Chest Pain

Introduction

Chest pain is one of a few medical complaints that always require emergency medical care.

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The specific cause of chest pain may be difficult to interpret initially and can vary from minor problems such as heartburn and rheumatism of the intercostals muscles to serious medical emergencies. As chest pain is often an indicator of a heart attack, the condition needs immediate attention.

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The foremost part in first aid for chest pain is to recognize the signs of chest pain. The chest pain of a heart attack characteristically occurs in the center of the chest radiating to the neck, left shoulder and left arm. The pain is described as squeezing, pressurizing or stabbing in nature and is often associated with nausea, sweating, palpitation and shortness of breath or fainting.

First Aid

The action taken during the first few minutes of an emergency is critical in the survival of an individual with chest pain of cardiac origin.1 In the absence of immediate medical help, the following steps should be practiced:

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  • Have the person sit and try to calm down.
  • Loosen any tight clothing.
  • Enquire if the person takes any chest pain medication for a known heart condition.
  • If he or she does, help the person to take the medication (usually nitroglycerin, placed under the tongue. Aspirin can help if the chest pain is moving towards the neck or arms).
  • If the pain does not subside with rest or within 3 min of taking nitroglycerin, call for emergency medical help as soon as possible.
  • Monitor the person for breathing and pulse.

If the person is unresponsive, begin cardiopulmonary resuscitation (CPR).1 The procedure involves the following steps:

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  1. Look for the notch at the lower edge of the ribcage. Place your middle finger in this notch and your index finger beside it. Take the heel of the other hand and slide it down the breastbone until it touches the index finger and position it on the middle of the lower half of the breastbone.
  2. Then, place the heel of the other hand on top of the first. Interlace the fingers together and keep them off the chest.
  3. Keep your elbows straight and press down. Apply pressure through the heels of the hands only.
  4. Compress the chest about one and half to two inches (four to five cm). Allow the chest to completely recoil before the next compression.
  5. Repeat the movement 15 times, followed by artificial respiration twice and check for carotid pulse for at least 10 sec. Alternate this procedure in the ratio of 15:2 until help arrives.
  6. Chest compressions are extremely important. If you are not comfortable giving rescue breaths, continue with chest compressions.

The latest guidelines published by the American Heart Association had recommended compression: ventilation ratio of 30:2 instead of 15:2. This was based on observations that rescue breaths caused unacceptably long interruptions during chest compressions. When chest compressions are interrupted by rescue breathing, blood flow to the heart and the 24-hsurvival had been shown to decrease and the probability of return of spontaneous circulation is reduced from high to low, when CPR is interrupted for 20 sec.2

Do’s and Don’ts

  • Never drive yourself to the hospital when you are having chest pain.
  • Never leave the person suffering from chest pain alone except to call for help.
  • Do not wait to see if the symptoms go away.
  • Do not give the person anything orally unless a heart medication such as nitroglycerin has been prescribed.
  • When performing chest compressions do not take off your hand. Let the chest recoil fully but keep the heel of your hand in contact with the sternum at all times.
  • Do not stop if you feel pops and snaps, when you begin chest compressions, as this is not going to make the victim any worse.

References

1.Sreevastava DK, Roy PK, Dass SK, Chakrabarty A, Tarneja VK. Cardiopulmonary resuscitation: An overview of recent advances in concepts and practices. MJAFI. 2004; 60(1): 52–58.
2.Ali B, Zafari AM. Narrative review: Cardiopulmonary resuscitation and emergency cardiovascular care: review of the current guidelines. Ann Intern Med. 2007; 147(3): 171–179.

Written by: healthplus24 team
Date last updated: May 02, 2015