Chest Pain
Lukáš Dadák
Learning objectives:
̶ Student will learn the most common causes of chest pain.
̶ Student will learn the differences between visceral and parietal
pain.
̶ Student will learn the FA to a casualty with chest pain.
Anatomy of the Chest
̶ chest wall:
̶ skin,
̶ muscles,
̶ bones, joints
̶ parietal pleura
̶ organs:
̶ heart, pericardium
̶ (lung), visceral pleura
̶ esophagus
̶ aorta
https://healthjade.com/what-is-pain-in-the-esophagus/
Pain
̶ unpleasant sensation caused by illness or
injury
̶ ischemic heart disease
̶ the most common cause of chest pain
̶ 30% EMS
http://wakehealthse3.adam.com/content.aspx?productid=117&pid=1&gid=003079
Shortness of Breath
̶ subjective feeling
̶ unpleasant breathing associated with a feeling of lack of air
̶ The patient becomes aware of increased breathing work.
Anatomy of the Chest
̶ chest wall:
̶ skin,
̶ muscles,
̶ bones, joints
̶ parietal pleura
̶ parietal pain
̶ precisely localizable
̶ sharp, cutting
̶ change in movement
̶ pointed by finger
̶ organs:
̶ heart, pericardium
̶ (lung), visceral pleura
̶ esophagus
̶ aorta
̶ visceral pain
̶ diffuse, dull, vaguely defined,
̶ located in the middle line
̶ burning
̶ pointed by fist / palm
Ischemic Heart Disease
̶ coronary artery obstruction
̶ heart muscle insufficiently supplied
with O2  dysfunction  death of
cells
̶ predisposition:
̶ obesity
̶ smoking
̶ stressful lifestyle
̶ M after 45, F after menopause
https://loyolamedicine.adam.com/content.aspx?productid=117&pid=1&gid=000198
Artery occlusion
https://en.wikipedia.org/wiki/Myocardial_infarction#/media/File:Heart_ant_wall_infarction.jpg
Manifestations of Ischemia
̶ conduction disturbance = rhythm disturbances
̶ cardiac arrest
̶ contractility disorder
̶ lung edema (shortness of breath)
̶ cardiogenic shock (cold, pale or bluish skin, sweating,…)
̶ pain
̶ behind the sternum / in front of the backbone
̶ uncomfortable pressure / burning in the middle of the chest
̶ radiate up the neck and into the jaw and teeth
̶ radiate into the shoulder or down one or both arms
Manifestations of Ischemia
̶ angina pectoris
̶ pain during exertion / at rest, forces to stop - arterial spasm
̶ Medication: nitroglycerin – tbl/ spray under the tongue - dilation of blood vessels improvement
of blood circulation - relief of problems within minutes
̶ acute myocardial infarction
̶ visceral pain
̶ restlessness, anxiety and fear of death
̶ shortness of breath
̶ sweating, nausea, vomiting, shock
̶ slow / fast / irregular pulse
̶ sudden cardiac arrest - ventricular fibrillation, death
̶ mute ischemia
̶ dysfunction of heart, no pain (shortness of breath, cyanosis)
Occurrence of AMI
̶ household (70%)
̶ employment (10%)
̶ rest (45%)
̶ sleep (17%)
̶ normal activity (30%)
̶ hard work (8%)
FA
̶ SSSABC
̶ make casualty comfortable (calm, no stress, no exercise)
̶ half sitting, loosen clothes to breathe better
̶ call EMS
̶ monitor vital signs (ABCD)
̶ do not eat / drink / smoke
̶ (Acylpyrin = Anopyrin = acetylsalicylic acid 100 mg p.os)
̶ Be ready to start BLS with AED immediately!
Pulmonary embolism
̶ embolus = a clot obstructing a
lung artery
̶ signs and symptoms:
̶ shortness of breath
̶ chest pain
̶ cough
̶ (rapid or irregular heartbeat)
̶ (dizziness)
̶ (sweating, fever)
̶ (leg pain or swelling)
̶ (cyanosis)
https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647
Pulmonary embolism
̶ shock
̶ FA:
̶ SSSABC
̶ sit and rest
̶ EMS
Gastroesophageal Reflux
̶ the acidic content of the stomach irritates
the esophageal wall
̶ pain
̶ forward bend, lying down
̶ with an increase in intra-abdominal pressure
̶ there may be temporary relief after a meal
https://loyolamedicine.adam.com/content.aspx?productid=117&pid=1&gid=0
00265
Back pain
̶ degenerative diseases of the spine
̶ related to movement, position
̶ pain radiates along the intercostal
nerves
̶ spasms of paravertebral muscles
https://coloradopaincare.com/condition/thoracic-back-pain/
Pneumonia, pleuritis
̶ pain
̶ lateralized (lungs do not hurt, pleura hurts)
̶ exacerbated by coughing, breathing
̶ high temperature (fast pulse)
̶ cough
̶ shortness of breath
̶ fatigue
Learning outcomes:
̶ Student is able to list the most frequent reasons of chest pain.
̶ Student masters the concepts of visceral and parietal pain.
̶ Student is able to provide first aid to a casualty with chest pain.
Literature:
̶ https://www.mayoclinic.org/diseases-conditions/heart-
attack/symptoms-causes/syc-20373106
̶ https://www.mayoclinic.org/diseases-conditions/pulmonary-
embolism/symptoms-causes/syc-20354647
̶ https://www.mayoclinic.org/diseases-conditions/chest-
pain/symptoms-causes/syc-20370838
Simulation Centre, Faculty of Medicine, Masaryk University
2020