflammation from exercise, lung infections, or blood clots in lungs."
Critical Warning Signs—Go to Hospital Immediately
Rush to emergency if chest pain is:
Sudden and severe crushing sensation (not burning or stabbing)
Central upper chest, more on left side
Feels like something heavy sitting on your chest
Radiates to neck, back, or left arm
Affects heart rate (faster or slower than usual)
Causes breathing difficulty
Doesn't go away after 5 minutes of rest
"Don't drive yourself. Should it be a full-blown heart attack, you might not make it on your own."
When It's Probably Not an Emergency
Muscle strain: Pain during exercise that resolves after 1-2 minutes rest. You know the pattern.
Acid reflux: Burning going up into front of neck, worse lying flat, better sitting upright.
Muscle inflammation: Stabbing or sharp pain—not crushing.
If you're used to pain patterns that resolve with rest, monitor them. But if intensity changes or doesn't resolve as usual—go to hospital.
The 6-Hour Window
"The heart needs its own oxygen supply," Dr. Matla explained. Heart attacks occur when arteries supplying the heart become blocked. "We have less than six hours to unblock before heart muscle dies completely and can't be recovered. Any body tissue has 4.5-6 hours without blood supply before it dies."
Treatment must start within that window—not just running to hospital, but treatment initiated.
Other Emergencies
Aortic dissection: Biggest artery ruptures—sudden severe pain radiating to back and neck, shortness of breath. Surgical emergency; many don't survive.
Ruptured ulcer: Mild pain suddenly intensifies, emergency when vomiting blood.
Large pulmonary embolus: Clot blocking major lung arteries—can be fatal without immediate treatment.
Non-Emergencies: Pneumonia or TB causing chest pain while coughing—if breathing normally, can wait for clinic/GP. Inflammation of cartilage or muscles—treatable over time.
Public Healthcare Reality
"That's the million-dollar question." Rural areas with only level 1 hospitals lack emergency drugs to open blood vessels. Patients need referral to level 2/3 hospitals hours away.
The system should work from ambulance call: alert hospital so teams prepare medication, ICU beds, and senior doctors. Ambulances should divert to level 2 hospitals when level 1 can't provide thrombolysis (clot-dissolving medication).
Location matters: Vanderbijlpark residents reach Seboke in 10-15 minutes. Parys or rural areas travel two hours to Kroonstad or Bloemfontein.
From Mind to Muscle
"Chest pain ranges from psychological (panic attacks) to abdominal to cardiac to musculoskeletal—sometimes fractures after accidents."
The Bottom Line
"Listen to your body. If you're used to certain pains that resolve, monitor them. But if anything worries you or changes intensity—rather safe than sorry. But don't rush to emergency shouting you're dying when it's just muscle strain from exercise."
