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Chest Pain
By Iman Noufal
Amb.Nsg. /UCU

Chest Pain
Introduction

Definition
Causes of Chest pain
Patient Care Guidelines ( EMS-8)
Summary
References

Chest Pain
Introduction

Definition

Chest Pain
Definition

What is Chest Pain?

Chest Pain
Definition
What is Chest Pain?

Chest pain is discomfort or pain that the patient feels

anywhere along the front of the body between the neck
.and upper abdomen

Chest Pain
Definition

Is chest pain the warning sign of a heart attack only? Or

could it be a sign of another illness?

Chest Pain
Definition
Is chest pain the only warning sign of a Heart
Attack, or could it be a sign of serious illnesses?

Many people with chest pain fear a heart attack, but there
.are many possible causes of chest pain

Chest Pain

Causes of Chest Pain

Chest Pain
Causes of Chest Pain

Heart Disease
Inflammation
Digestive System Problems
Anxiety or Panic Disorder
Recent Chest Trauma

Chest Pain
Causes of Chest Pain

Heart Disease
Coronary Artery Disease (Angina)
Heart Attack (MI)
Heart Valve Disease
Heart Muscle Disease (Cardiomyopathy)
Aortic Dissection

Heart Disease

Coronary Artery Disease (Angina)

Symptoms
Discomfort, heaviness, pressure, aching, burning,
fullness, squeezing or painful feeling in the chest
(It can be mistaken for indigestion or heart burn).
Angina is usually felt in the chest, but it may also
be felt in the Lt. shoulder, arms, neck, throat , jaw,
or back.
S.O.B. palpitation (irregular heart beat , skipped
beats, or flip-flop feeling in the chest).
Rapid heart beat , weakness, dizziness, nausea
and sweating.

Heart Disease
Heart Attack (MI)

Symptoms
Chest discomfort or pain that is crushing or
squeezing or feels like a heavy weight on the
chest.
Sweating .
Shortness of breath .
Nausea & vomiting .
Pain spreads from the chest to the neck, jaw,
or to one or both shoulders or arms .
Dizziness or light headedness .
A fast irregular heart beat .

Heart Disease
Heart Valve Disease.

Symptoms
Palpitations, feeling that the heart
is "running away".
Pounding in the chest.
Dizziness, feeling light headed,
fainting.
Shortness of breath.
Chest discomfort & fatigue.

Heart Disease
Heart Muscles Disease

Symptoms
Chest pain or pressure occurs usually with exercise or physical
activity, or with rest or after meals.
Heart failure symptoms, e.g. S.O.B., quick weight gain, dizziness,
swelling in ankles, chest pain.
Swelling of the lower extremities.
Fatigue & fainting.
Palpitation.

Heart Disease
Aortic Dissection

Tearing of the lining of the aorta (the body's main artery that comes
directly off the heart). It often leads to heart attack or stroke.
Symptom:
Chest pain is: very sudden and severe in onset described as a tearing
pain, located beneath the breastbone.

Chest Pain

Causes of Chest Pain

Inflammation
Pneumonia
Pleurisy
Pericarditis (Acute, chronic)
Pericardial Effusion
Bronchial Asthma

Inflammation

Pneumonia

Inflammation of the lungs caused by a bacterial or viral infection.

Symptoms often begin suddenly & may follow an upper respiratory
infection such as flu or cold.

Inflammation

Pneumonia

Symptoms

Sudden onset
Chest wall pain, getting worse by coughing or deep breathing.
Fever, cough with sputum, rapid shallow breathing.
Fatigue, shaking chills, malaise.

Inflammation
Pleurisy

Inflammation of the outside lining of the lungs.

Symptoms
Chest pain, sudden onset, stabbing pain increasing on
inhalation.
Rapid shallow breathing.
Pain spreading to the shoulder or the abdomen.
Cough or fever.

Inflammation
Pericarditis

Acute inflammation of the Pericardium (the membrane sac around the heart).

Inflammation
Pericarditis

Symptoms
Acute
Severe sudden chest pain, which may spread to the neck, back,
shoulders or arms. It gets worse when breathing deeply, moving or
lying down. May be relieved by sitting up and leaning forward.
Fever.

