EMS: “I Have Chest Pain”

“Chest pain” is a comprehensive complaint that could signify several medical or trauma-related issues. On the other hand, your patient might deny a complaint of chest pain or discomfort but still be experiencing a life-threatening illness.

Differential diagnosis

Any first responder who has a patient who, no matter the individual’s age, complains of chest pain or discomfort always should keep in the back of the mind that this could be a significant cardiac event. We sometimes forget that even an 18-year-old could have a heart attack but play off that event, possibly because of age. Never be impeded by your patient’s age. Treat all signs and symptoms as if they have the worst-case scenario, such as an acute myocardial infarction (AMI).

I am very passionate about any patient who is having signs and symptoms of a heart attack. I have had two heart attacks. They landed me in the ICU. I received stents and underwent bypass surgery. That said, in neither incident did I experience “chest pain” as an initial symptom or even endure it. Therefore, I preach, please don’t just look for the “book” style AMIs—the patient having “chest pain.” Look at your overall patient and always treat for the worst-case situation.

I was an outpatient who was getting a cardiac catheterization when I first was diagnosed with an AMI. I had weird neurological and respiratory events that my cardiologist couldn’t explain. Immediately afterward, I was admitted to the ICU. I had quintuple bypass surgery the next day. The second that I was home relaxing and watching TV, I suddenly experienced severe upper back pain and shortness of breath. I was rushed to the emergency room, had two stents placed and was admitted.

Not everyone experiences the same type of chest pain, pressure or discomfort (i.e., women, in general, and diabetics). Not everyone has the same pain threshold. Further, chest pain, pressure or discomfort might be a symptom of other medical or traumatic complications.

So, look at other signs and symptoms besides chest pain, pressure and discomfort complaints that a patient might have during a significant cardiac event.

Difficulty breathing or shortness of breath is prevalent because of the close working relationship between the cardiac and respiratory systems.

Neurological complaints, such as lightheadedness, confusion and disorientation, can be symptoms.

Gastrointestinal complaints, such as upset stomach, nausea and vomiting, are common.

Other obvious signs or symptoms can be skin color; temperature or moisture differentials; and abnormal vital signs, including high or low blood pressure, fast, slow or irregular heart rate, and abnormal respiratory rate, with or without atypical breath sounds.

Remember, electrocardiogram findings themselves don’t prove that your patient has a cardiac incident.

‘Chest pain’

Patients can describe this complaint as pain, pressure, squeezing and discomfort. You might hear them say that it “feels like an elephant is sitting on my chest.” Some experience back, neck, jaw or arm pain or radiating pain to or from these areas.

First responders must ascertain good family or medical history.

It would be best to have the patient describe what came first—shortness of breath or pain—and what they were doing before the event. Further, the answer to whether the patient ever experienced this before and what happened afterward can help your diagnosis.

Does the pain come and go during patient exertion or when the patient is at rest? Was the patient suddenly awakened by the pain? Does the pain worsen during a deep breath or when you palpate the chest area?

Be safe, not sorry

Chest pain does equal an AMI or other life-threating issue until proven otherwise. You never can go wrong treating a patient’s worst-case scenario.