Hi, welcome to our video on
medications for chest pain.
Now, before we get into the treatment of
chest pain, I want you to understand what
cardiac chest pain feels like.
Lots of times, abdominal pain,
or gallbladder pain, or different
types of pain in your body
can be misunderstood as cardiac chest pain.
So I want to kind of give you a baseline
so you know what to expect
when you're interacting with your patients
because cardiac chest pain can take
all different kinds of forms.
Now, you look in the picture, you can tell
that person feels very uncomfortable,
but we're going to talk about
several different symptoms
that patients may experience.
They might feel like a pressure in their
chest. I've had patients tell me
it feels like there's an elephant
sitting on my chest.
They might feel a fullness or some type
of burning or tightness in their chest.
They might have some crushing or
searing pain that radiates
all the way to the back, or to their
neck, or to their jaw,
maybe even to their shoulders,
and usually a left arm or sometimes,
even both of the arms.
So, we've got several
different symptoms to go and are
you starting to get a picture
that there's no one way that cardiac
chest pain appears?
So listen to your patients closely
when they start to tell you that they're
that they have some pressure
or some tightness,
pain can be all over the map, as we say.
Now, the difference is the pain usually
lasts more than a few minutes, and if
the person tries to get active, it
gets worse with activity.
So if they're doing something,
that pain gets worse and worse
the more active they are.
Now, it might also go away
and come back, and it can vary in
intensity in all those different times.
So, are you starting to see the problem here?
There's no 1 specific chest pain symptom
that's the same for everybody.
And you know how we all are. We always
think that we're fine and we don't
want to go to the hospital.
So if it goes away, we try to tell ourselves,
"Yeah, yeah, yeah. I'm fine. I'm fine."
But that could indicate that your patient
is really getting into trouble.
So you want your patient to learn what
chest pain feels like in their body.
You want to listen very closely,
when a person tells you they're
having some unusual types of
feelings in their chest, arm,
shoulders, or back.
Now, they might also have some
other physical symptoms.
They might be breaking out
in like a cold sweat. That's
their body telling you,
"Wow, this is getting serious."
They might have some real
dizziness or weakness
because their perfusion is
They might also be short of breath.
That's because when they're starting to have
cardiac chest pain, that's an
indication that they're
not getting enough oxygen to
the rest of their body,
which is why they also feel dizzy
and are short of breath.
Now, the last is my least favorite,
but a lot of times, patients have this
really intense nausea with chest pain,
and certain types of myocardial
infarctions or heart attacks,
they always throw up. So I knew when I got
a patient with a specific diagnosis, oh, my,
they're going to have a really rough
time as we go through this
because they're going to be really nauseated
and tend to always vomit.
Okay, so now I want you to think through,
pause the video, and I just want you
to quickly guess what you think
what actually causes cardiac chest pain?
Okay, well, clinically we'd say the cause is
inadequate oxygen to the heart muscle.
But how I like to think about it is
the heart is saying, "Hey, listen.
I'm not getting what I need, oxygen,
so I'm going to make sure you feel the pain,"
because that's our body's way of telling us,
"Hey, things are not right, and I really,
really need to get your attention."
So, when the heart is not
getting enough oxygen,
you're going to feel pain to let you know
something is not right in here, and
we need to do something.
So the cause of cardiac chest pain
is not enough oxygen to the heart muscle.
Now, I want you to pause and make sure
you're really clear on that concept
because how we treat chest pain
rests right on this concept.
We've got to figure out how to get
adequate oxygen to the heart muscle.
So we're going to see if it's a supply
issue, or a demand issue.
Is the heart needing more
than we can provide?
Or is it demanding, "What's going on?
You cannot meet that supply." Okay, now,
2 important terms that you learn are
the difference between ischemia
and myocardial infarction. But
let's start with ischemia.
So that's a chest pain or discomfort.
Remember, it might not actually be described
as pain by your patient,
it might just be kind of uncomfortable.
And it's caused by the cardiac muscle,
like we just talked about,
not getting enough oxygen.
Now, why is the heart --
What are some reasons that you
think the heart muscle
could not be getting enough oxygen?
Well, one of them is vasospasm.
That means the vessels that supply the
blood are just clamping down.
And so, that's obviously going to impede
the blood flow to the heart.
It could be a thrombus. That's just
a very fancy word for clot.
So that makes sense to you.
If you have a clot
that lodges in that blood supply, it's
not going to get good blood flow,
that could be the reason of ischemia.
Now, you might have coronary
Well, that means that you've got some plaque
building up in the arteries that
supply blood to the heart.
Because that plaque is building
up in those arteries,
the diameter or the opening of
the artery is much smaller.
So, the heart is not going to get
as strong and solid and good
of a blood supply that's oxygenated
because of the plaque that's building
up in those arteries, and making
the supply diameter much smaller.
the one thing I want you to focus on,
so star this point right here,
it's an early sign, and that
tissue is still viable,
if we can figure out how to
fix the perfusion issue.
Okay, so star that point. Ischemia,
that's much better than a
Ischemia says, "Man, if we can recognize it
and intervene, we can help
that heart recover."
The treatment goal is to do just that.
I want to stop ischemia
from progressing to myocardial infarction,
because here's the difference.
Myocardial infarction means
a dead tissue, okay? So,
dead tissue is never good, but let me tell
you why it's not that good in a heart.
The heart needs to move together, right?
It needs to contract and expand and contract
and relax and contract and relax.
Anytime I have dead tissue in
the wall of my heart,
that part becomes stiff,
and so, the heart can't as effectively
contract and expand and
contract and expand.
So that means, depending on where
your heart took the hit,
depending on where the dead tissue is
or the infarcted tissue is,
that's going to really impact the
overall function of the heart.
Think if it's in that left ventricle,
the one that's responsible for pushing
blood out to the rest of your body.
If that left ventricle wall is really stiff,
we're going to have major problems, right?
Now, no spot is a good spot to
have dead tissue in your heart
or any other organ,
but you can see that depending on
the location of the heart attack,
that's going to significantly impact
that patient's ability
of their heart to function well.
So, myocardial infarction
means that the inadequate oxygenated
blood supply to the heart
was long enough or severe enough
that it caused the actual death of
the oxygen-deprived tissue.
Okay, so I would put,
in big letters above "myocardial
infarction," tissue death.
Over ischemia, that red box, I would put,
"We still have time," right?
So know that here's our goal. When a patient
tells us they're having any symptoms
that are similar to cardiac chest pain,
that we intervene quickly.
As we say in the hospital,
man, time is muscle.
So the quicker we can intervene,
we need to educate our patients so
they recognize what chest pain is,
we need to encourage them
to seek medical help,
even if they're not sure if it's cardiac pain,
because we can rule that out with
lots of lab work and tests.
Now, we'll talk about more in detail
about the overall treatment plans
of heart attacks and MIs
in other videos. Here, we're going
to focus on the pharmacology
and how we treat it with drugs.