This document provides information about chest pain, including its definition, common causes, symptoms, and guidelines for patient care. Chest pain can be caused by issues with the heart, lungs, esophagus, or other organs in the chest cavity. The physical examination and diagnostic tests are aimed at evaluating the chest, heart, and lungs to determine the underlying cause and appropriate treatment for the patient's chest pain.

1. Welcome

2. Chest Pain By Iman Noufal Amb.Nsg. /UCU

3. Chest Pain Definition Causes of Chest pain Patient Care Guidelines ( EMS-8) Summary References Introduction

4. Chest Pain Definition Introduction

5. Chest Pain What is Chest Pain? Definition

6. Chest Pain What is Chest Pain? 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. Chest Pain Is chest pain the warning sign of a heart attack only? Or could it be a sign of another illness? Definition

8. Chest Pain Is chest pain the only warning sign of a Heart Attack, or could it be a sign of serious illnesses? Definition Many people with chest pain fear a heart attack, but there are many possible causes of chest pain.

9. Chest Pain Causes of Chest Pain

10. Chest Pain Causes of Chest Pain Heart Disease Inflammation Digestive System Problems Anxiety or Panic Disorder Recent Chest Trauma

11. Chest Pain Heart Disease Causes of Chest Pain Coronary Artery Disease (Angina) Heart Attack (MI) Heart Valve Disease Heart Muscle Disease (Cardiomyopathy) Aortic Dissection

12. Heart Disease Symptoms 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.

13. Heart Disease Symptoms Heart 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 .

14. Heart Disease Symptoms Heart 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.

15. Heart Disease Symptoms Heart Muscles Disease Chest 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.

16. Heart Disease Aortic Dissection Tearing 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.

17. Chest Pain Inflammation Causes of Chest Pain Pneumonia Pleurisy Pericarditis (Acute, chronic) Pericardial Effusion Bronchial Asthma

18. Inflammation of the lungs caused by a bacterial or viral infection. Symptoms often begin suddenly & may follow an upper respiratory infection such as flu or cold. Pneumonia Inflammation

19. Symptoms Pneumonia Sudden onset Chest wall pain, getting worse by coughing or deep breathing. Fever, cough with sputum, rapid shallow breathing. Fatigue, shaking chills, malaise. Inflammation

20. Symptoms Pleurisy Chest pain, sudden onset, stabbing pain increasing on inhalation. Rapid shallow breathing. Pain spreading to the shoulder or the abdomen. Cough or fever. Inflammation Inflammation of the outside lining of the lungs.

21. Acute inflammation of the Pericardium (the membrane sac around the heart). Pericarditis Inflammation

22. Symptoms Pericarditis Acute 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

23. Symptoms Pericarditis Chronic Difficulty in breathing. Swelling of the legs and abdomen. Fatigue Inflammation

24. Fluid in the space between the Pericardium and the Heart. Pericardial Effusion Inflammation

25. Symptoms Pericardial Effusion Chest pain with a feeling of fullness or pressure. Difficulty in breathing and swallowing. Inflammation

26. Inflammatory disorder of the airways characterized by: Bronchial Asthma Inflammation

27. Symptoms Bronchial Asthma Periodic attacks of wheezing. Shortness of breath. Chest tightness and cough Inflammation

28. Chest Pain Digestive System Problems Causes of Chest Pain Heart Burn or Oesophageal Reflux Oesophageal Spasm Gall Bladder Disease Peptic Ulcer

29. What does Heartburn feel like? Heartburn ,Oesophageal Reflux Digestive System Problems

30. 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

31. Is it Heartburn or Heart Attack? Heartburn or Oesophageal Reflux Digestive System Problems

32. 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 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. Heartburn may indicate a serious problem that needs evaluation. Heartburn or Oesophageal Reflux Digestive System Problems

34. Possible signs of Heartburn could be mistaken for a Heart Attack 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. Irregular contraction of the muscles in the Oesophagus Oesophageal Spasm Digestive System Problems

36. Symptoms Oesophageal Spasm Pain in the chest or upper abdomen Heartburn Difficulty in swallowing because of pain Digestive System Problems

37. Includes inflammation, infection, stones, or obstruction of the Gall Bladder. Gall Bladder Disease Digestive System Problems

38. Symptoms Gall Bladder Disease Chest 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

39. An erosions in the lining of the stomach or duodenum . 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. Symptoms Peptic Ulcer Chest pain Nausea and vomiting Weight loss Heart burn, belching Vomiting blood Bloody or dark stools Digestive System Problems

41. Anxiety or Panic Disorder 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. 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

43. The Chest Pain Recent Chest Trauma Causes of Chest Pain Chest trauma of any type can cause chest pain by causing a rib fracture, muscle strain or contusion.

44. 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 pressure PAIN

45. Patient Care Guidelines (EMS-8) Chest Pain

46. Chest Pain Patient Care Guidelines ( EMS-8) Triage Assessment Nursing Actions Evaluation

47. Patient Care Guidelines ( EMS-8) Initial observation Subjective assessment Objective assessment Triage Assessment

48. Triage Assessment Initial Observation Skin color Respiratory effort Anxiety

49. 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

50. 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

51. Triage Assessment Measures taken to relieve pain before arrival at EMS Relevant medical history. Subjective Assessment

52. 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

53. Chest Pain Nursing 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

54. Chest Pain Evaluation Document initial assessment data and interventions Extent of diminished anxiety

55. Summary Chest Pain

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. 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. Summary The 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?

59. Summary Is 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

60. Summary Diagnostic 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

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. References Chest Pain

63. Chest Pain References www.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

64. Chest Pain Thank You