Chest pain

In this month's blog, as aching hearts aren’t just related to Valentines Day, we’re taking a look at chest pain! 

Chest pain is a common reason for calls for an ambulance or to shoreside, and frequently it’s not actually due to cardiac (heart) issues. But you will often hear Paramedics tell their patients that they have done the right thing; they would genuinely prefer to get to a patient and find the chest pain is a minor issue, than it being cardiac, and too late!

Last year, we wrote this blog about 20 causes of chest pain (plus a bonus one!). Some of the conditions described are acute (sudden onset), some are chronic (long term), some need urgent attention, others not so much. But we should always take chest pain seriously and make sure a full assessment is done at the earliest opportunity to rule out anything life threatening. 

Typical symptoms of cardiac chest pain and/or a heart attack are:

• Pale, cyanosed (blue/grey colour)

• Clammy, sweaty

• Nausea, vomiting, indigestion

• Chest pain often described as heavy, crushing, pressure, tight or squeezing

• Pain anywhere in the chest or ‘epigastric’ - like heartburn/in

• Pain radiating into the neck, jaw, back or arms. Normally the left arm, but can be the right too

• Short of breath, wheezing

• Dizziness, light headed, faint

• Increased heart and respiratory rate

• ‘Impending sense of doom’, sudden anxiety

• They ‘look like they are having a heart attack’ - they look really unwell!

While symptoms are largely similar for men and women, some women describe the pain as more burning, stabbing or like indigestion/heartburn and located as back or epigastric pain. Research is taking place to investigate this area of medicine to ensure women are diagnosed and treated in the same way, and as quickly, as men. This quite hard hitting film from British Heart Foundation describes the symptoms effectively.

However it’s concerning that women often delay seeking help as they don’t recognise the symptoms. They’re also 50% more likely to receive a wrong initial diagnosis, less likely to receive potentially life saving treatments at the right time or be prescribed medication to prevent a second heart attack. This makes it all the more important that we are alert to the symptoms and know what to do.

For suspected cardiac chest pain, there are a few things we can do while we wait for help, or to get the patient off the vessel - hospital is where they need to be. We’d recommend calling for help from your telemedicine provider, or via the Coast Guard sooner rather than later. Much better to find out it’s a false alarm than leaving it too late!

Advice for treating a suspected heart attack will normally follow this guidance:

• Give 300mg of Aspirin providing they aren’t allergic to it. It’s not a pleasant taste, but they need to chew the tablet/s up as they work quicker and more effectively when absorbed through the mucous membranes of the mouth, rather than being swallowed and digested.

• Give GTN (or TNG) spray or tablets. Glyceryl Tri-Nitrate spray should be administered under the tongue or tablets placed next to the gum. As GTN has the potential to lower the blood pressure, make sure you take a blood pressure before and after administering, or at the very least check that they have a radial pulse.

• Keep them warm and calm. Reassure them. 

• Keep them sitting/lying or in a semi-recumbent position. 

If you’d like more information about heart attacks, just follow this link to a really useful booklet from the UKs British Heart Foundation and make sure your knowledge is up to date.

Note: please ignore the rubbish social media posts regularly doing the rounds about coughing if you think you’re having a heart attack. The science just doesn’t work that way and there is zero clinical evidence to back this up.  You need to be in the hospital!