[Quick info] Things to order/do for chest pain (angina) patients

Get a good history

• LQRST SARAS
  • Location of pain
  • Quality of pain
  • Does pain radiate or move anywhere (to left arm or back)
  • Severity of pain (0-10 scale)
  • Timing of pain -frequency, when it first started, how long it lasts, how is it from the beginning vs now
  • Setting -what was the patient doing when they first had the pain
  • Aggravating activities
  • Relieving activities or things (medications)
  • Associated symptoms (seen below)
  • Similar symptoms in the past
    • Chest pain with activity vs without activity
    • Leg pain
    • Shortness of breath, palpitations felt, nausea/vomiting, recent illnesses.
• Heart disease history
  • Any valve replacements, stents or CABG done, any heart catheterizations they had done in the past
  • Smoking history, drug history, alcohol usage
  • Hypertension (high blood pressure), arrhythmia diseases, high cholesterol, CHF ect
  • family history of any heart disease
• Cardiologist (heart doctor) they see
• Check vital signs- make sure they are stable – (blood pressure, heart rate, respiratory rate)
  • If unstable -> catheterization lab
  • Nitroglycerin for chest pain
• Get troponin (heart enzyme) levels and see the trend of the levels either increasing or decreasing (but troponin levels can increase for a variety of reasons, not only because of a heart attack)
• Get Echo
• Get chest x-ray
• Then- if they are able, do stress test -> if they are having pulmonary or lung symptoms, typically this gets held until their pulmonary symptoms calm down.
• One thing: if there is pain with palpation on the chest area, most likely NOT a myocardial infarction (heart attack)
  • You don’t normally feel chest pain or pressure from a heart attack when someone physically is pressing on your chest or arm.