Chest pain emergency management

A Heart Attack is a Matter of LIFE & DEATH!
SEEK IMMEDIATE MEDICAL ATTENTION.

Chest pain is a common symptom of heart attack (Coronary Artery Disease) .If any adult person has symptoms of chest pain, they should be evaluated for possible heart disease, irrespective of age and gender. Chest pain is an important complaint of people coming to the emergency departments all over the world. At Kokilaben hospital, about 8 per cent of people coming to the Accident & Emergency (A&E) department present with chest pain.

Frequently asked questions

Where should I come to if I have chest pain and what is doctor’s availability?
You should come to the Accident & Emergency department straight away which is open 24x7x365. It is located on the ground floor of the hospital. There are Emergency Physicians 24×7 available who will check and treat you immediately after consulting with the Cardiologist.

How should I come to the hospital if I have chest pain?
Call for a cardiac ambulance to get you transferred to the hospital. If the ambulance is not available promptly,take a car or any other comfortable vehicle to the hospital. Do this only if the hospital is close-by to your home/ office. Avoid driving yourself. Kokilaben hospital provides cardiac ambulances to pick up patients with chest pain or heart attack. The emergency telephone number to call for an ambulance is (91-22) 3091 9191. The ambulances are dispatched within 2 minutes of the call. The cardiac ambulances of Kokilaben Hospital are clean,comfortable and equipped with all critical care equipment to handle patients with chest pain and heart attack. Our accompanying nurses and emergency physicians are well trained and experienced in handling all emergencies, including heart attack

Should I take Aspirin/ nitroglycerine (e.g.,Sorbitrate) before coming to the hospital?
If you have chest pain lasting for more than 30 mins. chew a regular aspirin tablet. Take nitroglycerine only if your doctor has already prescribed for you.

Should I eat something before coming to the hospital?
It is best to come to the hospital empty stomach,as some tests require few hours of fasting. Eating just before coming to the hospital may delay your crucial tests.

Will the evaluation and treatment start immediately?
The doctors in the A&E department will see you immediately and start treatment.

Do I have to pay in advance or deposit any money?
No advance payment is required for initial evaluation and treatment in the Accident & Emergency department. For any further treatment or admission, our admission counter personnel will guide you.

What is chest pain?
Chest pain is any pain/ discomfort/ uneasiness that is felt anywhere in the chest.

What are the causes of chest pain?
The shaded area in the picture above shows the regions where the heart-related pain can be felt.There may be many causes of chest pain,but the most critical concern is if the pain originates from the heart.This kind of chest pain is called angina. Angina is caused when the blood flow to a portion of heart decreases due to blockage in one of the arteries of the heart (coronary arteries).This often happens with exercise,high emotion or distress,cold weather or after eating a large meal. The pain usually lasts for few minutes and eases after taking some rest.If the pain lasts for more than 30 minutes and does not go away with rest, this may indicate a heart attack and is due to sudden blockage of one of the arteries of the heart.

Chest pain can also originate from other structures in chest or abdomen like:

• Major arteries in the chest: Tears in the walls of the major arteries in the chest (aortic dissection)
• Covering of the heart: Inflammation of the covering of the heart (pericarditis)
• Lungs: Inflammation of the covering of the lung (pleurisy),bronchitis,pneumonia
• Oesophagus (food pipe): Inflammation,acid reflux
• Muscles: Muscle strains
• Bones: Inflammation of ribs / breast bone (costochondritis)
• Abdomen: Indigestion,acidity and reflux,gall bladder disease/ stones
• Skin: Shingles causing reddening of skin with blisters (herpes zoster)
• Anxiety: Stress can cause chest pain (panic attack)

All chest pain is considered to be heart-related until proven otherwise

What are the common tests done to find the cause of chest pain?
It is not always easy to diagnose the cause of chest pain;however your doctor will try to rule out serious causes our doctor will choose the tests appropriate for you from the following tests:

• ECG – may be repeated 2-3 time over few hours
• Troponin test in blood – performed immediately and again after 3 hours
• X-ray of the chest
• 2D Echocardiography of the heart
• Sonography of upper abdomen
• Routine blood tests (CBC,S.Creatinine,Electrolytes,S.Amylase)
• Stress test
• CT scan coronary angiography
• Coronary angiography by Cardiologist

