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Treatments and drugs
By Mayo Clinic staff
Cardiac causes
If it appears that heart problems are the cause of your chest pain, your doctor may give you medications such as:
- Aspirin. Aspirin inhibits blood clotting, helping to maintain blood flow through narrowed heart arteries. When taken during a heart attack, aspirin can significantly decrease death rates. You may be asked to chew the aspirin to hasten its absorption. Aspirin is recommended for most people who have had a heart attack.
- Nitroglycerin. This medication for treating angina temporarily widens narrowed blood vessels, improving blood flow to and from your heart.
- Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure, which decreases the demand on your heart. These medications help limit the amount of damage during a heart attack and prevent a second heart attack.
- Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. These drugs are most effective when taken within an hour after symptoms of a heart attack begin.
- Ranolazine (Ranexa). This is a relatively new drug for treating chronic angina. It's used only when other anti-anginal drugs haven't worked because it can cause a heart problem known as QT prolongation, which can increase your risk of heart rhythm problems. It should be used with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
- Calcium channel blockers. When treating coronary artery spasm, doctors sometimes use heart medications such as calcium channel blockers to relax the coronary arteries and prevent spasm.
Heart attack treatments
If it's clear you're having a heart attack, you may be treated with clotbusting drugs or undergo a surgical procedure such as:
- Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — doctors insert a catheter with a special balloon into a blocked coronary artery. The balloon is inflated to open up the artery and restore blood flow to your heart. Then, a small wire mesh coil (stent) is usually inserted to keep the artery open. Many people will go straight from the emergency room to the catheterization laboratory to have angioplasty performed as quickly as possible.
- Coronary bypass surgery. This procedure creates an alternative route for blood to go around a blocked coronary artery.
Angina treatment
Doctors usually first treat angina with medication. You'll likely start receiving medication in the emergency room, including aspirin, nitroglycerin, beta blockers and blood thinners.
If you have unstable angina — chest pain while you're at rest — you may need immediate coronary catheterization followed by angioplasty and stenting. In some cases, you may need coronary bypass surgery.
Treatment for other cardiovascular conditions
Other heart and lung conditions can be treated initially in the emergency room. If it's clear you're experiencing a pulmonary embolism, you'll likely be treated with emergency blood-thinning medications, sometimes including clotbusting medications (thrombolytics).
Aortic dissection often requires emergency surgery.
Noncardiac causes
If emergency room doctors determine you're out of immediate danger, you may be referred to your own physician or a specialist for further evaluation. Treatments for noncardiac causes of chest pain depend on the type of problem. These problems and their treatments include:
-
Heartburn. If your symptoms suggest heartburn, you'll likely need to take an over-the-counter or prescription-strength stomach acid blocker or antacid in the emergency room. Most episodes of heartburn are isolated events caused by overeating or by eating fatty foods.
If you experience frequent heartburn (at least one episode a week), your doctor or a doctor who specializes in stomach and intestinal problems (gastroenterologist) may ask you to undergo more tests. Left untreated, chronic, frequent heartburn can occasionally lead to scarring and narrowing of your esophagus. Treatment for chronic heartburn may include dietary modifications, antacids, acid blockers or other prescription medications and, in some cases, surgery.
- Panic attack. This anxiety-related cause of chest pain can be treated with prescription anti-anxiety medications, relaxation techniques and counseling to find out what may be triggering your attacks. Panic attacks are often mistaken for heart attacks, and many people are seen in emergency rooms for this problem. But once your condition is diagnosed, you can be referred for treatment to help you gain control over these attacks.
- Pleurisy. This inflammation of the pleura, the membrane that lines your chest cavity and covers your lungs, may result from a variety of conditions, including pneumonia and, rarely, autoimmune conditions such as lupus. Your doctor will want to identify and treat the underlying disease that caused pleurisy. Over-the-counter pain relievers can help minimize the pain until the inflammation subsides.
- Costochondritis. Treatment for this inflammation of the cartilage of your rib cage is generally rest, heat and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others).
- Sore muscles, injured ribs or pinched nerves. Chest pain from injured ribs, pinched nerves and sore chest muscles improves with time and self-care measures recommended by your doctor.
- Swallowing disorders. These disorders have many causes, which can usually be treated with medications, minor surgery or endoscopic techniques. You'll probably be referred to a gastroenterologist for evaluation and treatment.
- Shingles. Treatment with acyclovir (Zovirax) or a similar antiviral medication is best started as quickly as possible, preferably within 24 hours from the onset of pain or burning, and before the appearance of blisters. Doctors use other treatments, such as analgesics and antihistamines, to control symptoms such as pain and itching.
- Gallbladder or pancreas problems. You may need surgery to treat an inflamed gallbladder or pancreas that's causing pain to radiate from your abdomen into your chest.
Chest pain can be one of the most difficult symptoms to interpret. But spending time in the ER having your chest pain evaluated can bring you peace of mind, and may even save your life.
- Meisel JL. Diagnostic approach to chest pain in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 20, 2009.
- Cannon CP, et al. Approach to the patient with chest pain. In: Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50052-2&uniq=159657875&isbn=978-1-4160-4106-1&sid=887271424. Accessed Sept. 20, 2009.
- Talley NJ. Functional gastrointestinal disorders: Irritable bowel syndrome, dyspepsia, and noncardiac chest pain. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/159657875-6/887271424/1492/531.html#4-u1.0-B978-1-4160-2805-5..50144-0--cesec86_5963. Accessed Sept. 20, 2009.
- What is angina? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html. Accessed Sept. 20, 2009.
- What is a heart attack? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_WhatIs.html. Accessed Sept. 20, 2009.
- Shingles disease: Questions and answers (herpes zoster). Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/shingles/dis-faqs.htm. Accessed Sept. 20, 2009.
- Mercier LR. Costochondritis. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/160691114-3/889462700/2088/162.html#4-u1.0-B978-0-323-05609-0..00012-5--sc0235_3245. Accessed Sept. 20, 2009.
- What are pleurisy and other disorders of the pleura. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_treatments.html. Accessed Sept. 20, 2009.
- Ferri FF. Angina pectoris. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/160691114-8/889471687/2088/48.html#4-u1.0-B978-0-323-05609-0..00010-1--s4220_886. Accessed Sept. 20, 2009.
- Heart attack, stroke and cardiac arrest warning signs. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3053. Accessed Sept. 20, 2009.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 25, 2009.
