Initial treatment of chest pain

If you have chest pain, initial treatment generally consists of taking ASA, using oxygen, and if appropriate, using nitroglycerin. Morphine may be used if you cannot use nitroglycerin or if you still have pain after receiving treatment.

Initial treatment for chest pain

Treatment	What it does	Advantages	Possible risks
Oxygen therapy	Increases the concentration of oxygen in the blood	May relieve symptoms of shortness of breath and chest pain	Slowed rate of breathing in people with lung disease (which can increase carbon dioxide levels)
Nitroglycerin	Slows the return of blood to the heart and lowers blood pressure, which decreases workload Opens up (dilates) coronary arteries	Helps decrease workload on the heart May improve coronary artery blood flow	Low blood pressure Headache Interaction with erection-enhancing medicines
Morphine	Relieves pain and anxiety Improves shortness of breath Lowers blood pressure	Helps decrease workload on the heart, which can improve blood flow Reduces anxiety Controls pain	Low blood pressure Nausea Slowed respiratory rate

Oxygen therapy

Oxygen therapy increases the amount of oxygen in the lungs and bloodstream. By breathing in oxygen through a tube in your nose (nasal cannula) or a face mask, you can increase the amount of oxygen in your blood, which ultimately reaches your heart. This can potentially limit the amount of damage to your heart if a heart attack is occurring. Breathing oxygen can reduce pain, breathlessness, and anxiety in people who are having chest pain.

Doctors generally recommend that anyone who has a heart attack receive oxygen therapy during the first 6 to 12 hours. Oxygen therapy can be stopped after that time if you do not have any more pain and are not experiencing shortness of breath.

Nitroglycerin

Medicines that contain nitroglycerin help treat a heart attack by opening up (dilating) the blood vessels in your body, which lowers blood pressure and may help increase blood flow through the coronary arteries to the heart. Lowering your blood pressure also reduces the strain on your heart. Nitroglycerin also helps dilate the coronary arteries, which helps deliver blood to the heart.

When you first come to the emergency room with chest pain, doctors will likely give you a tablet of nitroglycerin that you place under your tongue. If you are taking any erection-enhancing medicine, such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis), tell your doctors before they give you nitroglycerin. Combining nitroglycerin with any of these medicines can cause a life-threatening drop in blood pressure.

After placing nitroglycerin under your tongue, the tablet of nitroglycerin dissolves and the medicine is rapidly absorbed through the lining of your mouth and into your bloodstream. Administering nitroglycerin this way allows it to start working within 1 to 2 minutes.

If more nitroglycerin is needed, you may receive the medicine through an intravenous (IV) tube. The amount you receive is adjusted to lower your blood pressure and to relieve your chest pain. You will be monitored closely while you are receiving this form of nitroglycerin to make sure that your blood pressure does not drop too low.

Morphine

It is important to relieve pain and anxiety if a heart attack is occurring, not only for your own comfort, but also to help prevent further damage to your heart.

During a heart attack, most people experience severe chest pain, shortness of breath, and anxiety. Your body's natural response to these symptoms is to increase your heart rate and blood pressure dramatically. When your heart beats faster, it has to work much harder, which means it needs more oxygen. Controlling pain and anxiety with morphine helps slow your heart rate, decreases the workload on your heart, and therefore decreases the amount of blood flow and oxygen your heart needs.

Morphine can be injected through an IV tube and is commonly used to quickly relieve your pain and anxiety. Morphine is highly effective, but it can also decrease blood pressure, cause severe nausea, or slow respiratory rate.

Author:	Douglas Dana Robin Parks, MS	Last Updated August 15, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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