Review of Cardiac Chest Pain (Nursing)

00:01 Hi, welcome to our video on medications for chest pain.

00:05 Now, before we get into the treatment of chest pain, I want you to understand what cardiac chest pain feels like.

00:11 Lots of times, abdominal pain, or gallbladder pain, or different types of pain in your body can be misunderstood as cardiac chest pain.

00:20 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.

00:29 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.

00:38 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.

00:45 They might feel a fullness or some type of burning or tightness in their chest.

00:51 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.

01:03 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 feeling uncomfortable, that they have some pressure or some tightness, pain can be all over the map, as we say.

01:22 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.

01:30 So if they're doing something, that pain gets worse and worse the more active they are.

01:35 Now, it might also go away and come back, and it can vary in intensity in all those different times.

01:41 So, are you starting to see the problem here? There's no 1 specific chest pain symptom that's the same for everybody.

01:50 And you know how we all are. We always think that we're fine and we don't want to go to the hospital.

01:55 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.

02:03 So you want your patient to learn what chest pain feels like in their body.

02:08 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.

02:17 Now, they might also have some other physical symptoms.

02:19 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 becoming affected.

02:31 They might also be short of breath.

02:33 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.

02:44 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.

03:07 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.

03:29 But how I like to think about it is the heart is saying, "Hey, listen.

03:34 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.

03:55 So the cause of cardiac chest pain is not enough oxygen to the heart muscle.

04:01 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.

04:10 We've got to figure out how to get adequate oxygen to the heart muscle.

04:15 So we're going to see if it's a supply issue, or a demand issue.

04:19 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.

04:36 So that's a chest pain or discomfort.

04:37 Remember, it might not actually be described as pain by your patient, it might just be kind of uncomfortable.

04:43 And it's caused by the cardiac muscle, like we just talked about, not getting enough oxygen.

04:48 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.

04:58 That means the vessels that supply the blood are just clamping down.

05:03 And so, that's obviously going to impede the blood flow to the heart.

05:06 It could be a thrombus. That's just a very fancy word for clot.

05:10 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.

05:18 Now, you might have coronary artery sclerosis.

05:21 Well, that means that you've got some plaque building up in the arteries that supply blood to the heart.

05:27 Because that plaque is building up in those arteries, the diameter or the opening of the artery is much smaller.

05:33 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.

05:47 Now, ischemia, 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.

06:00 Okay, so star that point. Ischemia, that's much better than a myocardial infarction.

06:07 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.

06:24 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.

06:34 The heart needs to move together, right? It needs to contract and expand and contract and relax and contract and relax.

06:42 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.

06:53 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.

07:06 Think if it's in that left ventricle, the one that's responsible for pushing blood out to the rest of your body.

07:12 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.

07:32 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.

07:46 Okay, so I would put, in big letters above "myocardial infarction," tissue death.

07:52 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.

08:06 As we say in the hospital, man, time is muscle.

08:09 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.

08:23 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.