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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
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