1. Nursing Instruction
  2. Overview
  3. Emergency and Critical
【Major Points】
  1. It is important to conduct tests quickly when a patient is complaining of chest pain.
  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. 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: pulmonary disease( e.g. pulmonary inflammation, pleurisy, pneumothorax) ; gastrointestinal disease(e.g. esophagitis, gastroesophageal reflux disease, gastro-duodenal ulcer, cholecystitis, gallstones);neuromuscular disease( e.g. fracture of rib, fracture of thoracic vertebrae);others(e.g. panic disorder, herpes zoster) etc.
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 identify those symptoms and get immediate medical help.
  1. Chest pain that may feel like pressure, tightness, or squeezing in the chest. 
  2. Chest tightness or pain that spreads to your left shoulder, left arm, neck, jaw, upper abdomen, or gum
  3. Not improved after resting
  4. Chest pain combined with shortness of breath, trouble breathing, nausea, vomiting, cold sweating, dizziness, blanched face, and generalized weakness.

If you have the above symptoms that may be caused by the heart, get medical help immediately.

Principles for care
  1. When chest pain occurs, find a quiet space to sit and rest. If the pain persists, it is highly possible to be caused by the heart. In this case, you should get emergency medical assistance immediately. 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
    1. Maintain good physical condition
      • Maintain ideal body weight
      • Control blood pressure, cholesterol, glucose level.
    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. Make sure to warm up your body before going out for exercise.
      • Avoid using extremely cold or hot water for a bath. It is highly recommended to use warm water for shower.
      • Keep yourself warm, especially for outdoor activities during winter time. Avoid hypothermia, which can cause vasoconstriction and elevate blood pressure.
    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) 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.
Reference
  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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    1. Nursing Instruction
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    Self-care / Home Care
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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