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any area above the waisr.)

Duration-Lasts longer than 20 minutes? (Cardiogenic chest pain

typically lasts 2-20 minutes.)

APPENDIX X: PHYSICAL THERAPY CONSIDERATIONS FOR CHEST PAIN 923

Characteristics-Pressure, tightness, or heaviness versus other feelings, such as sharpness, or with inspiration? (Cardiogenic chest pain is usually described as a deep visceral sensation.)

Accompanying symptoms-Associated with diaphoresis, dyspnea, or

light-headedness versus a lack of these symptoms? (Cardiogenic

chest pain is typically associated with one or more of these accompanying symptoms.)

Radiation-Does the pain radiate to the atm(s), shoulder(s), neck,

jaw, or teeth? (Cardiogenic chest pain can radiate widely.)

Treatment-Relieved by rest, oxygen, or nitroglycerin? (Cardiogenic

chest pain is usually relieved by these interventions.)

As this information is ascertained, the physical therapist should

discontinue the activity (if not resting) and determine the need for

seated or supine rest, observe the patient for signs of altered cardiac

output (decreased blood pressure), take vital signs, and monitor

telemetry as appropriate. If the chest pain appeats cardiogenic, the

physical therapist must determine whether it is stable or unstable.

Refer to Myocardial Ischemia and Infarction in Chapter J for a

description of stable, unstable, and variant (Prinzmetal's) angina.

During an episode of unstable angina, an electrocardiograph may

reveal ST segment elevation or depression with or without T-wave

inversion that reverses when anginal pain decreases.4 These electrocardiograph changes are depicted in Figure X-1. Vital sign findings include the following:

•

Hypotension or hypertension

•

Bradycardia Ot tachycardia

•

Irregular pulse

If the patient presents with one or more of these unstable anginal

findings, the therapist should Stop or defer treatment and immediately

notify the nurse.

Regardless of the etiology of the patient's complaint of chest pain,

the physical therapist must be ptepared to expedite a reliable chest pain

description and respond accordingly for prompt medical therapies or

for further investigation of the cause of noncardiogenic chest pain.

924 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Pathological -

o wave

(a) Dead myocardium

Raised ST

segment

(b) Acutely damaged myocardium

Twave

(c) Myocardial ischemia

Note: There are a range of other

causes for T wave Inversion

Figure X-l. Ischemic electrocardiographic chmJges.

References

1. Becker RC (ed). Chest Pain. Boston: Butterworrh-Heinemann, 2000;40.

2. McAvoy JA. Cardiac pain: discover the unexpected. Nursing 2000;

30:34.

3. Pathophysiology of Coronary Artery Disease. In FJ Brannon, MW Foley,

JA Starr, MG Black (eds), Cardiopulmonary Rehabilitation: Basic Theory

and Application (2nd ed). Philadelphia: FA Davis, 1993;82.

4. Chandra NC. Angina Pcccoris. In LR Barker, PD Burton, PD Ziere (eds),

Principles of Ambulatory Medicine (4th cd). Baltimore: Williams &

Wilkins, 1995;69 t.