Chest Pain/Angina Pectoris
Reversible ischemic event, resulting in decreased oxygenated blood supply to the myocardium.
Signs and symptoms#
- substernal pain
- radiating pain to the shoulders, arms, or mandible
- spontaneously subsides with rest
- symptoms subside with antianginal medications
- atypical symptoms in women and diabetics
Action#
- be calm and reassuring
- discontinue dental treatment
- place the patient in a slightly upright position
- evaluate breathing, airway and circulation
- monitor pulse, blood pressure, and respiration rate every 5 min
- administer oxygen, 6-8 L/min by nasal cannula or mask
- administer 0.3 mg nitroglycerin sublingually; repeat up to 3 times every 5 minutes
- give an aspirin (325 mg), chew and swallow
- if no relief after 3 administrations of nitroglycerin, assume the patient is having a myocardial infarction. (See Emergency – Myocardial Infarction.)
- if not a myocardial infarction, arrange for home escort
- notify the patient’s primary care provider
- call later to check on patient
Differential diagnosis#
- myocardial infarction
- dyspepsia, GERD, esophageal spasm
- musculoskeletal
- pulmonary embolus
- spontaneous pneumothorax
- aortic dissection
- esophageal rupture
- panic disorder## Comorbidities
- hypertension
- diabetes mellitus
Related Pages#
- Medical Disorders
- Medical Emergencies
References/Websites#
References/Emergencies
- Greenwood M, et al. General medicine and surgery for dental practitioners: part 2. Medical emergencies in dental practice: the drug box, equipment and basic principles of management. BDJ. 2014;216(11):633-637.
- Greenwood M. General medicine and surgery for dental practitioners: part 3. Management of specific medical emergencies in dental practice. BDJ. 2014;217(1):21-26.
- Haas DA. Preparing dental office staff members for emergencies. Developing a basic action plan JADA. 2010;141(5 suppl):8S-13S.
- Rosenberg M. Preparing for medical emergencies. The essential drugs and equipment for the dental office. JADA. 2010;141(5 suppl):14S-19S.
- Jevon P. Medical emergencies in the dental practice poster: revised and updated. BDJ. 2020;229(2):97-104.
References/Angina
- Balla C, et al. Treatment of Angina: Where Are We? Cardiology. 2018;140(1):52-67.
- Blumenthal DM. Prevalence of angina among primary care patients with coronary artery disease. JAMA Netw Open. 2021;4(6):e2112800.
- Ford TJ, et al. Angina: contemporary diagnosis and management. Heart 2020;106:387–398.
- Kloner RA, et al. Angina and its management. J Cardiovasc Pharmacol Ther. 2017 May;22(3):199-209.
- Levy BI, et al. The many faces of myocardial ischaemia and angina. Cardiovasc Res. 2019 Aug 1;115(10):1460-1470.
Websites