Chest Pain In Seniors
ContentsCauses Of Chest Pain When To See A Doctor Diagnosing The Cause Of Chest Pain When Surgery Is Required Common Care Needs Related To Chest Pain Identifying Individual Care Needs Care Provider Options Selecting A Care Provider Effects On Caregivers Financial Considerations Legal Considerations FAQs About Chest Pain In Seniors
Chest pain may be caused by a variety of underlying conditions and concerns. While many of these causes are related to the heart and blood vessels, there may be other unrelated underlying causes. For example, chest pain may also be caused by conditions affecting the lungs, digestive system, or nervous system.
Chest pain may be felt as a sharp stab, a dull pain, a crushing feeling, or a burning sensation depending on the cause and on the individual.
The medical term for chest pain is angina. However, angina actually refers to a specific and common type of chest pain. Angina occurs when the muscles of the heart are not getting enough blood and oxygen due to blockage or narrowing of the coronary arteries (the larger arteries that supply blood to the heart muscles). Other types of chest pain include:
- Pleuritic chest pain: Pleuritic chest pain occurs when there is inflammation of the tissues that line the lungs and chest cavity.
- Non-cardiac chest pain: Chest pain that feels like heart pain. Non-cardiac chest pain occurs in patients who do not have heart disease.
- Substernal Chest Pain: When someone experiences pain below the sternal bone, this is referred to as substernal chest pain.
- Pleuritic pain: When a sudden and intense stabbing or burning occurs in the chest wall when breathing.
- Epigastric pain: When someone experiences discomfort or pain below their ribs in the upper abdomen, this is called epigastric pain.
- Post-thoracotomy pain: Following a surgical incision (called a thoracotomy) in the chest wall, a patient may experience post-thoracotomy pain.
- Costochondritis chest pain: An inflammation of where the upper ribs join the cartilage joining them to the sternum. Costochondritis also causes localized chest pain, also referred to as costochondritis chest pain.
Angina more specifically is a symptom of an underlying heart disease such as coronary heart disease (CHD) or coronary microvascular disease (MVD). Angina often feels like pressure in the chest and may spread to other areas of the upper body such as a shoulder, arm, or the neck and face.
Causes Of Chest Pain
There are several conditions that may cause chest pain in seniors. Some of these conditions are serious and require immediate medical attention while others may not be life-threatening. Some underlying causes of chest pain related to the heart include:
- Coronary heart disease - Individuals with CHD experience angina due to reduced blood flow to the heart. CHD may increase a person’s risk of experiencing a myocardial infarction, or heart attack, in the future. CHD is the leading cause of chest pain.
- Heart attack - Chest pain due to a myocardial infarction (what we call a heart attack) is often felt as a severe and crushing pain. During a heart attack, blood flow to one or more of the coronary arteries is blocked which causes death of the heart muscle. A heart attack is always a medical emergency.
- An inflammation of the heart or pericardium (heart sac) - Myocarditis is an inflammation or infection of the heart muscle itself. Pericarditis is caused by inflammation of the pericardium. Both of these conditions may result in chest pain as well as other symptoms.
- Hypertrophic cardiomyopathy - In hypertrophic cardiomyopathy, the heart muscle grows abnormally thick. This condition is genetic and may lead to problems with blood flow out of the heart. This may result in acute chest pain and shortness of breath.
- Mitral valve prolapse - Mitral valve prolapse is a condition caused by a heart valve not closing properly. It may cause no symptoms at all, however, it may cause acute chest pain in some people.
- Aortic dissection - An aortic dissection occurs when there is a tear in the aorta causing sudden and severe chest pain. This condition is rare but serious and life-threatening.
Not all chest pain is caused by conditions related to the heart. Approximately 25% of people with chest pain have chest pain that is not related to heart problems. Other common causes of chest pain include:
- Lung conditions - Several lung conditions, including pulmonary embolism, pneumonia, and a collapsed lung may result in chest pain.
- Injury or inflammation in the chest - Injury or inflammation of the ribs, sternum, breastbone or chest muscles are common causes of chest pain.
- Gastrointestinal conditions - Conditions that impact the digestive system such as stomach ulcers, gallstones, acid reflux, or gastroesophageal reflux disease (GERD) may also produce chest pain. Chest pain caused by acid reflux is often confused with heart-related chest pain, however, this pain originates in the stomach.
- Panic attacks or other anxiety disorders - For many people, panic attacks and anxiety disorders affect more than one’s mental state. These conditions often produce physical symptoms including chest pain.
When To See A Doctor
An individual with chest pain should see a doctor if the pain is not easily relieved by at-home treatments such as over the counter (OTC) pain medications or rest. A doctor will be able to determine the underlying cause of the chest pain and what steps, if any, need to be taken to alleviate it.
