Chest Pain (HB)

Chest Pain (HB)

When we hear the words “I’m having chest pain” or “my chest hurts” we immediately think of a heart attack. There are many reasons for a patient to have chest pain, some of them are very serious and some are not serious at all.

Most of the reasons for chest pain fall in between the two, the hard part is knowing what to worry about. The first thing we need to do after we have completed the patient assessment is to try and figure out the origin of the pain–is it coming from the heart? Or somewhere else in the chest?

We differentiate by the terms CARDIAC chest pain vs CHEST WALL pain If we ask good questions as part of our patient assessment then we can narrow this down pretty quickly.

Cardiac pain does NOT change with breathing, movement, or position–it is steady pain. The cause of this pain could be angina (which is ischemia to the heart muscle) or a heart attack from tissue infarction. Another possible cause is cardiac arrhythmia–an abnormal heartbeat caused by electrical conduction problems in the heart.

Chest wall pain, on the other hand, is generally not a steady pain, it changes in intensity as the patient moves, coughs, or breathes. The patient can usually find a position that feels better to them, and when you find them, they will likely already be in this position.

Chest wall pain can come from a variety of causes:

  • Pleurisy is an infection or irritation of the lining that encloses the lungs.
  • Fractured ribs
  • Respiratory Infections, pneumonia, bronchitis
  • Dirty/polluted air
  • Continuous intense coughing
  • Gastric Esophageal Reflux Disease (GERD)
  • Asthma

Signs and Symptoms

The patient may describe the pain as crushing, vice-like, pressure on their chest. They may have shortness of breath or be sweating profusely.

Red Flags

Any time we have other critical system problems or fever we should consider the problem to be high risk. If the patient has signs and symptoms of a cardiac event we should also consider this to be high risk.

Treatment

Treat what you find. If the patient has a cardiac issue, encourage them to take aspirin—chewable if possible (162-325 mg).

If you have access to oxygen, put the patient on it as soon as possible–this applies to any patient with chest pain especially if they have difficulty breathing.

If the patient has a history of GERD you can have them try an antacid.