Two Causes of Chest Pain
There are many causes of chest pain, but angina is the most common one, MI (or heart attack) the most serious. Normally the coronary arteries (blood vessels to the heart) carry oxygen and remove waste products. They may become narrowed from fatty deposits in the blood vessel walls or hardened – often both. The combination is called atherosclerosis and it causes several heart problems.
Most commonly is Angina (Pectoris): The chest pain of angina is caused by temporary loss of oxygen to the heart muscle from reduced blood flow. Lack of blood flow also causes a build up of carbon dioxide and lactic acid. This combined with the reduced oxygen results in chest pain, which is like 'cramp' in the heart muscle.
Angina episodes are often caused by exercise – but that may simply mean running for the bus, not necessarily a marathon. Similarly, the chest pain goes away again when the person rests. The work which the heart has to do (and so the amount of chest pain) can be reduced by the drug Nitroglycerin. As a First Aider, you can help the person to administrator this (hint, read the label – it goes under their tongue) but do not simply decide to give something you happen to find in their pocket!
Angina Pectoris may be stable or unstable
Stable Angina is the commonest form. It follows a typical, predictable pattern. Worsened by exercise, emotion or other triggers and usually relieved by rest in 2-5 minutes.
Unstable angina is more serious. It may be caused by increasing blockage in the blood vessels to the heart. Pain may change in intensity or 'come and go'. Unstable angina may come on at rest and not be relieved by rest. It may be a warning of an MI or heart attack in the near future. Treat it seriously!
More serious yet is the MI (Myocardial Infarction) or heart attack . This is the process of damage or death of heart muscle due to a complete stoppage in blood flow. It can be due to blood clot, embolism, spasm, tumor, etc. Whatever the course, the area of muscle not getting blood flow will start to die. Heart failure and death of the person may follow, depending on the area affected and how much of the heart has been affected. Acute MI is a common cause of death and effective CPR, Defibrillation and ACLS are needed to reduce the chances of this happening.
The first step in managing either of these conditions is to recognize them!
Signs & Symptoms
Common to both:
- Pain in the chest, often spreading
- Often the person says their chest feels 'heavy' or 'crushed'
- Pale skin, can be sweaty
- Pain in the throat / jaw / teeth
- May have increased pulse rate, irregular pulse
- May be short of breath.
Extras for MI
- Probably nausea or vomiting
- Dizziness or confusion
Of course, the symptoms can vary, and can be identical for both conditions. If you are not sure, call an ambulance and be safe.
First Aid Treatment for Angina
- Get them to rest (ie: sit down, stop doing whatever caused the angina)
- Help with any medication
- Free flow of air (open windows, loosen ties / collars)
First Aid Treatment for MI (Heart attack)
- All of the above, plus
- Get an ambulance!
- If they are not seriously allergic to it, give ASA / Aspirin to suck or chew
- Give oxygen if trained to do so
- Take & record pulse & resp rate while waiting for the ambulance
- Ask about any history of heart conditions.
When to get help
Always – for a Heart Attack!
- If this is a first attack of angina, but passes quickly (less than 5 minutes) tell them to see their doctor
- If this is a first attack of angina lasting more than 5 minutes, get an ambulance
- If the angina attack does not settle with meds / rest call an ambulance
- If they say the angina is different from their 'normal' – call an ambulance
Red Cross Courses
Angina and Chest Pain are covered in CPR & AED, OFA1, Emergency First Aid and Standard First Aid.