There can be multiple causes of chest pain, depending on your age, family history and any related medical conditions you have. One of the most serious is if you’re having a heart attack, or a myocardial infarction (MI). Let’s take you through when to worry and what requires immediate action from any bystanders and urgent medical treatment.
The following are concerning signs that require you to call the emergency services for an ambulance – chest pain that: · causes the chest to feel heavy, pressing or it’s crushing pain · comes on suddenly · continues for at least 15 minutes · spreads to the arm, back, neck or jaw · is also causing difficulty in breathing or feeling short of breath · is causing other symptoms such as nausea, sweating or coughing up blood Risk factors for an MI include obesity, smoking, high blood pressure, high cholesterol or diabetes. Men over 45 and women over 55 are generally at greater risk than those who are younger. If any of these are present alongside symptoms, suspicion of an MI is increased. Diabetes can sometimes cause a “silent MI”, so if you are diabetic and have a mild version of any of these symptoms, have a low threshold for seeking urgent medical attention.
If the person experiencing chest pain is conscious, have them seated on the floor, a sturdy chair or a bed, and reassure them that you’re there to help. Stay with them and call the emergency services, where they will ask about your location, the symptoms, and provide a reference for you to call them back if the situation changes. If you think an MI is a high possibility and you have aspirin to hand, give them 300mg (4 standard-dose tablets, 75mg each) to chew and then swallow. This helps keep the blood flowing in the heart vessels. If they have been prescribed a GTN (glyceryl trinitrate) spray and it’s close by, give them this. If they are unconscious, lay them on the floor or on a bed and call 999. The call handler will talk you through the next steps, which include giving CPR (chest compressions or cardio-pulmonary resuscitation) if there is no pulse or they are not breathing and if you feel confident. You do not have to give mouth to mouth if you don’t feel confident or there’s no mouthpiece to hand, CPR can save a life. Press hard on the centre of their chest – put the heel of one hand on their breast bone, in the centre of their chest, and the heel of the other hand on top, arms straight and leaning over the patient. Press rapidly, less than a second per press, and allow the chest to come fully up. Depending on where you are, there may be a defibrillator nearby, where the call handler may ask you to put stickers on the patient’s chest and turn it on, as using this may save their life, depending on what the machine finds. Do not try to give any medications by mouth if they are unconscious.
An MI means that one of the blood vessels to the heart is blocked, depriving the heart muscle of oxygen. These vessels sometimes get temporarily blocked or restricted, in a condition called angina, and it can give similar symptoms of chest pain, shortness of breath and feeling sick and sweaty. This often occurs on physical activity or emotional stress – the key difference is that this improves with rest. If you’ve had an episode of this, even if it improved, you should see your doctor or Emergency Department with urgency. If you get this repeatedly, keep the GTN spray they will prescribe you nearby to alleviate symptoms and call an ambulance if the pain is not resolving after 15 minutes or if it occurs at rest. Tell your doctor if you’re getting more frequent attacks of this, or if it happens at rest.
An MI and angina are causes for concern. Other conditions can mimic these symptoms, such as heartburn or gastro-oesophageal reflux (GOR), panic attacks, a pulled or strained muscle in your chest wall or a painful inflammatory condition called costochondritis, lung conditions such as pneumonia or pleurisy, an inflammatory heart condition called pericarditis, a pulmonary embolism where a blood clot blocks a blood vessel to the lung, shingles, which can cause nerve pain across a part of the chest, aortic dissection, which is an emergency where a major blood vessel develops a leak, or problems with the stomach such as ulcers, gastritis or gall bladder inflammation. Any of these are reasons to see your doctor or the Emergency Department, depending on the severity of your symptoms, your risk factors and your level of concern.