Chest Pain


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Chest Pain

  1. 1. Welcome
  2. 2. Chest Pain By Iman Noufal Amb.Nsg. /UCU
  3. 3. Chest Pain <ul><li>Definition </li></ul><ul><li>Causes of Chest pain </li></ul><ul><li>Patient Care Guidelines ( EMS-8) </li></ul><ul><li>Summary </li></ul><ul><li>References </li></ul>Introduction
  4. 4. Chest Pain <ul><li>Definition </li></ul>Introduction
  5. 5. Chest Pain <ul><li>What is Chest Pain? </li></ul>Definition
  6. 6. Chest Pain <ul><li>What is Chest Pain? </li></ul>Definition Chest pain is discomfort or pain that the patient feels anywhere along the front of the body between the neck and upper abdomen.
  7. 7. Chest Pain <ul><li>Is chest pain the warning sign of a heart attack only? Or could it be a sign of another illness? </li></ul>Definition
  8. 8. Chest Pain <ul><li>Is chest pain the only warning sign of a Heart </li></ul><ul><li>Attack, or could it be a sign of serious illnesses? </li></ul>Definition Many people with chest pain fear a heart attack, but there are many possible causes of chest pain.
  9. 9. Chest Pain <ul><li>Causes of Chest Pain </li></ul>
  10. 10. Chest Pain Causes of Chest Pain <ul><li>Heart Disease </li></ul><ul><li>Inflammation </li></ul><ul><li>Digestive System Problems </li></ul><ul><li>Anxiety or Panic Disorder </li></ul><ul><li>Recent Chest Trauma </li></ul>
  11. 11. Chest Pain <ul><li>Heart Disease </li></ul>Causes of Chest Pain <ul><li>Coronary Artery Disease (Angina) </li></ul><ul><li>Heart Attack (MI) </li></ul><ul><li>Heart Valve Disease </li></ul><ul><li>Heart Muscle Disease (Cardiomyopathy) </li></ul><ul><li>Aortic Dissection </li></ul>
  12. 12. Heart Disease <ul><ul><li>Symptoms </li></ul></ul>Coronary Artery Disease (Angina) <ul><li>Discomfort, heaviness, pressure, aching, burning, </li></ul><ul><li>fullness, squeezing or painful feeling in the chest (It can be mistaken for indigestion or heart burn). </li></ul><ul><li>Angina is usually felt in the chest, but it may also be felt in the Lt. shoulder, arms, neck, throat , jaw, or back. </li></ul><ul><li>S.O.B. palpitation (irregular heart beat , skipped beats, or flip-flop feeling in the chest). </li></ul><ul><li>Rapid heart beat , weakness, dizziness, nausea and sweating. </li></ul>
  13. 13. Heart Disease <ul><ul><li>Symptoms </li></ul></ul>Heart Attack (MI) <ul><li>Chest discomfort or pain that is crushing or squeezing or feels like a heavy weight on the chest. </li></ul><ul><li>Sweating . </li></ul><ul><li>Shortness of breath . </li></ul><ul><li>Nausea & vomiting . </li></ul><ul><li>Pain spreads from the chest to the neck, jaw, or to one or both shoulders or arms . </li></ul><ul><li>Dizziness or light headedness . </li></ul><ul><li>A fast irregular heart beat . </li></ul>
  14. 14. Heart Disease <ul><ul><li>Symptoms </li></ul></ul>Heart Valve Disease. <ul><li>Palpitations, feeling that the heart </li></ul><ul><li>is &quot;running away&quot;. </li></ul><ul><li>Pounding in the chest. </li></ul><ul><li>Dizziness, feeling light headed, </li></ul><ul><li>fainting. </li></ul><ul><li>Shortness of breath. </li></ul><ul><li>Chest discomfort & fatigue. </li></ul>
  15. 15. Heart Disease <ul><ul><li>Symptoms </li></ul></ul>Heart Muscles Disease <ul><ul><li>Chest pain or pressure occurs usually with exercise or physical </li></ul></ul><ul><ul><li>activity, or with rest or after meals. </li></ul></ul><ul><ul><li>Heart failure symptoms, e.g. S.O.B., quick weight gain, dizziness, </li></ul></ul><ul><ul><li>swelling in ankles, chest pain. </li></ul></ul><ul><ul><li>Swelling of the lower extremities. </li></ul></ul><ul><ul><li>Fatigue & fainting. </li></ul></ul><ul><ul><li>Palpitation. </li></ul></ul>
  16. 16. Heart Disease Aortic Dissection <ul><li>Tearing of the lining of the aorta (the body's main artery that comes </li></ul><ul><li>directly off the heart). It often leads to heart attack or stroke. </li></ul><ul><li>Symptom: </li></ul><ul><li>Chest pain is: very sudden and severe in onset described as a tearing </li></ul><ul><li>pain, located beneath the breastbone. </li></ul>
  17. 17. Chest Pain <ul><li>Inflammation </li></ul>Causes of Chest Pain <ul><li>Pneumonia </li></ul><ul><li>Pleurisy </li></ul><ul><li>Pericarditis (Acute, chronic) </li></ul><ul><li>Pericardial Effusion </li></ul><ul><li>Bronchial Asthma </li></ul>