If chest pain is severe or has certain accompanying symptoms, a person should seek medical attention as soon as possible. These symptoms include:
- Chest discomfort
- Difficulty swallowing
- Coughing that produces mucus
Since chest pain may be a sign of a serious, life-threatening condition, it should always be taken seriously. If an individual is having chest pain along with any of the following symptoms, they should call 911:
- Very low blood pressure
- Very slow heart rate or a very rapid heart rate
- Chest tightness
- Rapid breathing
- Shortness of breath
- Pain that is sudden and sharp
- Chest discomfort
- Pain that spreads to the left arm, back, or jaw
These signs and symptoms may indicate that the chest pain is due to a heart attack or other emergency condition.
Diagnosing The Cause Of Chest Pain
When an individual goes to the emergency room for chest pain, the first things the doctors will test for are urgent, life-threatening conditions such as a heart attack or pulmonary embolism. A variety of tests may be performed to determine the underlying cause of chest pain. Some of these tests include:
- Electrocardiogram (ECG) - An ECG measures and records the electrical impulses of the heart. During a heart attack, damaged heart muscle cannot conduct these impulses normally. This will show on the ECG.
- Echocardiogram - An echocardiogram uses soundwaves to produce a moving image of the heart in motion and will display any irregularities that may be causing chest pain.
- Chest X-ray - A chest X-ray allows doctors to view the inside of the chest and check for conditions such as a collapsed lung.
- Computerized tomography (CT scan) - A CT scan is used to check for blood clots, aortic dissections, and other problems in the blood vessels.
- Blood tests - When the heart is damaged, it may lead to increased levels of proteins and enzymes in the blood. Blood tests will check for this and help determine the presence and severity of any heart damage.
- Stress tests - A stress test is done to see how the heart and blood vessels respond to exertion. This test may be done through monitoring physical activity, such as walking on a treadmill, or by injecting a chemical into the bloodstream to stimulate activity. The type of test that is performed will depend on a person’s current health and ability level.
- Cardiac catheterization (coronary angiogram) - In this test, a long thin tube is inserted into the arteries of the heart. A dye is injected through the tube which allows doctors to see the flow of blood to the heart muscle and any potential blockages on an x-ray.
When Surgery Is Required
After the doctor has determined what is causing a person’s chest pain, it may be necessary to perform heart surgery to correct the problem and alleviate the pain.
Some types of surgery used to treat chest pain include:
- Heart bypass surgery - Heart bypass surgery is performed when one or more arteries on the heart are blocked. In this surgery, surgeons create a new route for blood to travel to the heart muscle by taking a blood vessel from another part of the body. This creates a new path around the blockage so that blood may continue flowing to the heart.
- Angioplasty and stent placement - This procedure is done to open a blocked artery. With this surgery, a balloon is placed on the end of a thin tube and inserted into the blocked blood vessel. The balloon is inflated once it is inside the vessel which causes the artery to open permitting blood flow.
A small wire tube known as a stent is placed on the end of the balloon which stays in the artery after the balloon is deflated.
- Lung reinflation - A lung reinflation procedure may be needed if an individual’s chest pain is caused by a collapsed lung.
- Dissection repair - If an individual has an aortic dissection, an emergency procedure to repair the torn artery will be performed.
Common Care Needs Related To Chest Pain
Regardless of the cause of a person’s chest pain, treatment and recovery may require significant changes to one’s medications and lifestyle. An individual may need extra help at home or be unable to care for themselves as they normally would. If surgery was required, there will be a risk of surgical complications that may prompt the need for additional care.
If chest pain is related to an underlying heart condition such as CHD, the pain may be chronic meaning it may be expected to continue for an extended period of time. Chronic pain may limit an individual's ability to perform activities of daily living (ADLs). ADLs are the tasks a person needs to perform on a daily basis such as bathing, toileting, eating, and getting dressed. Individuals with chronic pain may have difficulty completing these tasks.
Chest pain may have a serious impact on a person’s quality of life, even when it is not caused by heart-related conditions. According to a recent study, people with chronic chest pain are three times more likely to receive disability payments and twice as likely to leave the workforce before retirement age. These effects on daily functioning and quality of life may be more significant in seniors, especially if they are managing other health conditions.
