Chest pain is a symptom experienced by a patient that occurs suddenly, either at rest or during physical exertion, and is localised in the chest.
Causes
There are several causes of pain, some of which are more serious than others.
- in the heart, following a blockage in a coronary artery, or due to inflammation of the heart’s lining (pericardium), or a tear in the aorta.
- in a lung following an infection, a pneumothorax, inflammation of the lung lining (pleura) or a blockage of a pulmonary artery (pulmonary embolism).
- in the digestive tract when gastric fluid refluxes into the oesophagus
- in the chest wall (neuralgia).
An anxiety attack may also be accompanied by chest pain.
Some of these conditions require specific and urgent care, including, in particular, referral to a care pathway appropriate to the condition.
Risks & Consequences
Some causes of chest pain can lead to impairment of a vital function:
- Blockage of a coronary artery leads to a heart attack, which may be complicated by a heart rhythm disorder (ventricular fibrillation) and cardiac arrest.
- A tear in the aorta can lead to internal bleeding.
- A blockage in a pulmonary artery can lead to cardiac arrest if it is severe and affects a major blood vessel.
- Damage to one lung can lead to respiratory distress.
Signs
The pain is the main symptom. It may start spontaneously whilst at rest, or during or after physical exertion.
It may also occur in specific circumstances and point to an underlying cause, such as after a flight, prolonged bed rest, immobilisation in a plaster cast, or following childbirth. It may be accompanied by signs of distress identified during the emergency assessment, which indicate the seriousness of the situation.
As part of the further assessment, an analysis of the pain may also point to a specific condition. The pain may feel like a ‘vice-like’ or ‘stabbing’ sensation, such as a tearing pain, a weight on the chest or a burning sensation, or it may worsen with breathing movements.
It is important to specify the location of the pain and where it radiates to; pain in the centre of the chest, at the side, or in the back. This pain may spread to the neck, jaw, shoulders, or even the arms or the pit of the stomach. Its severity is assessed using the pain scale.
The progression of symptoms over time is a valuable piece of information: whether the onset was sudden or gradual, and whether the pain is continuous or intermittent. The duration of the pain must be specified.
Other symptoms may accompany the pain and be identified during the emergency assessment or whilst monitoring the patient. These indicate the severity of the condition, such as:
- feeling unwell, with paleness and sweating;
- nausea or even vomiting;
- signs of a life-threatening condition.
When interviewing the victim and those close to them, it may become apparent that the victim:
- has previously experienced a similar episode and was admitted to hospital;
- already has a history of cardiovascular conditions (angina, heart attack) or pulmonary conditions (pulmonary embolism, phlebitis);
- is associated with specific risk factors such as: smoking, smoking whilst taking oral contraceptives, obesity, diabetes, high blood pressure and high cholesterol;
- has a similar history among members of his family.
Principle of emergency response
The rescue operation must ensure that:
- to maintain vital functions and position the victim in the most comfortable position;
- to ensure that a defibrillator is nearby;
- to seek medical advice;
- to help the victim take medication if necessary.