“Non-Cardiac” Chest Pain - LPNI

Lutheran Parish Nurses International
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“Non-Cardiac” Chest Pain

 
LPNI Health Topic - January 2023

Chest pain is concerning to the client and to the nurse, it does need immediate attention. In the community it usually means a call for assessment and assistance from Emergency Services.  A full work-up is required at the hospital to rule-out cardiac origin of chest pain. There are other causes of chest pain other than of cardiac origin.

These include:
  • Gastrointestinal causes such as Gastroesophageal reflux disease, Oesophageal spasm, or Biliary disease.
  • Musculoskeletal causes such as Intercostal muscle strain, Costochondritis or Fibromyalgia.
  • Respiratory causes such as Pneumonia, Pleurisy, Pulmonary embolism, Pneumothorax.
  • Neurological causes such as Shingles.
  • Psychiatric causes such as Anxiety/panic attacks.
  • Emotional causes such as Grief.

For the client this is a very anxious time to go through a battery of invasive and non- invasive procedures. It is time consuming and adds a significant burden to the health system. It may happen that the patient presents in the emergency department several times. Throughout this process the nurse needs to remain vigilant as the patient’s condition may change. Chest pain cannot be ignored. It is important to exclude underlying cardiac conditions.

Of note is a short-lived cardiac condition called Takotsubo Syndrome or “Broken Heart Syndrome” it is most common in the first 3 to 6 months after the death of a spouse or other significant person in the patient’s life,  other significant emotional or physical trauma.  This condition can be picked-up on angiogram as the shape of the left ventricle changes. It usually resolves with medication and adherence to the recommended cardiac rehab program.

Panic attacks are a common disorder that may lead to chest pain. Panic attack is not always acknowledged, recognised, or treated in the emergency department. As community nurses, when we support our clients in the community, this is something to be followed through when chest pain of cardiac, gastrointestinal, and neurological cause has been ruled out.

Walking alongside clients at this time builds trust as their symptoms are validated rather than pushed aside. Words of encouragement and affirmation of what is going on in the mind and body with an explanation of how the body responds to stress builds rapport with the client. As nurses we can encourage healthy living which includes a healthy diet, regular exercise, social support, spiritual guidance, psychological support, and adequate sleep. Nurses can work alongside the client and with their consent attend General Practitioner appointments and advocate for the client if needed.

Nurses working in the community have the advantage of building relationship over time with the client and the multidisciplinary team to improve physical, emotional, psychological and spiritual health.

Angela Uhrhane BHSc (nursing), Grad Dip Theology (FCN), RN
Community Nurse in Wodonga, Victoria Australia
Member of Wodonga Lutheran Parish
Member of Lutheran Nurses Association Australia
Board member of AFCNA (Australian Faith Community Nurses Association)
auhrhane@westnet.com.au

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