Various medications may be used to treat chest pain. The medications used will depend on the underlying cause of the chest pain and on other health conditions a person has. Some commonly-prescribed medications include:
- Thrombolytic drugs to dissolve clots
- Artery relaxers such as nitroglycerin or blood pressure medication
- Blood thinners to prevent the formation of blood clots
- Acid reducers to slow the production of acid in the stomach
- Antidepressants if the chest pain is related to panic attacks or anxiety
If a person with chest pain is on medications, these medications may cause dizziness or changes in cognition. They may also feel overwhelmed by the demands of managing a chronic condition. These challenges may also result in an individual being less able to manage daily tasks such as housework, cooking, financial management and medication management. These tasks are known as instrumental activities of daily living (IADLs).
An individual’s doctor will explain what lifestyle changes should be made that may help reduce chest pain and/or improve its underlying causes. These changes will depend on what is causing chest pain and on an individual’s overall health.
Lifestyle changes that may be recommended for chest pain from CHD or a heart attack include:
- Quitting smoking - Smoking may damage the heart, blood vessels, lungs, and stomach lining. It may aggravate many conditions that result in chest pain and may cause serious complications.
- Lowering cholesterol - Cholesterol causes fatty buildup in the arteries leading to many heart problems including heart attacks. Cholesterol may be lowered with medication, diet, and exercise.
- Lowering blood pressure - High blood pressure is one of many risk factors for many heart-related diseases. Lowering blood pressure may improve overall heart health.
- Lowering stress levels - High stress levels may increase blood pressure and lead to other behaviors that affect heart health, such as smoking or overeating.
- Limiting alcohol consumption - Excessive alcohol use may raise blood pressure and increase the risk of other diseases that can cause chest pain. The American Heart Association recommends that alcohol consumption be limited to no more than 2 drinks a day for men and 1 drink a day for women.
- Eating a healthier diet - Choosing foods that improve heart and digestive health may also reduce chest pain. Heart-healthy diets are high in foods such as green leafy and colored vegetables, fruits, and some whole grains. They also include food such as healthy oils, low-fat dairy, nuts, fish, and other lean meats. Diets for the digestive system may include foods that are high in fiber or easier to digest.
- Increasing physical activity - Being physically active may lower blood pressure, lower cholesterol, and help an individual maintain a healthy weight. A physical therapist may help a person develop a plan to increase their physical activity in a way that is safe for them.
- Losing weight - Maintaining a healthy weight may help improve health conditions that predispose a person to chest pain. Obesity often leads to high cholesterol, high blood pressure, and type 2 diabetes.
- Managing diabetes - Diabetes and heart conditions are often linked. In seniors with Type 2 diabetes, at least 68% of deaths are related to a heart condition. Diabetes management may reduce these risks and help alleviate chest pain caused by these heart conditions.
Identifying Individual Care Needs
When a person with chest pain is no longer able to perform ADLs or IADLs independently, they may need assistance to remain safe. The type of chest pain one has and the underlying cause of the pain may result in specific care needs. Some important considerations when exploring options for care include:
- Does the individual live alone? - If an individual lives with a spouse, adult child, or other caregiver, they may be able to remain in their own home, even if they have advanced care needs. Caregivers may make it safer for a person to recover at home. They may be able to assist with IADLs and some ADLs. They may also be able to attend doctor’s appointments with the person recovering from chest pain and help ensure the plan of care is being followed.
- Is their home environment safe? - Homes may have hazards such as poor lighting or clutter that may increase a senior’s risk of falling. The home should be examined for these hazards as well as for things such as distance from the bedroom to the bathroom and number of stairs. Having an accurate assessment of the safety of the home may help an individual and their family make the safest care choice.
- Is the chest pain chronic? - An individual with chronic chest pain will need to manage the pain as part of their daily life as well as manage the underlying condition causing the pain. Chronic pain may lead to a decreased ability to perform ADLs and IADLs. In some cases, chronic pain may also lead to psychological concerns such as depression.
- Is surgery required? - Some types of chest pain require surgery. Care needs following surgery may be overwhelming and challenging. Recovery after surgery may include wound care, new medications, and physical or occupational therapy. Recovery from surgery may also be complicated by the fact that seniors are at a greater risk for surgical complications such as postoperative delirium which leads to confusion and cognitive concerns.
- Does the individual have other health conditions? - If an individual is managing other health conditions in addition to managing the underlying cause of their chest pain, this may cause additional stress. They may be taking several medications and/or need to follow up with several specialists.
- Is the individual able to cook for themselves? - In order to stay at home safely, a person needs to be able to cook for themselves and perform other IADLs. If a new diet is ordered to treat chest pain, an individual or their caregiver will need to be able to prepare meals that fit with the new diet requirements.
Other considerations such as transportation and financial management may also need to be considered. Taking the time to ensure the most appropriate care has been selected will allow an individual and their family to have a sense of safety and security as they manage chest pain.
