Chest Pain

Chest Pain

OVERVIEW

• Chest pain is a common symptom and can have many causes. It is important to take chest pain seriously because it can sometimes indicate a serious underlying problem and tests and investigations may be needed to exclude this.

• Our assessment today has not found a cause of your chest pain that requires an admission to hospital.  This leaflet provides further advice on possible causes of the pain and when to seek further help.

Assessing your Chest Pain in the Emergency Department

We check for the serious causes of chest pain such as a heart attack, clots in lungs, a collapsed lung and torn large blood vessels.  We may do blood tests to look at the heart (troponin) and clots in your lungs (d-dimer).  We may also perform a chest x-ray and/or ECG (tracing of your heart).  Investigations in the emergency department are used to identify and treat serious causes of chest pain. 

Some patients do not need blood tests and other patients may need multiple blood tests.  The reason for multiple blood tests maybe because: 

• there has been a problem analysing the sample in the lab, or
• it has been decided you need an additional blood test that was not required at first, or
• we need to see if there has been any change in the blood test between the first sample and a new sample (for example troponin test).

It may not be possible to find a reason for your chest pain, but we aim to reassure you that we do not think you have one of the serious causes of chest pain.  You may need further assessment to find the cause of your chest pain, but this does not need to be done urgently or as an emergency. 

Before you leave the emergency department the clinician looking after you should have:

• told you the results of any tests you have had performed 
• let you know whether you need any further follow-up and who this will be with (e.g. GP)
• whether it is you or the emergency department who will arrange any follow-up, if required

Your GP will automatically receive a short letter about your attendance at the emergency department.

Causes of Chest Pain

Most chest pain is not heart-related and is not serious. Some of the different causes of chest pain are listed below:

Gastro-oesophageal reflux disease:  A common condition where acid from the stomach comes up into the oesophagus (gullet).  Symptoms occur after eating, bringing up food or bitter tasting fluids, feeling full and bloated and may cause a burning feeling in the chest.

Bone or muscle problems: If your chest is painful and tender to touch it may be caused by an injury or a strained muscle in your chest wall.  Symptoms may get worse when you breathe in and feel better when movement is kept to minimum.  Muscle sprains can be surprisingly painful, but with painkillers the pain should ease and the injured muscle or tissue will slowly heal.

Anxiety and panic attacks:  Some episodes of chest pain occur as part of an anxiety or panic attack.  Symptoms may include sharp, continuous pain triggered by worries or a stressful situation, heartbeat gets faster, sweating, dizziness, tingling lips and hands.

Lung problems:

• Pneumonia – inflammation of the lungs, usually caused by an infection, often with fever, aches and coughing up discoloured sputum and chest pain which is worse on breathing in.  Sometimes you may need to come into hospital with this but – if you are not too unwell – you may be able to go home with antibiotics.

• Pulmonary embolism (lung clot) – this is a blocked blood vessel in your lungs.  Symptoms include chest pain which is worse on breathing in and feeling short of breath.  This can be a serious condition if the clot is large but if the clots are small and we may treat you with a medication to thin your blood and bring you back on another day for further tests to confirm the suspected diagnosis.

Cardiac (heart-related) chest pain:  Common heart related pain includes pericarditis – which usually causes a sudden, sharp, stabbing pain that gets worse when you breathe deeply or lie down.  Other causes include angina or a heart attack – which have similar symptoms, but a heart attack is more serious.

Treatment

Treatment will vary, depending on the underlying cause of your chest pain.  Treatments may include medicines such as pain killers (e.g. paracetamol), antibiotics, anti-inflammatory drugs (e.g. ibuprofen), antacids (e.g. lansoprazole) and heart medicines (e.g. aspirin and GTN spray).  Most patients do not require any medication.

Healthy Living advice

NHS advice about healthy living, including eating a balanced diet, healthy weight, exercise, quitting smoking and drinking less alcohol can be accessed by scanning the QR code or using the link https://www.nhs.uk/live-well/

Call 999 if: you get sudden pain or discomfort in your chest that does not go away – the pain can feel like squeezing or pressure inside your chest, burning or indigestion you get pain that spreads to your left or right arm, or your neck, jaw, stomach or back you have chest pain and you feel sweaty, sick, lightheaded or short of breath You could be having a heart attack. Call 999 straight away as you need immediate treatment in hospital.   See a GP if: you have chest pain that comes and goes you have chest pain that goes away quickly but you’re still worried

If you need further advice, please contact the Emergency Department – details below

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

For additional medical advice, if your symptoms or condition worsens:   Contact your GP   NHS 111:                                                                          Telephone 111 Get help with your symptoms, NHS111:                          https://111.nhs.uk/  Information to help you manage your health:                 www.nhs.uk   In an emergency telephone 999

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