What is the treatment for chest pain?

From the Guidelines

The most critical step in treating chest pain is to immediately activate emergency medical services (EMS) if symptoms suggest a myocardial infarction, and administer aspirin in a dose of 162 to 324 mg, as it improves survival in patients with myocardial infarction 1. For emergency situations like a heart attack, immediate medical attention is crucial.

Key Considerations

• The treatment for chest pain depends on its underlying cause, which can range from cardiac issues like myocardial infarction to non-cardiac causes such as acid reflux, musculoskeletal pain, or anxiety-related chest pain.
• For cardiac-related chest pain, medications may include aspirin, nitroglycerin, and pain relievers, with longer-term treatments involving blood thinners, beta-blockers, or statins.
• It's essential to have chest pain properly diagnosed before beginning treatment, as self-diagnosis can be dangerous.

Treatment Approaches

• Cardiac-related chest pain:
  • Aspirin (162 to 324 mg) as recommended by the 2024 American Heart Association guidelines 1.
  • Other medications like nitroglycerin, beta-blockers, or statins may be prescribed based on the specific diagnosis and patient condition.
• Non-cardiac causes:
  • Acid reflux: proton pump inhibitors like omeprazole.
  • Musculoskeletal pain: NSAIDs like ibuprofen.
  • Anxiety-related chest pain: breathing exercises and possibly anti-anxiety medications.

Diagnostic Evaluation

• The initial evaluation should focus on life-threatening causes such as acute coronary syndromes (ACS), pulmonary embolism (PE), aortic dissection, and esophageal rupture, to facilitate rapid implementation of appropriate treatment 1.
• Integrating the physical examination with other elements of the evaluation is crucial to establishing the correct diagnosis.

Important Considerations

• Activation of EMS and administration of aspirin are critical steps in the management of suspected myocardial infarction, as emphasized by the 2024 American Heart Association guidelines 1.
• The choice of treatment should be guided by the underlying cause of the chest pain, and it is crucial to follow the most recent and highest quality guidelines available.

From the FDA Drug Label

Nitroglycerin is a type of medicine known as an organic nitrate and is a vasodilating agent. It is used to treat a type of chest pain called angina. Nitroglycerin sublingual tablets can relieve this pain. One tablet should be dissolved under the tongue or in the oral cavity at the first sign of chest pain. The dose may be repeated approximately every 5 minutes, until the chest pain is relieved

The treatment for chest pain, specifically angina, is nitroglycerin sublingual tablets. The recommended dosage is to dissolve one tablet under the tongue or in the oral cavity at the first sign of chest pain, and the dose may be repeated approximately every 5 minutes, until the chest pain is relieved 2.

• Key points:
  • Sit down when taking nitroglycerin sublingual tablets
  • Use caution when standing up to avoid lightheadedness or dizziness
  • If the pain persists after a total of 3 tablets in a 15-minute period, or is different than typically experienced, call your doctor or seek emergency help.

From the Research

Treatment for Chest Pain

The treatment for chest pain depends on the underlying cause, which can be cardiac or noncardiac in origin 3.

• For cardiac-related chest pain, such as angina pectoris, treatment may include medication to manage symptoms and reduce the risk of further cardiac problems 3, 4.
• Medications used to treat cardiac-related chest pain include aspirin, antiplatelet agents, statins, angiotensin-converting enzyme inhibitors, beta blockers, nitroglycerin, and morphine 4.
• In cases of acute coronary syndrome, treatment may involve percutaneous coronary intervention (PCI) with stent placement, or coronary artery bypass grafting (CABG) 4.
• For noncardiac chest pain, such as gastroesophageal reflux disease (GERD), treatment may involve proton pump inhibitors and other medications to manage symptoms 3.

Prehospital Care

In the prehospital setting, emergency medical services (EMS) protocols for chest pain vary widely, but may include the use of supplemental oxygen, aspirin, nitrates, and opiates 5.

• The administration of aspirin early in the course of chest pain, as part of first-aid management, may improve survival compared to late or in-hospital administration 6.
• However, the relief of chest pain with nitroglycerin does not necessarily predict the presence of active coronary artery disease 7.

Medical Therapies

Medical therapies for chest pain may include:

• Aspirin and other antiplatelet agents to reduce the risk of further cardiac problems 4, 6
• Statins to manage cholesterol levels and reduce the risk of cardiac problems 4
• Angiotensin-converting enzyme inhibitors and beta blockers to manage blood pressure and reduce the risk of cardiac problems 4
• Nitroglycerin and morphine to relieve chest pain 4
• Proton pump inhibitors to manage symptoms of GERD and other noncardiac causes of chest pain 3