Logged in as | Logout

Multilingual Support:

Concerns

Chest Pain

Comorbidities

Signs and symptoms

Differential diagnosis

Action

Chest Pain

Reversible ischemic event, resulting in decreased oxygenated blood supply to the myocardium.

Comorbidities

  • smoking
  • hyperlipidemia
  • family history of artherosclerosis

Signs and symptoms

  • substernal pain
  • radiating pain to the shoulders, arms, or mandible
  • spontaneously subsides with rest
  • symptoms subside with antianginal medications
  • atypical symptoms in  women and diabetics

Differential diagnosis

  • myocardial infarction
  • dyspepsia, GERD, esophageal spasm
  • musculoskeletal
  • pulmonary embolus
  • spontaneous pneumothorax
  • aortic dissection
  • esophageal rupture
  • panic disorder

Action

  • be calm and reassuring
  • discontinue dental treatment
  • place the patient in a slightly upright position
  • evaluate breathing, airway and circulation
  • monitor pulse, blood pressure, and respiration rate every 5 min
  • administer oxygen, 6-8 L/min by nasal cannula or mask
  • administer 0.3 mg nitroglycerin sublingually; repeat up to 3 times every 5 minutes
  • give an aspirin (325 mg), chew and swallow
  • if no relief after 3 administrations of nitroglycerin, assume the patient is having a myocardial infarction. (See Emergency – Myocardial Infarction.)
  • if not a myocardial infarction, arrange for home escort
  • notify the patient’s primary care provider
  • call later to check on patient

OK