Caring for Your Heart in the Field
by Michael J. Manyak, MD, MED 92
Chest pain is an alarming situation when it occurs in the field, creating anxiety because of its association with cardiac issues. Chest pain is a major cause of emergency room visits for adults but the majority of individuals experiencing chest pain do not have life-threatening problems. However, early treatment is often very important for those who do. Awareness of risk factors, triggers, and key warning signs will improve your odds of preventing or surviving life-threatening chest pain.
Chest pain from potential life-threatening causes arises from myocardial infarction (heart attack), pulmonary embolism (blood clot in the lung), and, less commonly, from the aorta as it starts to rupture. These three emergency conditions must be ruled out before determining that the chest pain is something less serious.
Key information to determine for emergency personnel include:
- History of the onset, duration, severity, and the character of the pain
- Any precipitating factors
- Whether the pain extends into the arm, jaw, neck, or abdomen
- What relieves the pain
- Risk factors and health history including smoking, family history of cardiac problems, high blood pressure, diabetes, current medications, and obesity status
People with a history of angina are likely to be aware of the problem and have appropriate medications to relieve this condition. Commonly caused by exertion, angina is characterized by chest pressure like a weight with associated radiation of pain, shortness of breath, sweating, nausea, weakness, and anxiety. Persons experiencing this for the first time or who have a change in the pattern from previous episodes may be undergoing a myocardial infarction. A similar suspicion should be harbored if there is no relief with medications. A person with these symptoms should absolutely rest and be evacuated to medical care as soon as possible.
Chest pain that persists longer than 5 minutes without a clear reason, pain accompanied by shortness of breath, or significant chest pain accompanied by the major risk factors should be evacuated to appropriate medical facilities.
It is important to know that pregnancy, history of cancer, recent pelvic surgery, and prolonged immobilization add additional risks to development of a pulmonary embolus. Five percent of Americans, particularly those of European descent, have a coagulation defect that causes blood clots. This is often unknown and only found when a blood clot in the legs or a pulmonary embolus occurs. There is an association with pulmonary embolus and long airline flights, so it is important to walk about the cabin periodically and to keep well hydrated (without overdoing the alcohol). Wearing compression stockings helps to prevent formation of blood clots in your legs that can lead to a pulmonary embolism.
Several other serious and potentially life-threatening causes of chest pain have a more gradual course that include shortness of breath. These include pneumonia, bronchitis, pleuritis (inflammation of the lining of the chest cavity around the lungs), pericarditis (inflammation around the sac enclosing the heart), and pneumothorax (collapsed lung). Pericarditis is also characterized by pain in the left chest on inspiration or lying down. These disorders often have an associated fever or history of recent previous respiratory infection. Bronchitis and pneumonia may have a productive cough. Pneumothorax can occur spontaneously with some pulmonary conditions or after trauma to the chest. This is an emergency.
If the pain is very superficial, not deep in the chest, and not accompanied by shortness of breath, this is usually a good sign of a less serious problem. Common causes of this type of pain include inflammation or injury to the ribs or muscles of the chest, and shingles, a viral infection causing intense pain along rib outlines.
The upper digestive tract can be a source of chest pain, particularly arising from the esophagus or stomach due to problems such as reflux disease (heartburn) or gastritis. Sometimes the esophagus can spasm mimicking a heart attack. Gallstones can be another source of chest pain though that is not typical of gall bladder disorders.
The best treatment for chest pain is prevention including staying compliant with medicines prescribed for hypertension, diabetes, or indigestion. In a remote area or on an airplane, for example, your resources will be limited for immediate care. If you strongly suspect that someone may be having a myocardial infarction, you should have the victim lie down and keep quiet, keep bystanders away, and send for help (if possible). Be prepared to initiate CPR. One thing you can do for someone in this situation is to have them take an aspirin while awaiting medical assistance, provided the person can swallow. It is likely that someone on the plane or in the crowd will have aspirin which interferes with platelet function, a key component of clotting. This may prevent further extension of a developing clot in the cardiac arteries. Make sure to tell the medical responders that aspirin was administered.
This article was published in The Explorers Journal
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