CHEST PAIN

RAHAYU SETYOWATI
 OBJECTIVE
• Explain the definition of chest pain
• Describe the etiology of chest pain
• Desribe the pathophysiology of chest pain
• Describe the clinical manifestation of chest pain
• Describe the diagnostic study of the patient with
chest pain
• Identify commenly uses drug therapy in treating
patients with chest pain
• Describe the nursing management of the patient
following a chest pain
 OVERVIEW

• Any part of the chest can be the cause of the pain

including the heart, lungs, esophagus, muscle,
bone, and skin

• Because of the complex nerve distribution in the

body, chest pain may actually originate from
another part of the body.
 CAUSES
• Heart attack (acute myocardial
infarction): A heart attack occurs when blood
flow to the arteries that supply the heart
becomes blocked.

• Decreased blood flow  the muscle of the heart

does not receive enough oxygen  damage and
death of the myocard.
Causes (cont…)

• Angina: imbalance between the oxygen demand

of the heart and the amount of oxygen delivered
via the blood.

• Aortic dissection: tear in the inner lining of

the aorta  massive internal bleeding and
interrupt blood flow to the vital organs.
Chest Pain Causes

Heart Attack is caused by coronary heart

disease, or coronary arteri disease. Heart disease
may be caused by cholesterol buildup in the
coronary arteries (atherosclerosis), blood clots,
or spasm of the vessels that supply blood to the
heart.
Risk factors for a heart attack are:
• High BP
• diabetes
• smoking
• high cholesterol
• Family history
• Obesity
• postmenopausal women
Angina Causes
• Angina may be caused by spasm, narrowing, or
partial blockage of an artery that supplies blood
to the heart.
Types of angina:
• Stable angina: Induced by exercise ,relived by
rest or nitroglycerine
• Unstable angina: Angina of increasing frequency
or severe occurs on minimal exertion or at rest
but not relived by nitroglycerine.
• Variant angina: Caused by coronary spasm.
Relived by nitroglycerine.
Chest Pain Symptoms
Heart Attack Symptoms (MI)
• pain occurs in the mid to left side of the chest and
may also extend to the left shoulder, the left arm, the
jaw, the stomach, or the back.
• Pain more than 15 minits
• Chest pain not relieved by rest or nitroglycerin
• shortness of breath, increased sweating, nausea, and
vomiting.
• Symptoms vary considerably from person to person.
• Women may experience symptoms of heart attack
similar to men (chest pain), but they also may be
more atypical.
Angina Symptoms
• Angina is similar to heart attack pain but occurs
with physical exertion or exercise and is relieved
by rest or nitroglycerin
• Angina pain typically last 2-15 minutes
• Angina becomes life threatening when pain
occurs at rest, has increased in frequency or
intensity, or is not relieved with at least three
nitroglycerin tablets taken five minutes apart.
• This is considered to be unstable angina, which
may be a warning sign of an impending heart
attack.
Exams and Tests
Heart Attack (MI)
• In emergency department, the healthcare providers
use three basic procedures to decide if a patient is
having a heart attack(ABCs).
• The first is the symptoms reported by the patient.
• The second is anECG (T-invertion,
ST-elevation/deppresion, abnormal Q).
• The third is measurement of enzymes produced (CK
– creatine kinase (CK-MB)) by the heart muscle cells
when they do not receive enough oxygen. +
myoglobin (heme protein that helps to transport
oxygen) + increases troponin (a protein found in the
myocardium)
Creatine Kinase, Myoglobin & Troponin

Creatine Kinase (CK-MB)

• Earliest increase  4 – 8 hrs
• Peak  12 – 24 hrs
• Return to normal  3 – 4 days

Myoglobin
• Earliest increase  1 – 3 hrs
• Peak  4 – 12 hrs
• Return to normal  12 hrs
Troponin
• Earliest increase  few hours during acute MI
• Peak  12 - 24 hrs
• Return to normal  often as long as 3 weeks

There are three isomers of troponin : C, I and T.

