Sudden heartache like pins and needles may be related to unstable angina, intercostal neuralgia, cardiac autonomic dysfunction. 1. Unstable angina: most coronary angina manifests itself as a dull pain in the anterior region of the heart, but some patients may also have a pins-and-needles feeling. 2. Cardiac autonomic dysfunction: this condition is mainly manifested as pain like pins and needles, the duration is relatively short only a few seconds. It is associated with emotional changes and no abnormal findings in various examinations, and is mostly found in women above middle age. 3. Intercostal neuralgia: Herpes zoster virus infection can also cause pain in the intercostal nerves in the precordial area, which can be accompanied by skin rashes and blisters. Sudden heart pain like pins and needles, if occasional and short duration, usually do not need special treatment, if the duration is longer, to go to the hospital in time to do relevant examinations to clarify the diagnosis.