Chest Pain

CHEST PAIN

DEFINITION

  • Uncomfortable pressure, fullness, squeezing, or other pain in the chest
  • This includes the area from the clavicles to the bottom of the rib cage.

General Information

  • Not all chest pain is serious, but until your doctor has examined you it is always safer to assume that your chest pain is serious.
  • The most life-threatening cause of chest pain is a heart attack. Other serious causes include angina, pneumonia, lung blood clots, or a collapsed lung.
  • Some common causes of chest pain are not serious  (e.g. muscle strain, chest wall arthritis, and acid reflux).
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WHEN TO CALL YOUR DOCTOR

Call 911 (you may need an ambulance) if:

  • Passed out
  • Very weak (can't stand)
  • Visible sweat on face or sweat dripping down face
  • Severe difficulty breathing (e.g. struggling for each breath, unable to speak)
  • Lips or face are blue
  • Severe chest pain
  • Chest pain lasting longer than 5 minutes and any of the following:
    • Pain is crushing, pressure-like, or heavy
    • History of heart disease  (e.g. angina, heartattack, bypass surgery, angioplasty)
    • Over 50 years old
    • Over 35 years old and you have at least one cardiac risk factor  (i.e. high blood pressure, diabetes, high cholesterol, obesity, smoker or strong family history of heart disease)
    • Took nitroglycerine and chest pain was not relieved

Call your doctor now (night or day) if:

  • You feel weak or very sick
  • Chest pain lasts more than 5 minutes
  • Chest pain brought on by exertion and relieved by rest
  • Chest pain spreads into your shoulder, arm, or jaw
  • You have angina chest pain and it has been increasing in severity or frequency
  • Difficulty breathing or taking a breath makes pain worse
  • Coughing up blood
  • Dizziness, lightheadedness, or weakness
  • Heart beating irregularly or very rapidly  
  • Fever
  • Major surgery in the past month
  • Any prior "blood clot" in leg or lungs (Note: typically would have required treatment with a blood thinner such as heparin or coumadin)
  • Hip or leg fracture in past two months
  • Recent illness requiring prolonged bed rest within last month
  • Recent long distance travel with prolonged time in car, bus, plane, or train (i.e. several hours sitting in one spot) within last month
  • Drug abuse

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think you need to be seen
  • Rash in same area as pain (especially if described as "small blisters")

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Intermittent mild chest pain lasting a few seconds each time, and persists for more than 3 days
  • Chest pain only when coughing and persists for more than 3 days

Self care at home if:

  • Intermittent mild chest pain lasting a few seconds each time, and you don't think you need to be seen
  • Mild chest pain only when coughing, and you don't think you need to be seen
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HOME CARE ADVICE

  1. Fleeting Chest Pain: Fleeting chest pains that last only a few seconds and then go away are generally not serious. They may be from pinched muscles or nerves in your chest wall.
  2. Chest Pain Only When Coughing: Chest pains that occur with coughing generally come from the chest wall and from irritation of the airways. They are usually not serious.
  3. Cough Suppression Medications: The most common cough suppressant in over the counter cough medications is dextromethorphan. An example is Robitussin DM. You should not try to suppress coughs that produce mucus and phlegm. Dextromethorphan is best used in the late stages of a respiratory infection when the cough is dry and hacking.
  4. Expected Course: These mild chest pains usually disappear within 3 days.
  5. Call Your Doctor If:
    • Severe chest pain
    • Constant chest pain lasting longer than 5 minutes
    • Difficulty breathing
    • Fever
    • You become worse

And remember, contact your doctor if you become worse or develop any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. American Heart Association. 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 8: Stabilization of the patient with acute coronary syndromes. Circulation. 2005;112:IV-89-IV-110.
  2. Antman EM, et.al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction - executive summary Circulation. 2004;110(5):588-636.
  3. Canto JG, et.al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000;283(24):3223-3229.
  4. Eisenberg MJ, Topal EJ. Prehospital administration of aspirin in patients with unstable angina and acute myocardial infarction. Arch Int Med. 1996;156(14):1506-1510.
  5. Goldman L, Kirtane AJ. Triage of patients with acute chest pain and possible cardiac ischemia: the elusive search for diagnostic perfection. Ann Intern Med. 2003;139:987-995.
  6. Goodacre S, et.al. How useful are clinical features in the diagnosis of acute undifferentiated chest pain? Acad Emerg Med. 2002;9(3):203-8.
  7. Han JH, Lindsell CJ, Storrow AB, Luber S, Hoekstra JW, Hollander JE, Peacock WF 4th, Pollack CV, Gibler WB; EMCREG i*trACS Investigators. The role of cardiac risk factor burden in diagnosing acute coronary syndromes in the emergency department setting. Ann Emerg Med. 2007;49(2):145-52, 152.e1.
  8. Jaffy MB, Meischke H, Eisenberg MS. Prevalence of aspirin use among patients calling 9-1-1 for chest pain. Acad Emerg Med. 1998;5(12):1146-9.
  9. Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med. 2000;342(16):1187-1195.
  10. Marsan RJ, Shaver KJ, Sease KL, et.al. Evaluation of a clinical decision rule for young adult patients with chest pain. Acad Emerg Med. 2005; 12(1):26-31.
  11. Pope JH, et.al. Missed diagnosis of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342(16):163-1170.
  12. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected coronary syndromes. JAMA. 2005;294:2623-2629.
  13. Weber JE, Chudnofsky, Boczcar, et.al. Cocaine associated chest pain: how common is myocardial infarction? Acad Emerg Med. 2000;7:873-877.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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