How to deal with the emergency of chest pain

5 July 2022

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No form of chest pain should be taken lightly, even though there are many potential non-cardiac causes of this pain, according to experts like a General Physician in Karachi. In case of an acute attack, it is very difficult to pinpoint the exact cause of chest pain, and could herald more serious conditions. Read on to know more about chest pain, its potential causes and how to deal with this emergency:

Chest pain

Chest pain is a common symptom for which patients visit the ER. In the ER, the pain is evaluated based on its intensity, duration, location and radiation. Based on the type of chest pain and correlation with other symptoms, a provisional diagnosis is made, and this is confirmed with the help of investigations.

What are the diagnostic tests for chest pain?

Chest pain is evaluated with the help of certain investigations that confirm a disease or rule it out. These investigations include:

Chest x-ray: the x-ray is done in the ER to rule out a myriad of causes of chest pain
ECG: is one of the first investigations to diagnose cardiac causes of chest pain
Blood tests: measure enzyme levels
Echocardiogram: uses sound waves to check the motion of cardiac muscle
Endoscopy: upper GI endoscopy helps to diagnose acid peptic disease (APD) and GERD.

What are the possible causes of chest pain?

Cardiac causes of chest pain

Heart attack
Pericarditis
Angina
Aortic dissection
Cardiomyopathy
Myocarditis

Lung-related causes of chest pain

Pneumonia
Collapsed lung (pneumothorax)
Pulmonary embolism
Viral bronchitis
Bronchospasm

Musculoskeletal causes of chest pain

Broken ribs
Compression fractures pressing on nerves
Chronic pain syndrome

Gastrointestinal causes of chest pain

Gallstones
Acid reflux
Swallowing disorders of esophagus
Pancreatitis

Miscellaneous causes of chest pain

Shingles
Panic attacks
Anxiety

How to deal with the emergency of chest pain?

Chest pain secondary to cardiac causes usually occurs in high risk patients such as those suffering from heart disease, smokers, diabetics and those with previous attacks of angina. This pain is accompanied by other warning symptoms, such as radiating pain to the arm, nausea, shortness of breath, dizziness and sweating.

In such patients, the emergency steps include:

Calling for help: if you suspect a heart attack, immediately call for medical help and rush to the hospital.
Take aspirin: antiplatelet medication like aspirin is the first drug given for heart attack. It works to keep the blood flowing to the heart muscle through narrowed vessels. Contraindications to taking aspirin include: allergy to aspirin, bleeding disorders and chest injury.
Take nitroglycerin: patients with acute coronary syndrome (ACS) are prescribed nitroglycerin, which is a vessel dilator. Such patients should take this nitroglycerin in case of acute chest pain.
Begin CPR: the American Heart Association (AHA) recommends hands-only CPR with 100 to 120 compressions a minute for someone having a heart attack.
Using an automated external defibrillator (AED): if the person is unconscious, an AED can be used with instructions written on it.
In the hospital: in the ER, the patient is given high flow oxygen, morphine for pain management, aspirin (if not previously taken), nitroglycerin and other clot busters. This is followed by cardiac catheterization to stent the blocked vessels. If stenting does not resolve the pain, bypass grafting is performed to restore the blood flow.

For chest pain related to gastrointestinal disorder, the management includes:

Antacids: over-the-counter antacids are the emergency medication for treating GERD related chest pain. This medication is given after ruling out cardiac causes of chest pain.
Investigations: in the ER, the healthcare provider may choose to perform an upper gastrointestinal tract endoscopy to rule out other causes of pain.

For chest pain due to collapsed lung: