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Chest Pain By Iman Noufal Amb.Nsg. /UCU

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

Chest Pain Definition Introduction

Chest PainWhat is Chest Pain?Definition

Chest PainWhat is Chest Pain?DefinitionChest pain is discomfort or pain that the patient feels anywhere along the front of the body between the neck and upper abdomen.

Chest PainIs chest pain the warning sign of a heart attack only? Or could it be a sign of another illness?

Definition

Chest PainIs chest pain the only warning sign of a Heart Attack, or could it be a sign of serious illnesses?DefinitionMany people with chest pain fear a heart attack, but there are many possible causes of chest pain.

Chest PainCauses of Chest Pain

Chest PainCauses of Chest Pain Heart Disease

Inflammation

Digestive System Problems

Anxiety or Panic Disorder

Recent Chest Trauma

Chest PainHeart DiseaseCauses of Chest Pain

Coronary Artery Disease (Angina)

Heart Attack (MI)

Heart Valve Disease

Heart Muscle Disease (Cardiomyopathy)

Aortic Dissection

Heart DiseaseSymptoms Coronary Artery Disease (Angina)

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 DiseaseSymptomsHeart Attack (MI)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 DiseaseSymptomsHeart Valve Disease. Palpitations, feeling that the heart is "running away".

Pounding in the chest.

Dizziness, feeling light headed, fainting.

Shortness of breath.

Chest discomfort & fatigue.

Heart DiseaseSymptomsHeart Muscles DiseaseChest 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 DiseaseAortic DissectionTearing 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 PainInflammationCauses of Chest Pain

Pneumonia

Pleurisy

Pericarditis (Acute, chronic)

Pericardial Effusion

Bronchial Asthma

Inflammation of the lungs caused by a bacterial or viral infection. Symptoms often begin suddenly & may follow an upper respiratoryinfection such as flu or cold.PneumoniaInflammation

SymptomsPneumonia

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

SymptomsPleurisy

Chest pain, sudden onset, stabbing pain increasing on inhalation.

Rapid shallow breathing.

Pain spreading to the shoulder or the abdomen.

Cough or fever. InflammationInflammation of the outside lining of the lungs.

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

SymptomsPericarditisAcute 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

SymptomsPericarditisChronic Difficulty in breathing.

Swelling of the legs and abdomen.

Fatigue Inflammation

Fluid in the space between the Pericardium and the Heart. Pericardial Effusion Inflammation

SymptomsPericardial EffusionChest pain with a feeling of fullness or pressure.

Difficulty in breathing and swallowing.Inflammation

Inflammatory disorder of the airways characterized by:Bronchial AsthmaInflammation

SymptomsBronchial Asthma Periodic attacks of wheezing.

Shortness of breath.

Chest tightness and coughInflammation

Chest PainDigestive System ProblemsCauses of Chest Pain

Heart Burn or Oesophageal Reflux

Oesophageal Spasm

Gall Bladder Disease

Peptic Ulcer

What does Heartburn feel like?Heartburn ,Oesophageal Reflux

Digestive System Problems

What does Heartburn feel like?Heartburn or Oesophageal Reflux

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

Is it Heartburn or Heart Attack?Heartburn or Oesophageal Reflux

Digestive System Problems

The two problems have many of the same symptoms and occur in similar types of people e.g., older age group, over weight.Heartburn or Oesophageal Reflux

Is it Heartburn or Heart Attack?

Also, if the patient has a history of heart problems or is a risk factorfor 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 may indicate a serious problem that needs evaluation.Heartburn or Oesophageal Reflux

Digestive System Problems

Possible signs of Heartburn could be mistaken for a Heart Attack

Heartburn or Oesophageal Reflux

Digestive System Problems

Heart BurnAngina or Heart AttackSharp, burning sensation below the breast bone or ribs.1

Feeling of fullness, tightness or dull pressure in the center of the chestPain does not radiate to the shoulders, neck or arms.2

Pain radiating to the shoulders, neck, jaw or arms.Pain comes after meals when lying on the back or when doing exercise.3

Sudden chest pain or pressure that worsens.Symptoms respond QUICKLY to antacids.4

Pain often responds quickly to nitroglycerin.Rarely accompanied by cold and sweat.5

Usually accompanied by cold and sweat.

Irregular contraction of the muscles in the Oesophagus

Oesophageal SpasmDigestive System Problems

SymptomsOesophageal Spasm Pain in the chest or upper abdomen

Heartburn

Difficulty in swallowing because of pain

Digestive System Problems

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

SymptomsGall Bladder DiseaseChest 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

An erosions in the lining of the stomach or duodenum .Peptic UlcerAn 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

SymptomsPeptic Ulcer Chest pain

Nausea and vomiting

Weight loss

Heart burn, belching

Vomiting blood

Bloody or dark stoolsDigestive System Problems

Chest PainAnxiety or Panic DisorderCauses of Chest Pain

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 PainRecent Chest Trauma Causes of Chest Pain

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

Recent Chest Trauma

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 pressurePAIN

Chest PainPatient Care Guidelines (EMS-8)

Chest PainPatient Care Guidelines ( EMS-8)

Triage Assessment

Nursing Actions

Evaluation

Patient Care Guidelines ( EMS-8)

Initial observation

Subjective assessment

Objective assessment

Triage 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

Associated symptoms Nausea, vomiting

Shortness of breath

Diaphoresis

Cough; productive or nonproductive

Fever

Dizziness or change in level of consciousness

Palpitation Subjective Assessment

Triage Assessment

Measures taken to relieve pain before arrival at EMS Relevant medical history. Subjective Assessment

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 PainNursing 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 PainEvaluationDocument initial assessment data and interventions

Extent of diminished anxiety

Chest PainSummary

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

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

SummaryThe 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, pressure-like, 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?

SummaryIs 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? The Physical Examination

SummaryDiagnostic 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 Diagnostic Tests

SummaryMore complex tests may be required depending on the difficulty of diagnosis or the suspected cause of the chest pain Diagnostic Tests

Chest PainReferences

Chest PainReferenceswww.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 PainThank You