Chest pain is a common but serious symptom that can indicate various medical conditions, from minor issues to life-threatening emergencies such as heart attacks. Knowing how to respond immediately and provide long-term care can significantly help improve outcomes and potentially save lives.

In this blog, we will guide you through various aspects of chest pain – understanding it, immediate responses, and long-term care strategies.

Understanding Chest Pain

Chest pain can result from a variety of causes, ranging from minor issues to life-threatening conditions. Recognising the several types of chest pain can help you determine the appropriate response.

Let’s look at some of the common causes:

Cardiovascular

• Heart Attack (Myocardial Infarction): This occurs when a blockage in one or more of the coronary arteries reduces blood flow to the heart muscle, causing severe pain or pressure.
• Angina: Chest pain due to reduced blood flow to the heart, often triggered by physical exertion or stress and relieved by rest.
• Pericarditis: Inflammation of the pericardium, the sack surrounding the heart, causing sharp, stabbing pain that may improve when sitting up and leaning forward.
• Aortic Dissection: A tear in the inner layer of the aorta, leading to severe chest pain and requiring immediate medical attention.

Respiratory

• Pulmonary Embolism: A blood clot in the lung arteries causing sudden, sharp chest pain and shortness of breath.
• Pneumonia: Infection of the lungs that can cause chest pain along with fever and coughing.
• Pleuritis: Inflammation of the lining of the lungs, leading to sharp chest pain that worsens with breathing or coughing.

Gastrointestinal

• GERD (Gastroesophageal Reflux Disease): Acid reflux causes a burning sensation in the chest.
• Peptic Ulcer: Sores in the stomach lining that can cause pain mimicking heart-related chest pain.
• Gallstones: Can cause referred pain to the chest, particularly after eating fatty foods.

Musculoskeletal

• Costochondritis: Inflammation of the chest wall, causing sharp, localised pain.
• Muscle Strain: Overuse or injury to chest muscles leading to pain that worsens with movement.

Psychological Causes

• Panic Attacks: Severe anxiety can manifest as chest pain, often accompanied by rapid heartbeat, sweating, and fear.

Immediate Response to Chest Pain

When someone experiences chest pain, immediate action is critical. Every second counts. However, this is easier said than done. It’s easy to get flabbergasted when you are the immediate responder.

But worry not. Keep calm and simply follow these steps:

Step 1: Call Emergency Services

First, dial emergency services immediately. The emergency services number for Malaysia is 999. Alternatively, you can keep a few ambulance numbers handy as well and call any of them. Avoid driving the person to the hospital yourself; wait for an ambulance.

Step 2: Recognise the symptoms to understand the source of the chest pain

Yes, this is not easy, especially as a layman. Lookout for these symptoms:

• Is the pain spreading from the chest to the arms, neck, jaw, back, or stomach?
• Is the person also feeling shortness of breath?
• Are there signs of sweating, nausea, or vomiting?
• Ask the person if they are feeling dizzy or light-headed.
• Are they feeling fatigued or weak?

Understanding the source of pain or noting down the symptoms can be of great help once emergency services arrive. They may ask questions to gauge the situation so that they can provide the right kind of assistance to the patient. As a first responder, you will be better positioned to answer these questions.

Step 3: Provide immediate assistance

Try to make the patient as comfortable as possible till the emergency arrives. Here are a few things you can do:

• Keep the person calm and seated.
• Make the person comfortable by loosening tight clothing.
• If the person is conscious and not allergic, give them one adult aspirin (325 mg) to chew. Aspirin helps by thinning the blood and preventing further clotting.
• If the person loses consciousness and is not breathing, begin CPR. Push hard and fast in the centre of the chest at a rate of 100-120 compressions per minute.

You can read our article on first aid skills to know more about CPR and how it is performed.

Once emergency help arrives, explain the symptoms to the emergency responders in as much detail as possible. And most importantly, keep calm.

Long-Term Care After Chest Pain

Once the immediate crisis is managed, long-term care is essential for recovery and preventing future episodes. Long-term care involves medical follow-ups, lifestyle changes, and ongoing management of underlying conditions.

Medical Follow-Up

To maintain heart health, it is important to have regular check-ups with your healthcare provider, participate in cardiac rehabilitation programmes, and take prescribed medications as directed. Medications may include blood thinners, beta-blockers, statins, and antihypertensives.

Lifestyle Changes

To maintain a healthy heart, focus on eating a balanced diet high in fruits, vegetables, whole grains, lean proteins, and healthy fats while avoiding excessive salt, sugar, and saturated fats. Incorporate at least 150 minutes of moderate-intensity aerobic exercise each week through activities like walking, swimming, and cycling. If you smoke, it’s strongly recommended that you quit, as smoking significantly increases the risk of heart disease. Also, limit alcohol consumption to reduce the risk of heart problems.

Managing Stress and Mental Health

Manage stress by practising stress-relief techniques such as meditation, yoga, deep breathing, or pursuing hobbies that relax you. Seek mental health support for anxiety or depression, as they can impact heart health. Therapy or counselling can help.

Monitoring and Controlling Risk Factors

Regularly monitor and maintain healthy blood pressure, manage cholesterol levels through diet, exercise, and medication if needed, and control sugar levels with diet, exercise, and medication if you have diabetes.

Recognising and Responding to Recurring Symptoms

Even with long-term care, it is essential to remain vigilant for signs of recurring chest pain or other symptoms indicating a potential problem. Prompt action can prevent complications and avoid an emergency.

Understanding the warning signs that can lead to a medical emergency can help you avoid one. Look out for symptoms like

• Persistent or recurring chest pain
• Shortness of breath
• Unexplained fatigue
• Dizziness or fainting spells
• Swelling in the legs or ankles

If you see any of the symptoms, seek medical advice immediately. Keep emergency contact numbers handy and medical information readily available.

Sources:

• https://www.mayoclinic.org/first-aid/first-aid-heart-attack/basics/
• https://www.unitekemt.com/blog/chest-pain-emergencies/
• https://www.medicalnewstoday.com/articles/heart-problems
• https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/
• https://my.clevelandclinic.org/health/articles/heart-attack-recovery-cardiac-rehabilitation
• https://www.verywellhealth.com/chest-pain