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Care During Chemotherapy and Beyond

Chest Pain



What is a chest pain?

Chest pain is a painful or unpleasant sensation in your chest, which may or may not be associated with heart tissue damage. Chest pain can happen in adults for a variety of reasons. Some causes of chest pain may include:

  • Lung - you may have pneumonia, or another type of infection in your lung that may cause chest pain. Coughing may also cause pain.
  • Musculoskeletal -Common causes of chest pain include pain as a result of injury, joint or muscle strain. If you have had any damage to your ribs, from injuries or tumors, this can cause you to feel pain in your chest.
  • Gastrointestinal - You may have a type of gastro-esophageal reflux. This where the contents of your stomach travel up you esophagus pipe instead of downwards. This may cause pain after eating a large meal, lying down, or ending over. Antacids, such as famotidine (Pepcid®), omeprazole (Prilosec®), or Mylanta®, may relieve these symptoms.
  • Angina may cause your chest pain, which may be a feeling of "squeezing" in your chest. Anxiety or depression may often cause you to feel angina. Some other causes of angina may include:
  • Coronary artery disease (the most common cause of angina) - Fatty deposits (called atherosclerosis), may develop over time. This damages the walls of the arteries that carry blood to the heart, restricting the flow of blood to the heart. It causes less oxygen to reach the heart muscle. This lack of oxygen causes angina.
  • Coronary artery spasm - the coronary artery will "spasm" which creates a temporary narrowing of blood flow, and a temporary lack of oxygen to the heart muscle. When the spasm stops, the pain usually resolves when blood flow is returned to normal.
  • Anemia - low blood hemoglobin (Hgb) levels may cause angina. Hgb carries oxygen in the blood.
  • Polycythemia - This is when your blood has too many red blood cells (RBC's). This will cause your blood to thicken. Polycythemia can be a result of a lifelong illness, such as Chronic Obstructive Pulmonary Disease (COPD), or due to problems with the blood itself.
    o Irregular heart rhythms, heart valve problems, and thyroid disease will also cause angina.

Chest pain should not be ignored for any reason. Below are some serious symptoms to look for. If you experience any of these symptoms, you should seek emergency care, and then notify your doctor.

What are some symptoms to look for?

  • Chest pain may start in the chest, and spread to the throat, jaw, shoulder blades, or arms (left or right).
  • Chest pain may be sharp or burning in character
  • You may experience a feeling of chest heaviness, or tightness.
  • You may have nausea, sweating, or dizziness associated with your chest pain. It may also cause you to feel short of breath.
  • Chest pain may spread to the stomach, and feel like indigestion.
  • You may feel palpitations instead of pain.
  • Some people may feel terribly excruciating chest pain, and others may experience a mild discomfort. The severity of pain does not indicate how severe the damage to the heart muscle may be.

Things you can do:
The goal of chest pain is to relieve the cause. 

  •  If your chest pain is due to musculoskeletal problems, such as muscle strain, there is most likely an area you can locate that is causing most of the pain. Anti-inflammatory drugs (such as ibuprofen), along with a local application of heat, for no more than 20 minutes at a time, 3 or 4 times a day, may help.
  • If you have chest pain due to lung problems, such as pneumonia or pleurisy, your doctor may prescribe antibiotics to treat the condition. You may also have to be hospitalized, depending on how severe your problems are.
  • If you have chest pain due to anemia, your healthcare provider may order a blood transfusion, depending on your symptoms.
  • If your chest pain is due to coronary artery spasms, you may be prescribed drugs to control your discomfort. These include nitrates, such as nitroglycerin, which work by increasing blood flow to the heart. Nitrates also decrease the work of the heart by dilating (expanding) the arteries.  
  • If you smoke, be sure to quit. Smoking can increase the chance of developing chest pain and heart disease.
  • Make sure to exercise, under the supervision of your healthcare provider. Walking, swimming, or light aerobic activity may help you to lose weight, and promote the flow of oxygen in your lungs and blood.
  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). 
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease. You can try to control your heart disease, high blood pressure, and diabetes to decrease your chances of developing chest pain. Discuss this with your doctor.
  • Keep a diary of your chest pain, if it is occurring regularly. Write down the foods that you have eaten, the exercise or activity you were undergoing when the chest pain, and how you felt before the symptoms occurred. This diary may be valuable in determining the cause of your chest pain.
  • Questions to ask yourself, may include:
    • Did my symptoms occur gradually, or did this episode come on all of a sudden? Was I feeling anxious? Did I perform any kind of activity, or was I resting?
  • If you have a family history of heart disease, stroke, high blood cholesterol, or high blood pressure, in a first or second-degree relative, you may be at risk for certain problems. Notify your healthcare provider if you have any of these diseases in your family.
  • If you are ordered a medication to treat this disorder, do not stop taking any medication unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone.
  • If you miss a dose of your medication, discuss with your healthcare provider what you should do.
  • Use relaxation techniques to decrease the amount of anxiety you have. If you feel anxious, place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past.
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
  • Keep all your appointments for your treatments.

