Specific Nursing Care


Chest Pain





Chest pain (angina pectoris) occurs when an area of the heart muscle (myocardium) is not receiving enough oxygen-rich blood.  This could possibly due to narrowed coronary arteries which reduce the supply of oxygenated blood to the heart muscle. 
Chest pain is caused by temporary blockage of one or more of the coronary arteries.  If not treated, it can lead to a heart attack (myocardial infarction).


Stable chest pain is usually relieved within a few minutes by resting and/or by taking prescribed medicines but may last as long as 20 minutes.  It makes a heart attack more likely in the future. In contrast, people with unstable chest pain may experience pain on minimal exertion or even at rest.  Such condition is more prolonged and severe.  The pain is not relieved promptly with medications.  Immediate medical attention is required as it is a sign that a heart attack may happen soon.


Return to Top


Signs and Symptoms of Chest Pain


Mild to severe griping pain over the chest.


Pain may be described as pressure or tight/squeezing feeling in the chest.  It may also spread to the entire chest.


The pain may pass to the left or both shoulders and arms and occasionally up the neck to the jaw or even the teeth.


The person may also complain of weakness, indigestion, heartburn, dizziness, sweating, nausea, cramping and shortness of breath.


Return to Top


Glyceryl Trinitrate (GTN) Tablet


GTN is used to stop or prevent chest pain caused by narrowing coronary arteries which supply oxygenated blood to the heart muscle.   It works by relaxing the blood vessels and lowering blood pressure, hence helps to increase blood flow to the blocked or narrowed arteries, thereby relieving chest pain.


If the person is prescribed with GTN tablets, please note the followings:



GTN tablet is to be placed under the tongue (sublingual) and allow to dissolve completely.  This route allows the medicine to be absorbed into the body very quickly.



It is advisable to take GTN 2 to 3 minutes prior to activities which are known to trigger chest pain.



If pain occurs, GTN tablet should be given at the first sign of chest pain. Do not wait until severe pain develops.



The person will experience a tingling feeling on the tongue when first taken.  Other side-effects include headache, flushing, mild fullness, and warmth.  These side-effects usually diminish with continued use.



The person should obtain relief in 1-2 minutes after taking the tablet.



One tablet is to be given at a time.



If pain is not relieved within 5 minutes, a second tablet can be given. If pain continues for another 5 minutes, give a third tablet.  Note that GTN can be given up to 3 doses (each time 1 tablet) at 5 minute intervals.  A doctor should be called if there is still no relieve of pain.  Do Not give multiple doses to get quick relief of pain.



GTN is affected by both light and heat and should be properly stored.  Do Not carry them close to the body as the body temperature can damage the tablets.  Advise the person to carry them in a purse or bag.  Those that are not carried should be stored in cool, dark place.  Keep the tablets in a dark glass container and close tightly.  Do Not store them in the refrigerator because the moisture can spoil the tablets.


Return to Top


In the Event of Chest Pain


 When chest pain occurs:



Stops whatever activity the person may be engaged in.  Never attempt to push through the pain.



Ensure that he is sitting down and resting.  Prop up his feet.  These would facilitate blood flows and reduce the strain on the heart.



If the person is stressed or anxious, calm him down by instructing him to take slow and deep breaths.  This may help to control his stress and stop the pain.



Assist the person in taking GTN tablets.  Placed it under his tongue and allow it to dissolve.  If the chest pain continues in the next 5 minutes, you should give another tablet under his tongue.  If there is still no relief of chest pain after taking 3 GTN tablets (each at 5 minute intervals), you should immediately call an ambulance.



Monitor his heart beats, breathings and blood pressure.


Return to Top


Homecare Tips


Stable chest pain has a regular pattern.  Learn to recognise the pattern and predict when the pain will occur.


Some activities and factors that can bring on chest pain include excessive exercise, anxiety, severe emotional stress, heavy meals and cold weather.  During these periods, the heart muscle demands more oxygenated blood than the narrowed coronary arteries can deliver.


Advise on avoiding strenuous physical exertion and emotional outbursts which increases the workload of the heart.


It is important for the person to remain active.  Help him to identify and modify those activities that trigger chest pain instead of avoiding them completely.


Exercise such as walking on regular basis is encouraged. However, they must be moderated below the point of producing pain.  For example, you can advise the person to begin with short walks on level ground and gradually increase the distance over a period of weeks.


Advise the person to slow down his peace in any activity for a couple of hours after a full meal.


In cold weather, advise the person to dress himself warmly and perform activities more slowly than usual.


Encourage a slow peace morning routines, especially if the person is an elderly.  It has been noted that the early hours of the day are the most dangerous for the heart.  Forcing into the morning hours might put in unnecessary pressure on the heart, triggering chest pain.


Discourage smoking which increase the progression of the disease. Smoking absorbs oxygen out of the blood and nicotine constricts the blood vessels.


Advise the person to carry with him the GTN tablets at all times.


GTN may causes headache or flushing which will usually disappear within a few minutes.  If the headache is severe or do not go away, consult your doctor.


Remind the person to take GTN tablets 2 to 3 minutes prior to activities which are known to trigger chest pain.


Ensure that the person takes all his prescribed medicines as directed.


Return to Top