Chest Pain Evaluation
Maybe the cause of the chest pain is nothing more than indigestion, a muscle strain, or some other innocuous problem. However, chest pain can potentially point to a more serious and life-threatening cause, such as an acute myocardial infarction (AMI).
For this reason, chest pain must always be considered cardiac in nature until proven otherwise.
Making an Accurate Chest Pain Assessment
One of the most important skills available to the healthcare worker in this situation is the ability to perform an accurate pain assessment. This is particularly the case when a patient is experiencing chest pain, as it will help to determine whether the pain is cardiac in nature. Just as important, is the ability of the healthcare worker to conduct this assessment in a calm and controlled manner.
There are many different ways of assessing chest pain, however one of the most popular is the ‘PQRST’ pain assessment tool.
PQRST Pain Assessment Tool
P – Position/Provoking Factors
- Where is the pain? Can you point to it?
- What provoked the pain?
- What makes the pain better?
- What makes the pain worse?
- What were you doing when the pain started?
- Did the pain occur at rest or during exertion?
- Does the pain change with repositioning?
Tip: Repositioning tends not to change chest pain caused by an AMI. If repositioning improves the pain, perhaps the issue is of musculoskeletal origin, pleuritic, or pericarditis (where the pain is sometimes relieved by sitting up and leaning forward). Women who experience AMI often present with atypical chest pain and other symptoms such as dyspnea, weakness and fatigue (Mehta et al. 2016).
Q – Quality
- Can you describe the pain or discomfort?
- Is it dull, sharp, squeezing, pressure, burning, aching, pounding, cramping, stabbing or crushing?
Tip: The majority of patients experiencing an AMI will report with chest pain (Malik et al. 2013; Lichtman et al. 2018), however, sometimes the pain is atypical or even absent (a silent myocardial infarction) (Draman et al. 2013). It must be remembered that every patient is different and they will not all present with the classic substernal chest pain.
R – Radiation
- Does the pain radiate to any other areas?
- Can you point to it?
Tip: Roughly 65% of patients with an AMI will experience radiating pain (Granot et al. 2019). Common sites include the anterior chest, shoulders, arms, neck and jaw. Some patients describe jaw pain feeling like a dull ache or a toothache, whilst some may describe the radiation as a band around the ribs.
S – Severity/Symptoms
- Can you rate the pain out of ten?(0 being no pain experienced and 10 being excruciating pain.)
- Are you experiencing any other symptoms?
Tip: Accompanying symptoms of an AMI may include nausea, vomiting and diaphoresis. The patient may also experience dizziness, hypotension and bradycardia or a feeling of impending doom and feeling scared (Heart Foundation n.d. a).
T – Time
- How long have you had the pain for?
- Was the onset slow or sudden?
- Is the pain intermittent (starts and stops) or is it continuous (ongoing)?
- Have you had the pain previously?
- Is it the same as last time, or different?