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IMPORTANT: if this is the first episode of acute chest pain, contact an ambulance immediately as hospital investigation is vital to rule out possible life threatening conditions. REMEMBER: TIME = MUSCLE!

About Chest Pain

Although chest pain is a symptom of a wide variety of diseases, coronary artery disease (CAD) accounts for 10-34% chest pain in the general population and 50% of chest pain in adults aged over 50 years.

CAD is the leading cause of death in adults. 27% of males and 17% of females aged 65 to 75 years have CAD and the prevalence is higher after 75 years of age. 10% of individuals with CAD first present with unstable angina; 60% of Australians admitted to hospital with unstable angina are over 65 years.

Stable Angina

The underlying problem in stable angina, is chronic, slowly progressive obstructive coronary atherosclerosis (a disease in which plaque builds up on the insides of your arteries) that restricts myocardial blood flow.

Angina signals temporary reduced blood flow to the heart muscle (myocardial ischaemic) when exercise or emotional stress create a demand for more blood flow. In stable angina, onset of symptoms is sudden, subsides promptly with rest, and is usually exacerbated during activities involving effort or stress.

Unstable Angina or Acute Coronary Syndrome (ACS)

In unstable angina, also known as acute coronary syndrome (ACS), an atherosclerotic plaque in a coronary artery abruptly becomes active with endothelial rupture, platelet adhesion, thrombosis and/or inflammation. Over about 2 months, the plaque becomes less active, and the initially increased risk of heart attack (myocardial infarction or MI), arrhythmia and death settles back to the previous levels.

The acute coronary syndromes are differentiated on the basis of extent and duration of chest pain, ECG changes and biochemical markers. They are differentiated into unstable angina and acute myocardial infarction.

If the surface of a cholesterol plaque in a coronary artery ruptures, a blood clot forms on the surface of the plaque. The clot blocks the flow of blood in the artery and results in a heart attack.

Unlike exertion or rest angina, heart muscle dies during a heart attack, and the loss of muscle is permanent unless blood flow can be promptly restored within 1 to 6 hours.

Symptoms of Chest Pain

  • Substernal chest pressure.
  • Stabbing pain.
  • Squeezing pain.
  • Deep pain.
  • Radiation to L arm, neck or jaw.
  • Relieved with GTN.
  • Brought on by exertion.
  • Lasts 2-10 minutes.
  • Shortness of breath.
  • Pallor.
  • Sweating.

Many people do not get typical symptoms of chest pain, but present with ‘atypical chest pain symptoms’ including:

  • No chest pain, but pain radiating in L arm, neck and jaw.
  • Epigastric discomfort, indigestion, gas, belching.
  • Unexplained fatigue.
  • Stabbing pains.
  • Confusion.
  • Light-headedness.
  • Right arm pain.
  • Dizziness.
  • Back pain.

Once you have been assessed as having angina, if you experience a return of angina symptoms, please follow the flow chart below:

  1. Sit down immediately and rest.
  2. Administer Anginine or Nitrolingual spray as follows.
  3. Take 1 Anginine tablet under the tongue and let it dissolve or 1-2 sprays of Nitrolingual spray under the tongue.
  4. If not relieved, allow 5 minutes before taking the next dose.
  5. Repeat this every 5 minutes for up to 15-20 minutes.
  6. If the symptoms dissipate completely, rest and inform your GP of the return of angina symptoms who will contact your cardiologist for further advice and organizing further tests.
  7. If the symptoms persist, or after 3 episodes, phone an ambulance, as immediate hospital treatment is necessary to prevent a heart attack.