  18. 18. <ul><li>Inflammation of the lungs caused by a bacterial or viral infection. </li></ul><ul><li>Symptoms often begin suddenly & may follow an upper respiratory </li></ul><ul><li>infection such as flu or cold. </li></ul>Pneumonia Inflammation
  19. 19. <ul><ul><li>Symptoms </li></ul></ul>Pneumonia <ul><li>Sudden onset </li></ul><ul><li>Chest wall pain, getting worse by coughing or deep breathing. </li></ul><ul><li>Fever, cough with sputum, rapid shallow breathing. </li></ul><ul><li>Fatigue, shaking chills, malaise. </li></ul>Inflammation
  20. 20. <ul><ul><li>Symptoms </li></ul></ul>Pleurisy <ul><ul><li>Chest pain, sudden onset, stabbing pain increasing on inhalation. </li></ul></ul><ul><ul><li>Rapid shallow breathing. </li></ul></ul><ul><ul><li>Pain spreading to the shoulder or the abdomen. </li></ul></ul><ul><ul><li>Cough or fever. </li></ul></ul>Inflammation Inflammation of the outside lining of the lungs.
  21. 21. <ul><li>Acute inflammation of the Pericardium (the membrane sac around the heart). </li></ul>Pericarditis Inflammation
  22. 22. <ul><ul><li>Symptoms </li></ul></ul>Pericarditis <ul><li>Acute </li></ul><ul><li>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. </li></ul><ul><li>Fever. </li></ul>Inflammation
  23. 23. <ul><ul><li>Symptoms </li></ul></ul>Pericarditis <ul><li>Chronic </li></ul><ul><ul><ul><li>Difficulty in breathing. </li></ul></ul></ul><ul><ul><ul><li>Swelling of the legs and abdomen. </li></ul></ul></ul><ul><ul><ul><li>Fatigue </li></ul></ul></ul>Inflammation
  24. 24. <ul><li>Fluid in the space between the Pericardium and the Heart. </li></ul>Pericardial Effusion Inflammation
  25. 25. <ul><ul><li>Symptoms </li></ul></ul>Pericardial Effusion <ul><ul><ul><li>Chest pain with a feeling of fullness or pressure. </li></ul></ul></ul><ul><ul><ul><li>Difficulty in breathing and swallowing. </li></ul></ul></ul>Inflammation
  26. 26. <ul><li>Inflammatory disorder of the airways characterized by: </li></ul>Bronchial Asthma Inflammation
  27. 27. <ul><ul><li>Symptoms </li></ul></ul>Bronchial Asthma <ul><li>Periodic attacks of wheezing. </li></ul><ul><li>Shortness of breath. </li></ul><ul><li>Chest tightness and cough </li></ul>Inflammation
  28. 28. Chest Pain <ul><li>Digestive System Problems </li></ul>Causes of Chest Pain <ul><li>Heart Burn or Oesophageal Reflux </li></ul><ul><li>Oesophageal Spasm </li></ul><ul><li>Gall Bladder Disease </li></ul><ul><li>Peptic Ulcer </li></ul>
  29. 29. <ul><li>What does Heartburn feel like? </li></ul>Heartburn ,Oesophageal Reflux Digestive System Problems
  30. 30. <ul><li>What does Heartburn feel like? </li></ul>Heartburn or Oesophageal Reflux <ul><ul><li>A burning feeling in the chest just behind the breast bone that </li></ul></ul><ul><ul><li>occurs after eating and lasts for a few minutes to </li></ul></ul><ul><ul><li>several hours. </li></ul></ul><ul><ul><li>Chest pain, especially after bending over, lying down or eating. </li></ul></ul><ul><ul><li>Burning in the throat or hot, sour, acidic or salty </li></ul></ul><ul><ul><li>tasting fluid at the back of the throat. </li></ul></ul><ul><ul><li>Difficulty in swallowing. </li></ul></ul><ul><ul><li>Feeling of food &quot;sticking&quot; in the middle of the chest or throat </li></ul></ul>Digestive System Problems
  31. 31. <ul><li>Is it Heartburn or Heart Attack? </li></ul>Heartburn or Oesophageal Reflux Digestive System Problems
  32. 32. <ul><li>The two problems have many of the same symptoms and occur in </li></ul><ul><li>similar types of people e.g., older age group, over weight. </li></ul>Heartburn or Oesophageal Reflux Is it Heartburn or Heart Attack? Also, if the patient has a history of heart problems or is a risk factor for 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
  33. 33. <ul><li>Heartburn may indicate a serious problem that needs evaluation. </li></ul>Heartburn or Oesophageal Reflux Digestive System Problems
  34. 34. <ul><li>Possible signs of Heartburn could be mistaken for a Heart Attack </li></ul>Heartburn or Oesophageal Reflux Digestive System Problems Heart Burn Angina or Heart Attack Sharp, burning sensation below the breast bone or ribs. 1 Feeling of fullness, tightness or dull pressure in the center of the chest Pain 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.
