EMS Tips

Not all "Chest Pains" have chest pain

Thanks to paramedic and educator, Michael Fraley, for this guest post. If you would like to guest post or review on Everyday EMS Tips check out the guidelines here.

All of our textbooks have the classic Levine Sign picture of the grimacing middle-aged male with a clenched fist over his chest but that is not really how all patients present. We are all well aware now that heart attacks occur as frequently in women as they do men, but did you know that as many as 20% of heart attack patients don’t have angina (chest pain)? Elderly patients, diabetics and women are some of the groups that present with other symptoms referred to as anginal equivalents. These include nausea, weakness, syncope, sweating, shortness of breath or other pains and aches. These symptoms should be taken just as seriously as the class ic chest pain.

Males and females over age 35 with chest pain or anginal equivalents should be treated as cardiac chest pain (CCP) unless another cause is identified. Often times it is best to begin treating the patient as CCP while you search for other causes. In general, care of the CCP patient should include (within your scope of practice):

  • Thorough assessment including ABCs, vital signs, LOPQRST & AMPLE
  • Oxygen
  • Position of comfort
  • Aspirin – 324 mg chewed and swallowed (unless they are allergic)
  • Nitroglycerin sub-lingual
  • EKG monitor/ 12-lead EKG
  • IV Normal Saline

// Michael Fraley is a paramedic and educator in northern Wisconsin. He has been ground and air critical care transport medic and is currently the coordinator for the North Central Regional Trauma Advisory Council and the coordinator of a county EMS system. Connect with him on Twitter, @FraleyM and on Facebook.

By First Arriving

Dave is an EMS provider based in New York City for over 20 years and has been blogging for over 10 years. He is experienced in all facets of EMS Service Management, Emergency Management, and specializes in Event Medical Services. He maintains a blog at, is an Columnist, and will be authoring on all things social (including Social Media) here at The Social Medic.