Drugs that may be prescribed by your doctor:

Your doctor or healthcare provider may prescribe certain drugs to help your heart muscle work more effectively, or to control your symptoms. These may include:

  • ACE inhibitors - These drugs work by opening, or dilating, your arteries. They will lower your blood pressure, and improve blood flow to your kidneys, and through out your body. Your healthcare provider may also prescribe these medications if you have diabetes or protein in your urine, to protect your kidneys. Some examples of this medication may include: enalapril maleate (Vasotec®), lisinopril (Zestril®), and fosinopril sodium (Monopril®)
  • Antacids - If you have stomach upset, which may cause your chest pain, your healthcare provider may prescribe an antacid, such as Mylanta®.
  • Antianxiety medications: If your chest pain is due to anxiety, your healthcare provider may prescribe an Anti-anxiety medication, called an anxiolytic. These medications will help you to relax. These may include lorazepam (Ativan®), or alprazolam (Xanax®).  It is important to take these medications only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile while taking these. If these medications do not control your symptoms, discuss this with your doctor.
  • Aspirin - Depending on your overall health status, and the type and severity of your arrhythmia, your healthcare provider may prescribe aspirin as a "blood thinner." Aspirin works by preventing platelets in your blood from forming blood clots (anti-platelet).
  • Beta-blockers - can be used to slow down your heart rate, and improve blood flow through your body. You may take this drug if you have been diagnosed with irregular heartbeats, or high blood pressure. Some examples of this medication may include: metoprolol (Lopressor®), propanolol (Inderal®), and atenolol (Tenormin®).
  • Calcium Channel Blockers - These medications may be given to treat chest pain, high blood pressure, or irregular heart beats. A few common drugs include verapamil HCL (Calan®), and diltiazem (Dilacor XR®).
  • Nitrates - such as nitroglycerin, work to increase blood flow to the heart. They also decrease the work of the heart by dilating (expanding) the arteries.  You may take this during an episode of chest pain, if your doctor has determined that it is safe. 
  • Non-steroidal anti-inflammatory (NSAID) agents -  Such as naproxen sodium and ibuprofen, may provide relief of musculoskeletal pain. If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol®) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help. It is important not to exceed the recommended daily dose of Tylenol®, as it may cause liver damage. Discuss this with your healthcare provider.
  • Do not stop any of these medications abruptly, as serious side effects may occur

When to call your doctor or health care provider:

  • Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection).
  • If you are sweating a lot with chest pain, or if you are taking medication to treat your chest pain, seek emergency assistance if the pain is not relieved by nitroglycerin despite taking 3 pills each, 5 minutes apart. Also notify your doctor if you:
  • Feel your heart beat rapidly (palpitations), and have not noticed this before
  • Any new rashes on your skin, especially if you have recently changed medications
  • Any unusual swelling in your feet and legs
  • Weight gain of greater than 3 to 5 pounds in 1 week.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.