What should I do for new onset sternal pressure or pain?

Management of New Onset Sternal Pressure/Pain

For new onset sternal pressure or pain, seek immediate medical attention as it may indicate a life-threatening condition requiring prompt evaluation and treatment. 1

Initial Assessment and Actions

Immediate Steps for Anyone with Sternal Pain

• Call emergency medical services (EMS) immediately rather than self-transport 2
• While waiting for EMS:
  • Take a fast-acting aspirin tablet (160-325 mg, chewed) if no contraindications 2, 1
  • Rest in a comfortable position
  • Avoid exertion that could worsen symptoms

Warning Signs Requiring Urgent Attention

Sternal pain may indicate a serious condition if:

• It interrupts normal activity
• Is accompanied by:
  • Cold sweat
  • Nausea or vomiting
  • Fainting
  • Anxiety or fear 2

Differential Diagnosis Considerations

Sternal pain may represent several potentially life-threatening conditions:

• Acute coronary syndrome (heart attack or unstable angina)
• Aortic dissection
• Pulmonary embolism
• Pneumothorax
• Other severe pulmonary conditions 2

Features Suggesting Cardiac Origin

• Pain radiating to the arm(s), jaw, neck, or back
• Pain accompanied by shortness of breath, sweating, or nausea
• Pain that is not affected by respiration or body position 2

Features Suggesting Non-Cardiac Origin

• Pain that varies with respiration or body position
• Pain that is well-localized to the chest wall
• Pain accompanied by local tenderness 2

What to Expect During Medical Evaluation

When you arrive at the emergency department, expect:

1. Immediate ECG (within 10 minutes of arrival) 1
2. Vital signs assessment and oxygen saturation measurement
3. Establishment of IV access
4. Administration of aspirin if not already taken
5. Targeted history and physical examination
6. Initial cardiac marker levels and other blood tests
7. Chest X-ray (within 30 minutes) 2

Important Considerations

• Do not wait for symptoms to disappear as these are poor indicators of risk 2
• Do not rely on nitroglycerin response to determine if pain is cardiac in origin, as this is not a reliable diagnostic test 3
• Recognize that symptoms can be highly individual and may present as chest pain, pressure, oppression, dyspnea, heavy chest, or slight discomfort 2
• Be aware that atypical presentations are common, especially in elderly, women, and diabetic patients 1

Risk Factors to Report to Medical Providers

Be sure to inform medical providers about:

• Previous cardiovascular disease
• Risk factors like diabetes, hypertension, smoking, family history
• Prior abnormal stress tests
• Peripheral arterial disease 4

Remember that early diagnosis and treatment of cardiac conditions is life-saving. The initial hours are critical for effective treatment of conditions like heart attack, where time-to-treatment directly impacts survival 2.