Care Provider Options
Once an individual and their family have identified what care needs the person with chest pain has, they will then be in a better position to select the most appropriate care provider.
Home care may be the best option for individuals who wish to stay in their own homes but who need additional assistance due to chest pain. Home care agencies can help an individual manage their pain at home safely and assist during their recovery.
For some people, staying in their own homes for as long as possible provides a sense of independence and comfort. This may motivate these individuals to be more active participants in their own health and recovery.
A home care agency will send a team of professionals to the individual's home. These healthcare professionals will provide assistance with ADLs and perform skilled care needs. This team will help manage pain, any post-surgical care, therapy, other health conditions, and medications.
Generally, a person’s home healthcare team will consist of home health aides, nurses, and physical therapists. Additional professional services such as those of occupational therapists, social workers, or dieticians may also be ordered.
If an individual lives with a caregiver, home health staff may be able to teach the caregiver how to perform certain tasks or manage medication. They may also be able to teach the caregiver about the person's chest pain and the underlying condition. This may help the caregiver provide needed care when home health staff is not in the home and may keep the affected individual safe in their home longer.
It is important to consider that most home health care agencies are not able to provide care around the clock. If an individual is not able to be alone in their home safely for any period of time, home care may not be an appropriate choice.
Unlike home care, care at an inpatient facility is available 24 hours a day. Staff in inpatient facilities are always present to assist an individual and assist them with their care needs. A stay at an inpatient facility may be short-term or long-term, depending on the individual and their care needs.
Stays at an SNF are generally meant to be short-term and for an acute need. For example, if an individual with chest pain had emergency surgery, their doctor may recommend a stay in a SNF. At a SNF, a person’s progress will be monitored including their surgical wounds. They may be ordered therapy to regain their prior level of functioning. When the doctor feels it is appropriate and safe, the person will be discharged from the SNF to their home or to a lower level of care such as an ALF.
Skilled Nursing Facilities
When an individual has a hospital stay for chest pain and doctors and other hospital staff do not feel it is safe for them to return home, they will discuss the need for a SNF with the individual and their family. Hospitals are usually able to recommend options for local SNFs with beds available for individuals and their families to choose from. Family members may be able to visit a few SNFs to get a better sense of which facility they prefer.
Healthcare staff at a SNF will include therapists, dietitians other professionals. Skilled needs such as wound care and treatments will be completed by nurses and nursing assistants will provide help with ADLs. Individuals at a SNF will be closely monitored by a doctor who will oversee their care.
Assisted Living Facilities
An ALF is meant to be used as a long-term solution to care. ALFs are different from SNFs and do not offer skilled services. In an ALF, aides will provide assistance with ADLs and some IADLs. Different ALFs are able to provide different levels of assistance with ADLs and IADLs and will have guidelines for what an individual needs to be able to do on their own while living at the facility.
Nursing staff at an ALF may assist with medication management and some treatments. In an ALF, services such as transportation, meals, housekeeping, and activities are typically provided.
Continuing Care Retirement Communities
Some ALFs and SNFs may be part of communities known as continuing care retirement communities (CCRCs). At a CCRC, multiple levels of care are part of the same campus. An individual who lives at a CCRC may start at an ALF level of care and move back and forth to a SNF level as their care needs change.
Selecting A Care Provider
Once an individual and their family determine the most appropriate type of long-term care that is needed, they will need to select the most appropriate agency or facility to provide that care. According to the U.S. Department of Health and Human Services, some important considerations to keep in mind when selecting a long-term care facility include:
- Is the agency or facility accredited by the state and by other quality control agencies? - The results of recent inspections are available to the public in many states. A facility or agency should also be able to provide these records on request.
- Are the staff licensed to provide the necessary care for the individual? - Staff at all agencies and facilities should be CPR-certified. They should attend regular training on various health conditions and the best way to provide care for them.
- Can the agency or facility provide the care the individual needs? - Different levels of care, as well as different specializations in care, may be found among local agencies and facilities.
- Can the individual afford the costs associated with the facility? - Different agencies and facilities will accept different forms of payment. Social workers or financial planners from the agency or facility should be able to outline all payment options to individuals and their families.
Individuals and their families considering inpatient care may want to tour several facilities. On a facility tour, they should be able to observe how staff interact with residents and check the facility for cleanliness and safety. It is also recommended that they interview several providers and meet as many staff members as possible. These things will help a person and their family gain a sense of the facility or agency and assist them in making their choice.
Effects On Caregivers
Caregiving can be a very stressful role. An individual with chest pain may have changing care needs as their condition progresses. They may need significantly more assistance than they did in the past and they may experience mental health issues such as depression.