  35. 35. <ul><li>Irregular contraction of the muscles in the Oesophagus </li></ul>Oesophageal Spasm Digestive System Problems
  36. 36. <ul><ul><li>Symptoms </li></ul></ul>Oesophageal Spasm <ul><li>Pain in the chest or upper abdomen </li></ul><ul><li>Heartburn </li></ul><ul><li>Difficulty in swallowing because of pain </li></ul>Digestive System Problems
  37. 37. <ul><li>Includes inflammation, infection, stones, or obstruction of the Gall Bladder. </li></ul>Gall Bladder Disease Digestive System Problems
  38. 38. <ul><ul><li>Symptoms </li></ul></ul>Gall Bladder Disease <ul><li>Chest pain under the breast bone </li></ul><ul><li>Heartburn </li></ul><ul><li>Nausea & vomiting </li></ul><ul><li>Fever </li></ul><ul><li>Abdominal pain; </li></ul><ul><li>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. </li></ul><ul><li>Abdominal fullness or gas </li></ul>Digestive System Problems
  39. 39. <ul><li>An erosions in the lining of the stomach or duodenum . </li></ul>Peptic Ulcer An 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
  40. 40. <ul><ul><li>Symptoms </li></ul></ul>Peptic Ulcer <ul><li>Chest pain </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Weight loss </li></ul><ul><li>Heart burn, belching </li></ul><ul><li>Vomiting blood </li></ul><ul><li>Bloody or dark stools </li></ul>Digestive System Problems
  41. 41. <ul><ul><li>Anxiety or Panic Disorder </li></ul></ul>Chest Pain Causes 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.
  42. 42. Anxiety or Panic Disorder PAIN <ul><li>Usually localized to the chest wall </li></ul><ul><li>Can be fleeting </li></ul><ul><li>Can be sharp &quot;catch&quot; that interrupts a breath </li></ul><ul><li>The chest wall can remain &quot;sore&quot; for hours or days after a panic </li></ul><ul><li>attack </li></ul>
  43. 43. The Chest Pain <ul><ul><li>Recent Chest Trauma </li></ul></ul>Causes of Chest Pain Chest trauma of any type can cause chest pain by causing a rib fracture, muscle strain or contusion.
