Older Adults_Bars-Geriatric Pain

FAST FACTS: Chest Pain


Chest pain is defined as any pain located in the chest and it does not need to be heart related (cardiac). Chest pain is common in older adults and causes people to worry because of potential association with the heart. It is sometimes difficult to tell cardiac pain from other types of chest pain. Key discriminators include: 1) the way it is described, 2) whether the pain is related to exercise, and 3) whether is it relieved by receiving oxygen.

Chest Pain
  • Chest pain description
    • Cardiac pain: typically described as a pressure and squeezing of the heart area
    • Non-cardiac (non-heart related) pain: often described as sharp, burning, or painful with palpation (tapping or gentle pressure) on chest.
    • Older adults and women, do not always have always have typical symptoms

  • Potential Causes-Cardiac Chest Pain
    • Lack of oxygen to heart (i.e. angina, heart attack)
      • Often described as heaviness, pressure, squeezing or pain in left arm 
      • More common in men over 60
      • Improved or relieved with additional oxygen or nitroglycerine medication
    • Inflammation of the pericardium (the membrane around the heart)
      • Often sharp intense pain starting abdomen/back; radiate to thigh/scrotum
      • May/may not have fever; heart rate typically higher; NOT relived by oxygen
      • Medication typically needed; need to determine cause-viral or bacterial
    • Painful heartbeat (i.e. disorder of heart value, abnormal heart rate)
      • Occasionally have chest pain but usually not symptoms; medication to treat

  • Potential Causes- Non-Cardiac Chest Pain
    • Pulmonary (related to lungs- i.e. pleurisy, pneumonia, pulmonary embolism, etc.)
      • Often described as sharp, intermittent pain, can be worse with breathing
      • May have shortness of breath and rapid heartbeat
      • Treatment: Oxygen may help; NSAID/Tylenol or other pain meds if ordered
    • Gastrointestinal (i.e. reflux, esophagitis, peptic ulcer, pancreatitis, cholecystitis)
      • Often cause sharp intense pain NOT relived by oxygen
      • May or may not also have a fever; heartrate typically elevated
      • Treatment: Medication typically needed
    • Musculoskeletal (i.e. costochondritis, muscle strain, rib fracture, fibromyalgia)
      • Pain is usually sudden and localized; could be associated with muscle trauma; severe cough
      • Pain worse with deep breath
      • Treatment: Ice or heat may help; NASAIDs may also help
    • Chest wall pain (i.e. muscle strain, rib fracture)
      • Pain is usually sudden and localized; could be associated with a trauma to a muscle, severe cough
      • Pain is worse with deep breath
      • Treatment: Ice or heat; NSAIDs may also help
    • Psychogenic (i.e. anxiety)
      • Symptoms do not fit with physical signs
      • Treatment: relaxation, oxygen, massage

  • What You Can Do
    • Contact your Healthcare provider for assessment of all conditions
    • Use a Pain Diary to note important information useful to your Healthcare provider
    • Use medication or oxygen as prescribed by your Healthcare provider
    • Try a non-drug treatment to decrease minor pain

Revised 3/2020

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