Chest pain is a symptom with many causes, from heartburn and muscle strain to heart attack, pulmonary embolism and aortic dissection. The first goal is to quickly find or rule out the life-threatening causes.
Key symptoms
- Pressure, squeezing or tightness in the chest
- Pain spreading to the arm, jaw, neck or back
- Shortness of breath, sweating or nausea
- Sharp pain that changes with breathing or position
- Palpitations, lightheadedness or fainting
What you find on exam
- Vital signs, including blood pressure in both arms and oxygen saturation
- Heart and lung sounds: murmurs, rubs, crackles, uneven breath sounds
- Leg swelling or calf tenderness
- Chest wall tenderness, though it does not rule out heart disease
- General look: pale, sweaty, distressed
Tests
- 12-lead ECG within 10 minutes of arrival
- High-sensitivity troponin, repeated over time
- Chest X-ray, blood count, electrolytes, kidney function
- CT angiography if pulmonary embolism or dissection is suspected
Treatment basics
- Monitor, IV access and oxygen only if saturation is under 90 percent
- Chewed aspirin 162 to 325 mg if heart attack is suspected and no contraindication
- Nitroglycerin for ongoing pain if blood pressure allows
- STEMI: activate the cath lab for urgent reperfusion
- Treat the found cause, such as anticoagulation for pulmonary embolism
Red flags
- ST elevation on the ECG or rising troponin
- Tearing pain to the back or unequal arm blood pressures
- Low blood pressure, fainting or severe breathlessness
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Related guides
Sources: AHA Guidelines for CPR and ECC; NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.