Patient education: Chest pain – Discharge instructions (The Basics)

What are discharge instructions? — Discharge instructions are information about how to take care of yourself after getting medical care for a health problem.

What is chest pain? — Different things can cause chest pain or discomfort. Many of these are not serious. Having chest pain does not necessarily mean that you are having a heart attack. But chest pain can be a sign of a heart attack.

Doctors use the word "angina" for chest pain or discomfort that is caused by a condition called "coronary artery disease." In this disease, fatty deposits build up in the arteries that supply the heart with blood (figure 1). Chest pain can also be caused by a spasm in 1 of these arteries (figure 2).

When 1 of these things happens, the arteries narrow, and the heart muscle does not get enough blood. This causes chest pain or discomfort, especially during physical activity. People with angina often need to take medicines to help prevent or relieve chest pain.

In many cases, chest pain is not related to a heart problem. It can be caused by a lung problem, or something less serious such as muscle pain, heartburn, or anxiety.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Know how to take nitroglycerin pills or spray, if your doctor prescribed them:

•Rest. Sit or lie down while you take the medicine.

•Spray the nitroglycerin under your tongue, or place 1 pill under your tongue and let it melt.

•If the pain is not better or is getting worse after 5 minutes, call for emergency help. Then, take 1 more spray or pill under your tongue.

•If the pain does not get better after another 3 to 5 minutes, take a third spray or pill under your tongue.

•Drink a sip of water if your mouth is too dry for the pills to melt.

•Carry your nitroglycerin pills or spray with you at all times. Check often to make sure that they are not expired. Keep your nitroglycerin in the original bottle and at room temperature. The pill should burn or tingle when you put it under your tongue. If it does not, you might need to replace your medicine. You should also replace the nitroglycerin pills or spray 6 to 12 months after you open the bottle.

•If you have aspirin at home, chew and swallow a 325 mg tablet. The aspirin should not have an "enteric coating" (also called a "safety coating") or it will not dissolve fast enough.

●Take all of your medicines as instructed, even if you feel well. Check with your doctor before taking any new medicines or supplements.

●Keep your blood pressure and cholesterol under control. If you have diabetes, make sure that you know how to manage it.

●Quit smoking, if you smoke. Your doctor or nurse can help.

●Try to keep a healthy weight. If you have excess body weight, it can help to lose weight. Your doctor or nurse can help you do this in a healthy way.

●Eat a healthy diet. Talk with your doctor or nurse about how to add healthy foods to your diet.

●Go to "heart rehab," if you doctor recommends it. This is an important part of your care. Share your discharge information with the rehab staff so they can plan a program to help you recover. Let your doctor know if you need help finding a program.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if you think that you might be having a heart attack.

Symptoms of a heart attack can include (figure 3):

●Severe chest pain, pressure, or discomfort with:

•Breathing trouble, sweating, upset stomach, or cold and clammy skin

•Pain in your arms, back, or jaw

•Worse pain with activity like walking up stairs

●Fast or irregular heartbeat

●Feeling dizzy, faint, or weak

Call your doctor for advice if:

●You have a fever of 100.4°F (38°C) or higher, or chills.

●You cough up yellow or green mucus.

●You are more tired than normal, or have more trouble breathing with activity.

More on this topic

Patient education: Chest pain (The Basics)
Patient education: Pleuritic chest pain (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Treatment choices for angina (chest pain) (The Basics)
Patient education: Medicines for angina (chest pain) (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Heart attack recovery (The Basics)
Patient education: Medicines after a heart attack (The Basics)
Patient education: What can go wrong after a heart attack? (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: ECG and stress test (The Basics)

Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)
Patient education: Medicines for angina (chest pain) (The Basics)
Patient education: Heart attack (Beyond the Basics)
Patient education: Heart attack recovery (Beyond the Basics)