Chest Pain ED

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Overview

• Chest pain refers to pain felt anywhere in the chest area, from the level of your shoulders and lower neck to the top of your abdomen and base of your ribs. It may be described as pain, discomfort, tightness, pressure, or a feeling of burning or fullness in the chest. It may also be sharp, dull, throbbing, crushing, tearing, cramping or achy
• 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

Causes

• Most chest pain is not heart-related and is not serious
• 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 have to repeat the heart blood test to ensure it is not climbing even if it is initially normal. We may also perform a chest x-ray and/or ECG.

• Gastro-oesophageal reflux disease. A common condition where acid from the stomach comes up into the oesophagus (gullet)
• 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. This can be surprisingly painful but with rest 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
• Lung problems

Pneumonia is an inflammation of the lungs, usually caused by an infection, often with fever, aches and coughing up discoloured sputum. 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. This can be a serious condition and can sometimes be life-threatening if the clot is large. Often the clots are small and we may treat you with a medication to thin your blood and bring you back on another day for a CT scan to confirm the suspected diagnosis.

Risk factors include:

• Recent long flights
• Recent surgery
• Active cancer
• Pregnancy
• Being on the combined pill
• Cardiac (heart-related) chest pain. When we do blood tests for the heart (a test called troponin) and these are normal, it makes the likelihood of you having a cardiac problem lower but it does not necessarily always mean that the pain is not related to your heart. If we think it may be, we may ask you to follow up with either your GP or arrange a follow up with one of the cardiologists as an outpatient

Treatment

• Treatment will vary, depending on the underlying cause of your chest pain
• You should take simple pain killers regularly, such as paracetamol. You can take up to eight paracetamol tablets in a single 24 hour period (maximum 4 grams). Discuss your pain relief with a doctor if you have liver or kidney problems, are on medicines for epilepsy or tuberculosis (TB), weigh less than 50kg or regularly drink more than 14 units per week of alcohol
• If you have further episodes of chest pain and are worried please seek medical attention
• If you have any concerns about your symptoms you should contact your GP or call 111 for advice

When to seek urgent advice?

Chest pain is a common cause for people to visit the Emergency Department (ED). You have been seen today in the department and discharged home. Our assessment today has not found a serious cause of this pain. This leaflet provides further advice on possible causes of chest pain and when to seek further help.

Any new, severe, or persisting chest pain should be discussed with your GP. This is particularly important if you are an adult and have a history of heart or lung disease.

It’s important to get medical advice to make sure it’s nothing serious.

For general medical advice please use the NHS website, the NHS 111 service, walk-in-centres, or your GP.

• The NHS website provides online health information and guidance
• NHS 111 phone line offers medical help and advice from trained advisers supported by nurses and paramedics. Available 24 hours a day. Calls are free from landlines and mobile phones
• There are walk-in and urgent treatment services at Brighton Station, in Crawley and at Lewes Victoria Hospital