Initial treatment of heart attack

• Oxygen will be provided through your nose .
• A cannula will be inserted into a vein in your arm to give emergency medicines.
• Your heart rhythm will be monitored on a cardiac monitor.
• Pain killers like Morphine injection may be used for severe pain.
• Blood thinners (antiplatelet medicines) like Aspirin, Clopidogrel, Ticagrelor may be used.Tell your doctor if you have any ulcer,bleeding piles,allergy to these medicines, recent surgery,or you are taking any other blood thinners (anticoagulants).
• Statins may be used for stability of cholesterol plaques in the blocked arteries.
• Nitrates may be used to relieve the pain by expanding the blocked arteries. These are available as tablets,oral sprays,and intravenous injections.
• Medicines that protect the heart – beta-blockers, nicorandil, etc. may be used

Further treatment for acute heart attack

There are two types of treatments available to open the blocked artery which caused the heart attack:

• Immediate coronary angiography to find a blockage in artery of the heart; and opening the blockage by angioplasty and placing stent
• Giving a clot-buster injection in the vein

Your cardiologist will explain you and your family members as to which of the above two options will be best suited for you. You will be admitted in ICU for further care.

The risk factors for heart attack

• Age:
  Men more than 45 years and women more than 55 years
• High blood pressure:
  The excess strain from high blood pressure causes damage of part of the heart muscle, resulting heart attack
• Smoking:
  People who smoke are two to four times more likely to get heart disease. Avoid or keep moderate intake
• High blood cholesterol:
  When there is too much cholesterol in your blood, it builds up in the walls of your arteries, causing heart disease
• Diabetes mellitus:
  Patients with type 1 diabetes or type 2 diabetes are at high risk for several cardiovascular disorders
• Family history:
  History of coronary artery disease in male first-degree relative, or father at less than 55 years of age, or female first-degree relative or mother at less than 65 years of age
• Sedentary Lifestyle:
  Increases risk of dying from heart disease by 52 percent for men and 28 percent for women
• Obesity:
  If you have too much fat — especially around your waist — you’re at higher risk for health problems
• Illegal drug use:
  They are toxic to your heart muscle. They can lead to heart rhythm problems, cardiovascular disease, heart attack, or heart failure

Symptoms of heart attack

• Chest Pain:
  Areas could be chest, behind the breastbone, shoulders & arms, hands, neck, throat & jaw. It may be crushing,burning,squeezing or like heavy pressure on the chest.
• Shortness of Breath:
  If your heart can’t pump blood well (as is the case with a heart attack), you can feel short of breath.
• Acidity or Gas:
  Mild in digestion , heartburn or gas-like feeling could be a signal of heart attack.
• Anxiety:
  Anxiety or dizziness can occur with a heart attack. Some people feel like they might pass out if they try to stand up or over exert themselves.
• Sweating:
  An early sign of heart problems. I f y o u experience cold sweats or clammy skin, then you should consult your doctor.

Chest Pain Signs – Other Reasons

• A lightning bolt or electrical shock:
  This may happen due to musculoskeletal injury or inflammation,or nerve pain (e.g., a cracked rib,a pulled muscle in the chest wall or shingles involving the chest).
• Pinpoint chest discomfort that worsens with positional changes in breathing:
  May involve the lungs (e.g., pleurisy, an inflammation of the lung membranes;pneumonia;or asthma).
• Chest discomfort that gets better with exercise:
  Heart-related pain typically worsens with exercise. Sharp chest pain improving with movement is more likely to have other causes (e.g.,acid reflux).

Warning signs

• Persisting symptoms in spite of treatment
• Increase in duration, frequency and severity of pain episodes
• Chest pain lasting for more than 10 minutes
• Difficulty in walking up to your earlier comfort level
• Breathlessness on walking
• Feeling tired easily
• Feeling of dizziness
• Unexplained sweating

Consult a doctor If you experience:

• Severe chest pain lasting for more than 30 minutes
• Profuse sweating
• Transient fainting (syncope)
• Breathing difficulty, especially on lying down
• Repeated chest pains

Salmon, Oatmeal, Blueberries, Dark chocolate, Citrus fruits, Soy, Potatoes , Tomatoes, Nuts, Legumes, Extra-virgin olive oil, Green tea, Broccoli, Spinach, Kale, Coffee, Flax seeds, Avocado, Pomegranate.

Healthy heart tip

Eat less sodium.Don’t add extra salt to your meal. Be cautious of prepackaged food as they contain excessive amounts of salt for flavour and preservatives.

SAVE LIVES

Act immediately!

• Call an ambulance; it has trained staff and medicines that may save your life.
• Stop and rest quietly by sitting or lying down
• Chew a regular aspirin straight away (unless your doctor has told you to avoid it).
• Do not attempt to drive yourself to the hospital.
• With a heart attack, every minute counts. The faster a person gets treatment, the better.