It is important for caregivers of individuals with chest pain to take steps to ensure they are taking care of themselves while providing the best care they can. Some recommended steps include:
- Taking time to care for one’s own health - Caregivers may experience burnout and other effects on physical health. They should take time to sleep, eat well, exercise, and monitor their own needs. By taking care of themselves, caregivers will be better able to provide care to the individual with chest pain.
- Get help when needed - There are many resources available to assist caregivers. Local agencies may be able to help a caregiver sort through all the options that are available to them and select the ones that best meet the needs of their situation.
- Take breaks as needed - Taking a break may be an effective way to help caregivers provide care for a person with chest pain. Sometimes, short breaks throughout the day may be helpful. Other times, a day or weekend away may be needed. When a longer break is needed, respite care may be a good option.
- Have a support system in place - Emotional support for caregivers can play a vital role in their ability to provide care for a person with chest pain. Support groups, both in person and online, may be a great source of support. Since caregivers are at increased risk factors for depression, they may also want to talk to a counselor or therapist about their feelings and concerns related to caregiving.
There are costs associated with all types of long-term care. Different home care providers, SNFs, ALFs, and CCRCs will accept different forms of payment. These costs may vary depending on the level of care needed and on each facility’s policies.
More detailed information on the options for covering long-term care costs is available here, but some general guidelines for different options include:
- In a SNF, 100% of the cost is covered by Medicare for up to 20 days. On days 21 through 100, Medicare will pay a portion of the costs and the individual will be responsible for a coinsurance amount. After 100 days, Medicare will no longer cover the costs of care in a SNF and the individual will be responsible for the entire amount. Most SNFs accept payments such as long-term care insurance, Medicaid, and private pay.
- When using a home care agency, Medicare will pay 100% of the costs of home care if the agency is Medicare-certified and if the doctor ordering the care certifies that there is a skilled need. Medicare will pay the costs for services needed on a part-time and temporary basis.
However, Medicare will not pay for services to assist with IADLs such as housekeeping, transportation, and meal preparation. Different agencies will accept different payment forms but common payment options include Medicaid, private pay, and long-term care insurance.
- ALFs and CCRCs are not covered by Medicare. The cost of these facilities will need to be paid by other methods. ALFs and CCRCs may have social workers, financial planners, or Medicaid specialists on staff who may be able to assist individuals and their families with payment options.
Some legal concerns may need to be addressed when chest pain results in major life changes for a person. An individual who is overwhelmed with figuring out their care options and planning for how to pay for this care may want to consider setting up a power of attorney.
A power of attorney will be able to handle important financial decisions for a person. Setting up a living will or advanced directive may also be a useful step to take at this time. A living will helps to ensure that a person’s requests for medical treatments are followed if they should become incapacitated and unable to participate in decisions about their medical care.
FAQs About Chest Pain In Seniors
1. How does aspirin help chest pain?
Aspirin is a blood thinner. Aspirin may help blood flow to the heart through an artery that is narrowed or clogged. This may provide some relief for angina or help to limit the damage caused by a heart attack or heart failure. If an individual thinks they are having a heart attack, they should call 911 before taking any aspirin.
2. Is a heart attack or heart failure the only life-threatening condition that causes chest pain?
No. Conditions such as an aortic dissection and a pulmonary embolism are also life-threatening emergencies. While the underlying cause of chest pain may be something minor, it is important to take all chest pain seriously. Even in cases where chest pain is not caused by an emergency condition, the underlying cause may need treatment to prevent it from becoming an emergency in the future.
3. Why does acid reflux cause chest pain?
In acid reflux, stomach acid leaves the stomach and travels back up into the esophagus. The acid in the stomach causes pain to be felt in the chest. Pain from acid reflux may be difficult to distinguish from heart attack pain or angina. However, there are some signs that chest pain may be acid-related and not heart-related:
- The pain occurs within a few hours of eating.
- The pain starts as a burning sensation in the stomach.
- The pain wakes the individual up during the night.
- The pain is accompanied by a sour taste in the mouth.
- The pain lasts for several hours.
- The pain is relieved by antacids.
If an individual is unsure if their chest pain is acid reflux or a heart attack, it is safest to go to a hospital and get it checked it out.
4. Why would a panic attack cause chest pain?
When a person is having a panic attack, they may hyperventilate and breathe rapidly. This may cause over-contraction of the lungs and surrounding muscles, resulting in chest pain.
A person may also experience bloating and other gastrointestinal disturbances as a result of a panic attack which may cause chest pain. Additionally, for some people, chest pain may be psychosomatic (pain caused by the brain and not the area of the body where the pain is felt) and worsened by increased panic.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.