  44. 44. Recent Chest Trauma <ul><li>Almost always localized, is often described as soreness or a sharp </li></ul><ul><li>pain </li></ul><ul><li>It usually worsens with breathing </li></ul><ul><li>The chest wall is tender to touch or to pressure </li></ul>PAIN
  45. 45. <ul><li>Patient Care Guidelines (EMS-8) </li></ul>Chest Pain
  46. 46. Chest Pain Patient Care Guidelines ( EMS-8) <ul><li>Triage Assessment </li></ul><ul><li>Nursing Actions </li></ul><ul><li>Evaluation </li></ul>
  47. 47. Patient Care Guidelines ( EMS-8) <ul><li>Initial observation </li></ul><ul><li>Subjective assessment </li></ul><ul><li>Objective assessment </li></ul>Triage Assessment
  48. 48. Triage Assessment Initial Observation <ul><ul><li>Skin color </li></ul></ul><ul><ul><li>Respiratory effort </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul>
  49. 49. Triage Assessment Subjective Assessment <ul><ul><ul><li>Pain Categorization </li></ul></ul></ul><ul><ul><ul><li>Time of onset ; gradual or sudden </li></ul></ul></ul><ul><ul><ul><li>Activity at onset </li></ul></ul></ul><ul><ul><ul><li>Location of pain </li></ul></ul></ul><ul><ul><ul><li>Sharp, dull, pressure like, or other </li></ul></ul></ul><ul><ul><ul><li>Intermittent or constant </li></ul></ul></ul><ul><ul><ul><li>Radiation </li></ul></ul></ul><ul><ul><ul><li>Change in pain with deep inspiration, cough or movement </li></ul></ul></ul>
  50. 50. Triage Assessment <ul><ul><li>Associated symptoms </li></ul></ul><ul><ul><ul><li>Nausea, vomiting </li></ul></ul></ul><ul><ul><ul><li>Shortness of breath </li></ul></ul></ul><ul><ul><ul><li>Diaphoresis </li></ul></ul></ul><ul><ul><ul><li>Cough; productive or nonproductive </li></ul></ul></ul><ul><ul><ul><li>Fever </li></ul></ul></ul><ul><ul><ul><li>Dizziness or change in level of consciousness </li></ul></ul></ul><ul><ul><ul><li>Palpitation </li></ul></ul></ul>Subjective Assessment
  51. 51. Triage Assessment <ul><li>Measures taken to relieve pain before arrival at EMS </li></ul><ul><li>Relevant medical history. </li></ul>Subjective Assessment
  52. 52. Triage Assessment Objective assessment <ul><li>Complete vital signs (including apical & peripheral </li></ul><ul><li>pulse & breath sounds) </li></ul><ul><li>Presence or absence of edema: pitting or dependent </li></ul><ul><li>Presence or absence of neck vein distension </li></ul>
  53. 53. Chest Pain Nursing Actions <ul><li>Assess patient while obtaining history </li></ul><ul><li>Classify if chest pain could be of cardiac origin, including epigastric pain in elderly, take to Treatment Area Room </li></ul><ul><li>Notify clinician immediately </li></ul><ul><li>Request patient's file </li></ul><ul><li>Take the vital signs </li></ul><ul><li>Facilitate rapid admission </li></ul><ul><li>Explain treatment to patient & family to diminish anxiety </li></ul>
  54. 54. Chest Pain Evaluation <ul><li>Document initial assessment data and interventions </li></ul><ul><li>Extent of diminished anxiety </li></ul>
  55. 55. <ul><li>Summary </li></ul>Chest Pain
  56. 56. 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
  57. 57. Chest Pain The 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:
  58. 58. Summary The Physical Examination <ul><ul><li>Is the pain between the shoulder blades? Under the breastbone? Does the pain change location? Is it on one side only? </li></ul></ul><ul><ul><li>How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, constricting, tight, pressure-like, crushing, aching, dull, heavy)? </li></ul></ul><ul><ul><li>Does it come on suddenly? Does the pain occur at the same time each day? </li></ul></ul><ul><ul><li>Is the pain getting worse? How long does the pain last? </li></ul></ul><ul><ul><li>Does the pain go from your chest into your shoulder, arm, neck, jaw, or back? </li></ul></ul>
  59. 59. Summary <ul><li>Is the pain worse when you are breathing deeply, coughing, eating, bending? </li></ul><ul><li>When you are exercising? Is the pain better after you rest? Is it completely relieved or just less? </li></ul><ul><li>Is the pain better after you take nitroglycerin medication? After you drink milk or take antacids? After belching? </li></ul><ul><li>What other symptoms are also present? </li></ul>The Physical Examination
  60. 60. Summary <ul><li>Diagnostic tests that may be performed include: </li></ul><ul><ul><li>Blood tests (such as LDH , LDH isoenzymes , CPK , CPK isoenzymes , Troponin, CBC , and blood differential ) </li></ul></ul><ul><ul><li>Cardiac catheterization </li></ul></ul><ul><ul><li>ECG </li></ul></ul><ul><ul><li>Exercise ECG </li></ul></ul><ul><ul><li>Lung scan </li></ul></ul><ul><ul><li>X-rays of the chest </li></ul></ul>Diagnostic Tests
  61. 61. Summary More complex tests may be required depending on the difficulty of diagnosis or the suspected cause of the chest pain Diagnostic Tests
  62. 62. <ul><li>References </li></ul>Chest Pain
  63. 63. Chest Pain References www.mayo
  64. 64. Chest Pain <ul><li>Thank You </li></ul>