Inflammation
Pericarditis

Symptoms
Chronic

Difficulty in breathing.
Swelling of the legs and abdomen.
Fatigue

Inflammation
Pericardial Effusion

Fluid in the space between the Pericardium and the Heart.

Inflammation
Pericardial Effusion

Symptoms

Chest pain with a feeling of fullness or pressure.

Difficulty in breathing and swallowing.

Inflammation
Bronchial Asthma

Inflammatory disorder of the airways characterized by:

Inflammation
Bronchial Asthma

Symptoms

Periodic attacks of wheezing.

Shortness of breath.
Chest tightness and cough

Chest Pain

Causes of Chest Pain

Digestive System Problems

Heart Burn or Oesophageal Reflux

Oesophageal Spasm
Gall Bladder Disease
Peptic Ulcer

Digestive System Problems

Heartburn ,Oesophageal Reflux

What does Heartburn feel like?

Digestive System Problems

Heartburn
or Oesophageal
Reflux
What does Heartburn
feel like?
A burning feeling in the chest just behind the breast bone that
occurs after eating and lasts for a few minutes to
several hours.
Chest pain, especially after bending over, lying down or eating.
Burning in the throat or hot, sour, acidic or salty
tasting fluid at the back of the throat.
Difficulty in swallowing.
Feeling of food "sticking" in the middle of the chest or throat

Digestive System Problems

Heartburn or Oesophageal Reflux

Is it Heartburn or Heart Attack?

Digestive System Problems

Heartburn or Oesophageal Reflux

Is it Heartburn or Heart Attack?

The two problems have many of the same symptoms and occur in
similar types of people e.g., older age group, over weight.
Also, if the patient has a history of heart problems or is a risk factor
for heart attack e.g., has a family history of heart disease, diabetes,
hypertension, is a cigarette smoker, is obese, or is of advanced age,
it is more likely to be a heart attack.

Digestive System Problems

Heartburn or Oesophageal Reflux

Heartburn may indicate a serious problem that needs evaluation.

Digestive System Problems

Heartburn or Oesophageal Reflux

Possible signs of Heartburn could be mistaken for a Heart Attack

Heart Burn
1 Sharp, burning sensation below
the breast bone or ribs.
2 Pain does not radiate to the
shoulders, neck or arms.
3 Pain comes after meals when lying
on the back or when doing
exercise.

Angina or Heart Attack

Feeling of fullness, tightness or
dull pressure in the center of the
chest
Pain radiating to the shoulders, neck,
jaw or arms.
Sudden chest pain or pressure that
worsens.

4 Symptoms respond QUICKLY to

antacids.

Pain often responds quickly to

nitroglycerin.

5 Rarely accompanied by cold and

sweat.

Usually accompanied by cold and

sweat.

Digestive System Problems

Oesophageal Spasm

Irregular contraction of the muscles

in the Oesophagus

Digestive System Problems

Oesophageal Spasm

Symptoms
Pain in the chest or upper abdomen
Heartburn
Difficulty in swallowing because of pain

Digestive System Problems

Gall Bladder Disease

Includes inflammation, infection, stones, or obstruction of the Gall Bladder.

Digestive System Problems

Gall Bladder Disease

Symptoms
Chest pain under the breast bone
Heartburn
Nausea & vomiting
Fever
Abdominal pain;
severe , located on the right upper quadrant or in the upper
middle of the abdomen , occurring after meals , worse during
deep intake of breath , radiating to the back or below the right
shoulder blade , worse after eating or drinking fatty food.
Abdominal fullness or gas

Digestive System Problems

Peptic Ulcer

An erosions in the lining of the stomach or duodenum .

An ulcer in the stomach is called GASTRIC ULCER, an ulcer in the
duodenum is called DUODENAL ULCER. Stomach & duodenal ulcer
together, are referred to as a PEPTIC ULCER.

Digestive System Problems

Peptic Ulcer

Symptoms
Chest pain
Nausea and vomiting
Weight loss
Heart burn, belching
Vomiting blood
Bloody or dark stools

Chest Pain

Causes of Chest Pain

Anxiety or Panic Disorder

Characterized by repeated episodes of intense anxiety & fear that

occur with or without warning or identifiable causes .
Panic attacks are often accompanied by chest pain, caused by
muscle contractions in the chest wall.

