Tuesday, November 29

I have sudden chest pain: should I call the emergency room?


We are watching television, reading and already lying in bed, about to fall asleep, when suddenly we are assaulted by a stitch in the chest area which is maintained for a while and gradually increases in intensity.

It may end up passing with the minutes or it may last for hours, even becoming unbearable. Should we call the emergency room? Can we fix it with some kind of pill or exercise?

Everything will depend on the origin of the chest or chest pain, since some causes can be solved more or less easily, but others can involve episodes severe cardiovascular or pulmonary failure.

Tell me how is your pain and I will tell you what you have

Not all chest pain is the same, so from the Spanish Society of Emergency and Emergency Medicine (SEME) It is recommended to pay special attention to symptoms when deciding whether to seek medical help or not.

The SEME warns that “chest discomfort or pain can have many causes, among which are panic attacks, digestive problems, muscle pain, etc. but it can also be a symptom of a serious illness that must be evaluated urgently.”

This association recommends that if we notice “an oppressive pain or a burning sensation behind the sternum and/or radiating to the neck, arms or back, with difficulty breathing, sweating or nausea”, it is necessary that we undergo an emergency assessment.

However, the type of pain may be different and indicate other causes. A) Yes, the Spanish Society of General and Family Physicians (SEMG) differentiate between different types of pain.

For the SEMG, “the cardiac pain typical is usually oppressive, located in the center of the chest, which the patient describes as if he had a weight or as if he was being grabbed from the inside.

It also highlights that it can radiate to the left arm (or both), neck or jaw; and that “it usually lasts between two and fifteen minutes, and may be prolonged in the event of acute myocardial infarction”. In turn, it is associated with other symptoms such as paleness, sweating or dizziness.

On the other hand, the SEMG distinguishes the pain of pleuritic origin, related to lung problems, which he describes as “stabbing, which is usually located at the costal level (sometimes the patient locates it at the fingertip) and increases with breathing or coughing”.

Next, list the chest pain of digestive cause, which is often “indistinguishable from cardiological pain due to its location, intensity and accompanying symptoms”. These symptoms are nausea or a feeling of gastric fullness.

He also relates the same type of pain to states of anxiety, although pain due to digestive causes usually lasts longer and does not radiate to the arm, but sometimes, if he contemplates inflammation of the gallbladder or pancreasit does radiate to the back.

Finally, the SEMG cites the musculoskeletal painwhich depends on the area of ​​the chest wall affected and the intensity of the trauma or overexertion, although in most cases it is modified by movement and is reproduced by direct palpation of the affected area.

What does each pain imply?

According to United States National Library of Medicine pageheart pain can be caused by:

  • Heart attack by an obstruction of blood flow, often from a clot, to the heart muscle.
  • Angina pectoris. This is chest pain caused by insufficient blood flow to the heart due to the buildup of thick plaques on the inner walls of the arteries that carry blood to the heart. If the pain increases with physical activity, we may be in this scenario.
  • Aortic rupture. If the inner layers of this blood vessel separate, blood is forced to pass between the layers and can cause the aorta to rupture.
  • Pericarditis. This disease usually causes a stabbing pain that worsens when inhaled or when lying down. It is an inflammation of the membrane that surrounds the heart.

Regarding the digestive causes, the Mayo Clinic website lists:

  • Heartburn. It is an intense pain behind the breastbone that occurs when gastric acid passes from the stomach into the esophagus, the tube that connects the throat to the stomach. It is usually prolonged and throbbing and usually subsides with the intake of an antacid from the group of proton pump inhibitors.
  • Swallowing disorders. Disorders of the esophagus, such as gas that does not make it out of the throat, can cause pressure pains.
  • Gallbladder or pancreas problems. Gallstones or gallstone inflammation or pancreatitis can cause abdominal pain that spreads to the chest and back.

Among the muscle and joint causes, the Mayo Clinic cites:

  • Costochondritis. When the cartilage of the rib cage, especially the cartilage that attaches the ribs to the breastbone, becomes inflamed and painful.
  • Muscle pains. Chronic pain, such as fibromyalgia, can cause persistent muscle-related chest pain.
  • Rib injury. A bruised or broken rib can cause chest pain; in this case when pressing on the area the pain becomes much more acute.

Among the causes related to the lungs, the clinic highlights:

  • Pulmonary embolism. This is a blood clot that gets stuck in an artery in a lung and can block blood flow to the lung tissue.
  • Inflammation of the membrane that covers the lungs. Chest pain worsens when we inhale or cough.
  • Lung collapse. It can last for hours and is related to shortness of breath. It occurs when air leaks into the space between the lung and the ribs.
  • Pulmonary hypertension. Is a high blood pressure in the arteries of the lungs that affects the arteries that carry blood to the lungs.

The last cause can be a panic attack or anxiety. It occurs when we have periods of intense fear along with chest pain, rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness, and fear of dying.

How to act if we suspect a vascular or pulmonary problem

The SEMES recommends call 112 for help to the ER, and while this one arrives:

  • Keep the person seated and in a quiet place.
  • Loosen any tight clothing.
  • Ask the affected person if they take medications to relieve chest pain. If so, tell him to take it as on other occasions.
  • If the person loses consciousness and is not breathing, call 112 again and start Cardiopulmonary Resuscitation (CPR). If we don’t know how to do it, the health personnel on the phone will guide us.
  • We should never leave the person alone, except to ask for help if necessary.
  • We must also not allow the person to deny the symptoms and convince us not to seek help.
  • We do not give you any medication unless it is previously prescribed.
  • Nor do we feed or drink plenty of fluids.

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