First Aid for Chest pain

Chest pain may indicate a range of conditions from heart attack to musculoskeletal strain. Rapid assessment and action are vital, as cardiac causes can be life-threatening.

Chest pain is the pain or discomfort a person feels in any area of their chest. This particular pain can spread to different areas of a person’s upper body, such as into the jaw or neck and down the arms.

The pain one feels in their chest can either be dull or sharp, accompanied by an ache or tightness. The duration of it can vary, with some incidents lasting for just a few minutes and some staying for hours. In certain cases, the pain can remain for six months or even longer.

Symptoms of Chest Pain

If the reason for your chest pain is related to your heart, then you could experience the following symptoms:

• Tightness, burning, fullness, or pressure in the chest.
• Cold sweats.
• Vomiting or nausea.
• Shortness of breath.
• Racing heartbeats.
• Pain that keeps going and coming back, worsens with physical activity, lasts for over a couple of minutes, and keeps varying in intensity.
• Weakness, dizziness, or lightheadedness.
• Abdominal pain
• Pain in the arm, jaw, or back.

In case the chest pain is not related to heart problems, the symptoms could be:

• Pain that remains for several hours.
• Pain that gets worse with coughing or breathing deeply.
• Trouble swallowing.
• Feeling tenderness on the chest when you push on it.
• Pain that gets worse or better with the change in body position
• Mouth feeling sour or the feeling that food is reentering the mouth

Causes of Chest Pain

Numerous causes can lead to chest pain. While some are related to the heart, others are not. The causes of chest pain that are heart-related include:

• Heart attack
• Angina (chest pain caused due to blockages in the blood vessels)
• Cardiomyopathy (heart muscle disease)
• Pericarditis (swelling of the sac surrounding the heart)
• Aortic dissection (tearing in the aorta, which is the largest artery of the body)·   Myocarditis (inflammation of the heart muscle)

There are gastrointestinal causes as well that could lead to chest pain, such as:

• Acid reflux
• Gallstones
• Issues with swallowing
• Pancreas or gallbladder getting inflated

The lungs can cause chest pain too, with the conditions being:

• Pneumonia (lung infection)
• Pneumothorax (collapsed lung)
• Pulmonary embolism (blood clot in the lung)
• Lung cancer
• Bronchospasm (tightening of the muscles lining the airways in the lungs)

Chest pain can be related to the bones or muscles as well:

• Broken or bruised ribs
• Compression fractures that lead to pressure on a nerve
• Sore muscles caused due to chronic pain syndromes or exertion

Apart from the causes listed above, shingles and panic attacks can induce chest pain in a person too. Shingles is a viral infection that triggers a painful rash.

First Aid for Chest Pain

Chest pain can be a warning sign of a serious condition such as a heart attack and should never be ignored. While only a healthcare professional can diagnose the cause, the following first aid steps may help stabilize the situation until emergency medical care is available.

1. Recognize the Situation

• Assess the Symptoms: Look for warning signs such as:
  • A feeling of pressure, tightness, or squeezing in the chest
  • Pain that may radiate to the arm, back, neck, jaw, or stomach
  • Shortness of breath
  • Sweating, nausea, lightheadedness, or sudden fatigue
  • In some cases, chest pain might be vague or accompanied by less specific symptoms (this is especially common in women)
• Determine Urgency: If the chest pain is new, unexplained, or lasts more than a few minutes (especially if it’s severe), treat it as a medical emergency. These symptoms can be indicative of a heart attack or other life-threatening conditions.

2. Call Emergency Services Immediately

• Dial 911 (or Your Local Emergency Number): Do not delay in calling for help. Explain that the person is having chest pain and describe the symptoms. The sooner medical care is provided, the better the outcome can be.
• Provide Details: Clearly state the onset time of symptoms, the nature of the pain, and any additional symptoms (like difficulty breathing or radiating pain).

3. Help the Person Get Comfortable

• Rest and Positioning:
  • Have the person sit down in a comfortable, semi-reclined position. This can ease the strain on the heart and may help with breathing.
  • Loosen any tight clothing to facilitate smoother and easier breathing.
• Stay Calm: Reassure the person that help is on the way. Anxiety and panic can worsen the symptoms by increasing the heart rate and blood pressure.

4. Assist with Medications (If Applicable)

• Nitroglycerin:
  • If the person has been previously prescribed nitroglycerin (commonly used for angina or coronary issues), help them use it according to their own emergency plan. Typically, the medication is taken by placing the tablet under the tongue or using a spray under the tongue.
  • Important: Only assist with medication if you know it is prescribed for the individual. Do not take anyone else’s medication.
• Aspirin:
  • If advised by a healthcare provider in the person’s emergency action plan, chewed aspirin (usually 250 mg) may help reduce heart damage during a suspected heart attack.
  • Caution: Make sure the person is not allergic to aspirin and that they have no contraindications (such as a history of stomach bleeding).

5. Monitor the Person Closely

• Keep a Close Eye on Vital Signs:
  • Observe the person’s breathing, level of responsiveness, and pulse.
  • If the person becomes unresponsive or stops breathing, begin CPR immediately if you are trained. Remember, hands-only CPR is preferable if you are not trained in conventional CPR.
• Stay With the Person: Remain calm and stay by their side until emergency services arrive. Keep them reassured and encourage slow, steady breathing.

6. Do Not Delay Treatment

• Do Not Wait: Even if the chest pain seems to ease before help arrives, the underlying issue may still be serious. The person should be evaluated by medical professionals to rule out a heart attack or other life-threatening conditions.
• Avoid Food or Drink: Until advised by healthcare professionals, do not give the person anything to eat or drink, as it may interfere with potential treatments or procedures once they reach the hospital.

Prevention

Following a healthy lifestyle is the only way to reduce the risk of experiencing heart and other diseases. Some of the ways to do so include:

• Follow a healthy diet.
• Exercise multiple times a week.
• Stay away from tobacco products.
• Taking care of the health conditions one might have, such as diabetes, high cholesterol, and high blood pressure.
• Limit your alcohol intake.
• Reach a weight that is healthy for you and attempt to maintain it.

The tips that can help you prevent other causes of chest pain that are not related to the heart are as follows:

• Avoid your triggers for asthma.
• If you’re at risk of developing blood clots, take the necessary medications to prevent them.
• Take care of respiratory infections immediately.
• Get vaccinated for shingles or chickenpox.
• Prevent the formation of blood clots in your legs during flights or long road trips by getting up and walking around every few hours.

Do’s and Don’ts

When to Seek Emergency Help

Call emergency services immediately if the person has any of the following:

• Sudden, severe chest pain lasting more than a few minutes
• Pain radiating to the jaw, arm, back, or shoulder
• Difficulty breathing, cold sweat, nausea, or light-headedness
• Signs of stroke: vision changes, slurred speech, weakness on one side
• Swelling in one leg (suggesting a possible blood clot)
• Loss of consciousness or fainting

REFERENCES

1. Broaddus VC, et al., eds. Chest pain. In: Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Elsevier; 2022. https://www.clinicalkey.com.
2. Pellegrino JL, et al. 2020 American Heart Association and American Red Cross focused update for first aid. Circulation. 2020; doi:10.1161/CIR.0000000000000900.
3. Walls RM, et al., eds. Chest pain. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Elsevier; 2023. https://www.clinicalkey.com.
4. Krish Tangella, First Aid for Chest Pain, Apr 26, 2019, https://www.dovemed.com/healthy-living/first-aid/chest-pain

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