I woke up with sudden extreme pain on left side of my chest above breast going to back shoulder blade and neck?

Must check the heart: A woman in her late 40's with "extreme" chest pain with arm or shoulder symptoms usually has to go to the Emergency Room to be checked for a heart attack. That means not waiting at home to see if it turns into a bad heart attack. As the saying goes, "better safe than sorry." There are other causes of chest pain... but worry about that after verifying a good heart.