Troponin I and T are specific for cardiac muscle.
Angina
• Angina is diagnosed by the same methods to
diagnose heart attacks.

• ECG: Simple test shows usually normal, but may

show ST depression, flat or inverted T wave.
ECG must needed any patient complain chest
pain to exclude myocardial infraction
Medical Treatment
Heart Attack Treatment
• O2 Is very important (O)
• Treatment for a heart attack is aimed at increasing blood
flow by opening arteries blocked or narrowed by a blood
clot.
• Medicines used to achieve this include aspirin,heparin, and
clot-busting (thrombolytic) drugs. (A)
• Other medications can be used to slow the heart rate , which
decreases the workload of the heart and reduces pain
(morphin). (M)
• Angioplasty is a way of unblocking an artery.
• Surgery may be required if medical treatment is
unsuccessful. This could include angioplasty or cardiac
bypass.
Angina Treatment
• Nitroglycerin dilates (widens) the coronary
arteries. It is often taken under the tongue
(sublingually). (N)
• If the pain remains, nitroglycerin is given by IV,
and the patient is admitted to the hospital and
monitored to rule out a heart attack.
• Long-term treatment after the first episode of
angina focuses on reducing risk factors for
atherosclerosis and heart disease.
Prevention

Heart Attack Prevention

• Don't smoke.
• Maintain a healthy weight.
• Eat nutritious, low-fat foods in moderate
quantities.
• use alcohol moderately.
• Engage in physical activity or exercise for at least
30 minutes every day.
• Control high blood pressure and high cholesterol.
• Controlblood sugar every day.
 Nursing Care Plan
• Assessment

1. Primary Assessment
**Airway
- How does the airway
- Is there a blockage /
congestion, secretions in the airway?
- How does the sound of his breathing,
if there are additional breath sounds?
**Breathing
- How breathing pattern? Frequency? The
depth and rhythm?
- Do use a respirator muscles?
- Are there additional breath sounds?
** Circulation

- What about the peripheral arteries and

carotid arteries? The quality (content and
voltage)
- How capillary refillnya, whether there
akral cold, cyanosis or oliguri?
- Is there a decrease in consciousness?
- How vital signs?
2. Secondary Assessment

1. Location of pain
Where is a start, (coronary chest pain: from
sternal spread to the neck, chin or shoulder to
the left arm of the ulna)

2. The nature of pain

Feeling full, heavy feeling like cramps,
squeezing, stabbing, choking / burning, etc..
3. Pain characteristics
Degrees of pain, duration, how often arise in a
certain period.

4. Chronological pain
Beginning there is pain and progress in
sequence

5. The situation at the time of the attack

Does arise in times / circumstances
6. Factors that reinforce / relieve pain
such as attitude / body position,
movement, pressure, etc..

7. Other possible symptoms whether or

not a relationship with chest pain.
• Nursing Diagnosis

1. Changes comfort pain (acute pain) associated

with tissue ischemia secondary to arterial
occlusion, tissue inflammation

2. Changes in tissue perfusion (heart muscle)

associated with decreased blood flow

3. Activity intolerance related to imbalance

between O2 supply and demand tissue
metabolism.
• Intervention
The principles of Action:

1. bedrest with Fowler position / semi-Fowler

2. ECG

3. Observe vital signs

4. Collaboration O2 delivery and administration

of drugs, analgesics, nitroglycerin,anticoagulant
(MONA : Morphine – O2 – Nitroglycerin –
Aspirin) and observation drug side effects.
5. Install a drip and give peace to the client

6. Taking blood samples

7. Reduce environmental stimuli

8. Be calm in the works

9. Observe signs of complications

 REFERENCES
• Lou sole, Mary., Klein, Deborah. (2009). Critical
Care Nursing. 5th ed. Saunders : USA
• John, MA., Cline, David M. (2004). Emergency
Medicine. The McGraw-Hill : USA
• Smeltzer, Suzanne. (2004). Medical Surgical
Nursing. 10th ed. Lippincott : Philadelphia