Fear and perception of Chest Pain

Pain has always been a language—one of urgency, one of wisdom, one of misinterpretation. It does not simply arise; it calls out, seeking recognition, demanding understanding. But in the case of chest pain, it does something more—it plays with fear, conjures mortality, and challenges our belief in control.

From the moment we are born, the heart is the silent drummer of our existence, beating tirelessly, asking nothing in return. We do not thank it for its labor; we do not pause to acknowledge its rhythm. But the moment it falters—or we think it has—we are thrown into an existential crisis.And we start asking ourselves :

”What if this is the end”?

“What if this pain is not just pain but a harbinger of something final”?

The Fear of Sudden Endings

Cinema has taught us that death comes swiftly, a theatrical climax of grasping fingers and collapsing bodies. A man, strong and certain, clutches his chest, his breath stolen by an unseen force. He falls, and the audience understands—his time is up. We have inherited this script, absorbed it into our own fears, convinced ourselves that chest pain is the ultimate omen.

But the body is not so dramatic. The heart does not betray without warning. A true heart attack is not a singular event but a story told over years—a slow accumulation of choices, habits, and silent negotiations between blood and plaque. By the time the pain arrives, the war within has been raging for far longer than we realize.

Paradoxically , chest pain mostly is not from the heart at all. It is of the muscles, the bones, the lungs, the nerves and the mind. It is acid rising like an unsaid grievance. It is tension stored from years of unspoken worry. It is the weight of stress sitting on the ribs, pressing, pressing, until it feels like something deeper. The pain is real, but its origin is often misunderstood.

What a Deception of Mind !

The mind is both a protector and a deceiver. It wants to keep us safe, but often does so through fear. A small discomfort becomes a catastrophe. A moment of indigestion becomes an emergency. Anxiety wraps around the chest, tightens its grip, and suddenly, we believe we are dying. The body, ever obedient to the mind, follows suit—heart rate quickens, breath shallows, and the illusion of danger becomes indistinguishable from reality.

Thirty percent of those who rush to the emergency room with chest pain leave with no diagnosis of heart disease. Their bodies were not failing them—their minds were sounding false alarms. However , fear, once triggered, is hard to unlearn. Every future ache will carry its shadow.

Let’s listen without fear !

So how do we navigate this uncertainty? How do we distinguish between the whispers of the body and the screams of the mind? Perhaps the answer lies not in panic, but in presence. When pain speaks, listen, but do not assume. Be inquisitive to ask yourself questions.

  Can I press it? If the pain worsens under touch, it belongs to the muscles, not the heart.

  Does it burn? If so, it may be the fire of the stomach, not the collapse of an artery.

  Does it come with effort and ease with rest? Then, and only then, consider that the heart may be speaking.

And if there is doubt, do not wait—seek wisdom in the hands of those who understand the language of the body better than we do. But let it be wisdom, not panic, that guides us.

The metaphysics of heart

The heart is more than a muscle; it is a philosopher in motion. It teaches us about endurance, about rhythm, about the delicate balance between effort and rest. It reminds us that survival is not about fear but about understanding. The heart beats not because we demand it to, but because it knows how to persist.

And so must we. Not all pain is an ending. Not all fear is truth. Not all silence is peace. The challenge is not just to live, but to listen—to our bodies, to our minds, and to the spaces in between where wisdom is found.

Let me conclude with my perception of pain :

Pain is the door we fear to pass,

Still behind it, the truth holds fast.

Not a wound, but a carving deep,

Not to break, but to make you see.

It knocks, not to shatter, but to wake,

To unchain the self, to let it remake.

For pain is not grief, nor loss, nor end,

But the hand of the unseen, calling you in.

Dr Showkat Hussain Shah is consultant interventional cardiologist Govt medical college Anantnag