Anxiety or Panic Disorder

PAIN

Usually localized to the chest wall

Can be fleeting
Can be sharp "catch" that interrupts a breath
The chest wall can remain "sore" for hours or days after a panic
attack

The Chest Pain

Causes of Chest Pain

Recent Chest Trauma

Chest trauma of any type can cause chest pain by causing a rib
fracture, muscle strain or contusion.

Recent Chest Trauma

PAIN

Almost always localized, is often described as soreness or a sharp

pain
It usually worsens with breathing
The chest wall is tender to touch or to pressure

Chest Pain

Patient Care Guidelines (EMS-8)

Chest Pain

Patient Care Guidelines ( EMS-8)

Triage Assessment
Nursing Actions
Evaluation

Patient Care Guidelines ( EMS-8)

Triage Assessment

Initial observation
Subjective assessment
Objective assessment

Triage Assessment

Initial Observation

Skin color
Respiratory effort
Anxiety

Triage Assessment

Subjective Assessment

Pain Categorization
Time of onset ; gradual or sudden
Activity at onset
Location of pain
Sharp, dull, pressure like, or other
Intermittent or constant
Radiation
Change in pain with deep inspiration, cough or movement

Triage Assessment

Subjective Assessment

Associated symptoms
Nausea, vomiting
Shortness of breath
Diaphoresis
Cough; productive or nonproductive
Fever
Dizziness or change in level of consciousness
Palpitation

Triage Assessment

Subjective Assessment

Measures taken to relieve pain before arrival at EMS

Relevant medical history.

Triage Assessment

Objective assessment

Complete vital signs (including apical & peripheral

pulse & breath sounds)
Presence or absence of edema: pitting or dependent
Presence or absence of neck vein distension

Chest Pain

Nursing Actions

Assess patient while obtaining history

Classify if chest pain could be of cardiac origin, including epigastric
pain in elderly, take to Treatment Area Room
Notify clinician immediately
Request patient's file
Take the vital signs
Facilitate rapid admission
Explain treatment to patient & family to diminish anxiety

Chest Pain
Evaluation

Document initial assessment data and interventions

Extent of diminished anxiety

Chest Pain

Summary

Chest Pain

Summary

Any organ or tissue in the chest can be the source of pain, including
the Heart, Lungs, Oesophagus, Muscles, Ribs, Tendons, or Nerves.

Chest Pain

Summary
The Physical Examination

The physical examination will focus on the chest wall, lungs and
heart. The doctor or nurse may ask questions like the following:

Summary

The Physical Examination

Is the pain between the shoulder blades? Under the breastbone?
Does the pain change location? Is it on one side only?
How would you describe the pain? (Severe, tearing or ripping,
sharp, stabbing, burning, squeezing, constricting, tight, pressurelike, crushing, aching, dull, heavy)?
Does it come on suddenly? Does the pain occur at the same time
each day?
Is the pain getting worse? How long does the pain last?
Does the pain go from your chest into your shoulder, arm, neck,
jaw, or back?

Summary

The Physical Examination

Is the pain worse when you are breathing deeply, coughing, eating,
bending?
When you are exercising? Is the pain better after you rest? Is it
completely relieved or just less?
Is the pain better after you take nitroglycerin medication? After you
drink milk or take antacids? After belching?
What other symptoms are also present?

Summary
Diagnostic Tests
Diagnostic tests that may be performed include:
Blood tests (such as LDH, LDH isoenzymes, CPK, CPK
isoenzymes, Troponin, CBC, and blood differential)
Cardiac catheterization
ECG
Exercise ECG
Lung scan
X-rays of the chest

Summary

Diagnostic Tests

More complex tests may be required depending on the difficulty of

diagnosis or the suspected cause of the chest pain

Chest Pain

References

Chest Pain
References

www.webmed.com
www.heartdisease.about.com
www.health.discovery.com
www.health.yahoo.com
www.heartcenteronline.com
www.e_manual.aramco.com.sa
www.mayo clinic.com

Chest Pain

Thank You