Experts have put together new guidelines that will ensure people of diverse racial and ethnic backgrounds get the help they need when experiencing chest pain. That includes acknowledging and addressing that, like women, Black people with chest pain have been less likely to be treated urgently.
Chest pain is about more than pain in the chest. But when it comes on suddenly, experts behind new guidelines on evaluating and diagnosing it don’t want you pondering nuances. They want you to act. Now.
The recommendations aim to help patients and health care professionals act faster, make smarter choices and communicate better about chest pain.
“If we’re not connecting with our patients in a way that they feel respected and that they feel listened to, we won’t be able to close the gaps in cardiovascular care, and specifically in addressing their chest pain,” Dr. Martha Gulati, president-elect of the American Society for Preventive Cardiology and chair of the writing committee for the guidelines published Thursday in the AHA journal Circulation says.
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Some people may not report chest “pain” but rather chest “discomfort,” which may include pressure or tightness in the chest but also in other areas, including the shoulders, arms, neck, back, upper abdomen or jaw.
The sudden onset of any of those symptoms could be a sign of reduced blood flow to the heart, Gulati adds.
Chest pain does not always mean a heart attack, which happens when blood supply to the heart is stopped, starving it of oxygen.
“The majority of chest pain is not life-threatening,” Gulati shares. “And in fact, the majority of chest pain is not cardiac.” It may instead be due to
respiratory, musculoskeletal, gastrointestinal, psychological or other causes.
“But when it is cardiac, it can be deadly,” Gulati notes.
That’s why getting care is urgent. “We have such good treatment, but time is heart muscle,” she adds. “The sooner we see you, the sooner we can treat you.”
Chest pain accounts for more than 6.5 million emergency department visits annually in the United States, plus nearly 4 million outpatient visits. The guidelines, the first from the AHA and ACC dedicated solely to chest pain, outline standards to help doctors identify who is most at risk and reduce unnecessary testing in those who aren’t.
The guidance suggests other ways for health care professionals to alter how they talk to patients. For example, doctors should stop using the term “atypical” to describe chest pain. Aside from being confusing, it’s a technical detail with significant implications for women.
While both women and men experiencing heart problems most commonly report “typical” chest pain similarly, women more often report additional “atypical” symptoms such as nausea, fatigue and shortness of breath. This has resulted in women being less likely to receive timely and appropriate care.
“In the past, we have often said that women presented ‘atypically,'” Gulati says. “Nonetheless, this seems to be used to say that the pain isn’t cardiac, rather than meaning a woman is presenting differently than expected.” Instead, doctors should use the term “noncardiac” if heart disease is not suspected.
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“The most important thing people need to know about chest pain is that if they experience it, they should call 911,” Dr. Phillip Levy, a professor of emergency medicine and assistant vice president for research at Wayne State University in Detroit says. “People shouldn’t waste time trying to self-diagnose. They should immediately go to the nearest hospital. And if they’re going to go to the nearest hospital to get evaluated for chest pain, ideally, it should be by an ambulance.”
Even if most cases of sudden chest pain end up not being heart-related, it’s never something to ignore. When people put off going to the emergency department, they’re more likely to suffer complications if they are indeed having a heart attack. “And those complications can be as severe as death.”
Gulati says nobody should be afraid they’re calling for no reason. “I always tell my patients it’s better for us to laugh together once we find some other cause for it versus us not being able to laugh together again.”
Lastly remember that consulting with your doctor should be a shared decision-making process. Research shows “if they’re party to that decision-making, patients are much happier with the care delivered.” So if your doctor is not allowing you to weigh in on your treatment options, consider changing doctors.
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