【Major Points】
  1. Chest pain may not be heart related.
  2.  It can be life-threatening if chest pain caused by the cardiac origin. Therefore, it is important to identify those symptoms.
  3. If the pain persists and combines with shortness of breath or cold sweating, you should get emergency medical assistance immediately.
What is chest pain?
Chest pain is defined as pain in any area of your chest, which may be related to an abnormality in the internal or external organs of the chest cavity, e.g. heart, lung, esophagus, stomach, thoracic wall, rib, etc. Causes of chest pain simply can be organized into two categories: cardiac and non-cardiac origin.
  1. Cardiac origin, e.g. coronary artery disease (angina), myocarditis, myocardial infarction, aortic dissection.
  2. Non-cardiac origin
    1. Pulmonary disease, e.g.
      • Pulmonary inflammation and pleurisy (a thin layer of tissue that wraps your lungs while inflammation may cause chest pain)
      • Pneumothorax (When air leaks into the space between your lung and pleural space, this air presses exterior of your lung and makes them collapse, and, eventually, distresses breathing.)
      • Pulmonary embolism (When a blood clot formed by solid, liquid, or air gets lodged in a vessel in the lung, the blood clot blocks the blood flow of partial lung)
    2. Gastrointestinal disease, e.g.
      • Esophagitis
      • Gastroesophageal reflux disease, gastro-duodenal ulcer
      • Cholecystitis, gallstones
    3. Neuromuscular disease, e.g. fracture of rib, fracture of thoracic vertebrae
    4. Other, e.g. panic disorder, herpes zoster
What are the common symptoms of chest pain?

Although most cases of chest pain are caused by minor illnesses, it can still be life-threatening if it is caused by the cardiac origin. Therefore, it is important to learn and identify those symptoms and get immediate medical help.


Typical cardiac origin symptoms of chest pain

  1. Chest tightness: The pressure or tightness in your chest may become a dull ache that spreads to your left shoulder, left arm, neck, jaw, upper abdomen, gum
  2. Not improved after resting
  3. Chest tightness and pain combined with shortness of breath, trouble breathing, nausea, vomiting, cold sweating, dizziness, blanched face, and generalized weakness.
The above symptoms are not necessarily the pain caused by the heart, but it is recommended to seek medical attention as soon as possible.
Principles for care:
  1. When chest pain occurs
    1. Find a quiet space to sit and rest
    2. If the pain persists and combines with shortness of breath, cold sweating, nausea, and vomiting, it is highly possible to be caused by the heart.In this case, you should get emergency medical assistance immediately.
    3. Chest pain without the aforementioned symptoms is not necessarily caused by the heart. If chest pain occurs, it is recommended to seek medical care. (Request an appointment: Cardiology Clinic )
  2. Prevention of chest pain caused by the heart
    1. Maintain good physical condition
      • Maintain ideal body weight
      • Control blood pressure, cholesterol, glucose leve
    2. Maintain good lifestyle
      • Quit smoking and avoid second-hand smoke.
      • Maintain regular bowel habits; don’t strain to get the stool out.
      • Exercise daily for at least 30 minutes to relieve stress, and relax.
    3. Have a healthy diet
      • Limit alcohol consumption < 30ml per day. Female with menopause and older adults should halve their consumption.
      • Reduce saturated fats (e.g. butter, cheese, dairy products), hydrogenated fats (e.g. margarine, pastry, biscuit, French fries, dressing), cholesterol (e.g. heart, liver, and kidney), eggs(e.g. crab roe, shrimp roe, and fish roe), and shellfish (e.g. oyster, clams, abalone, octopus) in your diet.
      • Increase grains and fruits in your diet.
      • Avoid excessive sodium consumption, e.g. canned foods and pickled foods.
      • Reduce caffeine products, e.g. coffee, tea, and coke. No more than 300~400cc daily.
      • Avoid food consumption 2hrs prior bedtime or elevate your head while asleep, which can help prevent gastroesophageal reflux disease at night.
    4. Avoid situations that can cause vasoconstriction
      • Avoid using extremely cold or hot water for a bath. It is highly recommended to use warm water for shower.
      • Avoid hypothermia, which can cause vasoconstriction and elevate blood pressure.
      • Keep yourself warm, especially for outdoor activities during winter time. Make sure to warm up your body before going out for exercise.
  1. Eng-Frost, J., & Chew, D. (2021). Diagnosis and management of acute coronary syndromes. Australian Prescriber, 44(6), 180.https://doi.org/10.18773/austprescr.2021.049
  2. Hamel, S., Denis, I., Turcotte, S., Fleet, R., Archambault, P., Dionne, C. E., & Foldes-Busque, G. (2022). Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity. Health and quality of life outcomes, 20(1), 1-9.https://doi.org/10.1186/s12955-021-01912-8
  3. Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American journal of gastroenterology, 117(1), 27-56.https://doi.org/10.14309/ajg.0000000000001538
  4. Writing Committee Members, Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., ...  Zwischenberger, B. A. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(2), 197-215.https://doi.org/10.1016/j.jacc.2021.09.006
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