opinions on chest pains

  1. Okay nursing students ....patient grabs his chest and can't breathe. his face turned bright red...his lips were tingling(a little blue) and his jaw hurt. First response said blood pressure was 159/120. Paramedics came....did EKG ans it was normal....gave nitro and 4 baby aspirin. Went to ER and did chest Xray with blood work and repeat EKG...blood pressure continued to drop to normal. Sent home with instructions to take Mylanta for acid reflux and follow up with nuclear stress test with cardiologist. Have recently found out that he has had chest pains previously off and on without saying anything. I am not happy with the diagnosis at all. There is a history of heart disease in the family. Patient is overweight as well. Any thoughts? I have done research and it seems to be some sort of Angina, but I am not a doctor. This patient is my husband and I am very concerned...please give me your thoughts and prayers....thank you
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  2. 15 Comments

  3. by   BrandyBSN
    I do think that you are right. This sounds very much like angina to me. Angina can mimic all of the signs of an M.I. without the elevation in cardiac enzymes. This may have been your husbands "warning shot" however. Angina is just the symptom, not the problem. Changing dietary selections, starting a different excerise routine, keeping an eye on cholestrol and fat, along with BPs is never a bad thing. Its never too late to start, and maybe this could be more of a blessing by helping give your husband motivation to change, without having to suffer permanent damage.

    Good Luck, and keep us posted.
  4. by   CEN35
    well.........thing is "face was bright red, lips were tingling" = plenty of blood flow and possibly hyperventilation. (do not get offended either, it's not meant to be offensive). then say the lips were a little blue? which is contraindatory......and physiologically does not make sense?
    now the issue at hand......is he had the chest pain with the jaw pain. was he also diaphoretic? was there any nausea? when the para medics came........did they do a 12 lead 1st, or give the nitro 1st? most important.......what was he doing at the time the pain started?
    many times.........medics give the ntg/sl 1st...........instead of the ekg. as brandy stated, enzymes do not elevate with anginal episodes. however, if the 12 lead is done after the ntg/sl and/or the pain is gone..........the ekg will most likely not show anything.
    one more thing to consider? while it appears to me that 12 lead ekg's are accurate in the er the majaoratyt of the time, cardiology journals and others claim, 12 leads are only 60-70% accurate.
    did they keep him for observation over night, with follow up labs?
    something else to think about, whether you want to hear it or not. we have had people come into the er days after a stress test that was interpreted as fine, with an active mi. robin, the bottom line is trying to convince a cardiologist to see him, examine him and do a cath. nothing short of a cath is definative.......that's the bottom line. so.........push for it, if your concerened.
    also while people automatically assume heart...........there are other cause of pain that should be considered.
    an aortic disection.............which could be r/o with a cath also. or a pneumothorax.....and the most common thing found too cause pain that many feel...........gi stuff. did you know that ntg/sl will releive the pain created by a hiatel hernia also? just some more thoughts have a nice day and hope it works out.
    Last edit by CEN35 on Jul 15, '01
  5. by   Yalonda1
    Robin, I agree with Rick 110%. You should try to get a cardiologist to do a heart cath on your husband to check for any blockages. What you will find on cardiac units is that when a pt is having chest pain, an EKG is usually obtained before giving the 1st nitro in order to catch any changes such as ST elevations or depressions. Let us know how your husbands does. My prayers are with you and your family.
  6. by   Robin61970
    Okay guys keep in Mind I am not actually in the nursing program yet so I am winging it. He was laying a hardwood floor when the pain came on.....it was so severe he could not breathe and his face turned red....he was holding his chest....when the first response came they did BP 159/120 and 12 lead EKG....which showed fine....put him on oxygen. His lips tingled and his jaw hurt. When paramedics got there they put him in ambulanse....nitro....baby aspirin IV and new EKG....ER...chest xray and blood work...nothing wrong...acid reflux....sent home....6 TBSP Mylanta PO after eating...follow up with cardiologist for Nuclear stress test. I think I covered it all this time. I have found out this is not the first time he has had the pain...he has a VERY high tolerance for pain and rated his pain at 8.....8 for him would be like 11 or 12 for me.....that is why I am so terrified....oh when the paramedics got there he was shaking......his whole body kept shaking like he was cold, but he wasn't.....No nausea...have no idea what diaphoretic means...sorry....and the blue lips thing was someone elses observation....I couldn't think straight enough to see blue lips at the time....anyway thansk so much
  7. by   CEN35
    robin,
    sorry for the misunderstanding............diaphoretic means sweating, wet, usually accompanied by coolness if not associtated with a fever. i was just trying to get a better picture of the situation. there is always the possibility, a high one of it being a gastrointestinal thing. however, any good erp will check out and assume cardiac first, becaus that is potentially the most life threatening thing. in addition, to what i have asked so far.................how long in duration did the pain last, and did the nitro/sl help releiver the pain or not? if he was skeptical on pain releif or not, it is most likely not cardica, if the ekg showed nothing in conjunction with it. like i said though, the only definative way to r/o cardiac is a cath. let us know how he is doing.........i have ya on the pm list.
  8. by   Robin61970
    Yes he was Diaphoretic then....pain lasted at full force for about 15-20 minutes before it started to ease....he still had pain when they gave him the nitro and it did ease.....He has a nuclear stress test at 8 Friday mornign so....One way or another they will find out what caused this, because I'll be damned if I go through that experience again......thanks alot
  9. by   Robin61970
    He will have the thallium stress test monday morning and we will see how it goes from there...he has been very tired and short of breath this week so I'm keeping my fingers crossed and praying
  10. by   CEN35
    keep us informed robin
  11. by   nurs4kids
    This was a duplicate of the next post. For some reason, it isn't allowing me to delete my own post? Oh well.
    Last edit by nurs4kids on Jul 24, '01
  12. by   nurs4kids
    Since I'm pediatric and totally cardiac ignorant, I can add very little here, but in reading I was very impressed with two things..

    Rick! Whoa dude, your knowledge and assessment have totally turned me on Seriously, very impressed wid ya, bud!

    Robin, I hope you are headed into some type medicine. You gave a better report than most nurses I've heard. Very impressed with your medical terminology! I hope everything goes well with your husband, keep us informed. God Bless!

    Wait..I do have something to add. (you know me )
    Pain in itself can cause alot of the symptoms you described, Robin. So, as Rick and the others said, be sure and rule out any cardiac problems, but try not to worry too much.
  13. by   Robin61970
    We went and had the thallium stress test yesterday morning....the first thing noticed was his blood pressure was 150/110, which is somewhat high. After meeting with the Dr, he said the test showed that his heart was very healthy so that is one load off, and he feels that my husband needs to lose weight(we knew this,lol) The Dr stated that he did not wish to use alot of chemical medications to bring his blood pressure down when IF my hubby got off his ass(exact words,lol) and exercised then the weight would come off and his blood pressure would indeed come down....so diet, exercise....he did put him on a mild dosage of Atenolol and he will see him in six weeks to evaluate how he is doing.......I am a little relieved, but as a wife still very worried.....thanks guys
  14. by   Bonnie Blue
    Robin, I would strongly encourage you and your husband to look into some kind of supervised fitness program. Your husband should probably work with a trainer and a dietician at the very least. I am exercise physiologist by training, (starting nursing in the fall). I know many people who need that extra help to get started. Particularly with your husband's HTN, he shouldn't really go out just exercise. Many hospitals have fitness facilities that would provide the comprehensive lifestyle information and support to make changes. You might even be able to get your insurance or employer to help pay with a referral from the cardiologist.




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