Recognising Chest Pain for Student Nurses
Learn how to assess new chest pain, identify associated warning signs and recognise when chest symptoms may form part of serious cardiovascular, respiratory or wider patient deterioration.
Start with the patient, not the diagnosis
Chest discomfort can have many causes. Some are relatively minor while others can be life-threatening. Your first task is to recognise the symptom, assess the patient's condition and identify associated signs of deterioration.
What does it feel like?
Patients may describe pressure, tightness, heaviness, burning, aching, sharp pain or simply unusual chest discomfort.
What is changing?
Review breathing, circulation, oxygenation, consciousness and the patient's overall physiological state.
Is the patient unstable?
Chest pain accompanied by significant deterioration requires prompt registered or emergency support.
Use a structured chest-pain assessment
A structured pain history helps you describe the symptom clearly when escalating concerns. SOCRATES is one commonly used framework.
Site
Ask where the discomfort is located and whether the patient can point to the area.
Onset
Establish when it started, whether onset was sudden or gradual and what the patient was doing at the time.
Character
Ask the patient to describe the feeling in their own words rather than suggesting an answer.
Radiation
Ask whether the discomfort travels anywhere else, such as the arm, shoulder, back, neck or jaw.
Associated symptoms
Consider breathlessness, nausea, sweating, dizziness, palpitations or collapse.
Timing
Establish whether the pain is constant or intermittent and whether it has changed since it began.
Exacerbating or relieving factors
Ask whether movement, breathing, position or activity changes the discomfort.
Severity
Ask the patient to describe or score the severity using the assessment method used in your clinical area.
Do not let the pain history delay escalation
If the patient appears severely unwell, prioritise ABCDE assessment and urgent escalation. A complete symptom history can continue while appropriate help is being obtained.
Assess the physiological picture
Respiratory assessment
Check respiratory rate, work of breathing, oxygen saturation, oxygen therapy and new breathlessness.
Pulse and blood pressure
Review pulse rate and rhythm, blood pressure, peripheral perfusion and any significant change from baseline.
Consciousness
Look for new confusion, dizziness, collapse, drowsiness or reduced responsiveness.
The pain and the observations belong together
Chest pain with stable observations is different from chest pain accompanied by hypotension, tachycardia, hypoxia or reduced consciousness. Communicate both the symptom and the physiological changes.
Associated findings that increase concern
| Finding | What you may notice | Why it matters |
|---|---|---|
| Breathlessness | Increasing respiratory rate or difficulty breathing. | Chest symptoms with respiratory deterioration require prompt assessment. |
| Falling SpOβ | Oxygen saturation drops or oxygen needs increase. | This may indicate worsening respiratory or cardiovascular function. |
| Hypotension | Blood pressure is falling or markedly lower than baseline. | Chest pain with circulatory compromise is particularly concerning. |
| Abnormal pulse | Tachycardia, bradycardia or a new irregular pulse. | Heart-rate and rhythm changes may accompany cardiovascular deterioration. |
| Sweating or pallor | The patient becomes pale, clammy or unusually sweaty. | These signs may accompany significant physiological stress. |
| Altered consciousness | Confusion, collapse, drowsiness or reduced responsiveness. | Neurological change alongside chest symptoms requires urgent attention. |
Chest pain can have different causes
Student nurses should understand that chest pain can arise from several body systems, but bedside assessment should focus first on recognising serious illness rather than making a definitive diagnosis.
Heart and circulation
Cardiac and vascular causes can be serious and may be accompanied by sweating, breathlessness or haemodynamic changes.
Lungs and pleura
Respiratory causes may be associated with breathlessness, altered oxygenation or pain affected by breathing.
Several possibilities
Musculoskeletal, gastrointestinal and other problems can also produce chest symptoms.
You do not need the diagnosis before you escalate
A useful escalation is: βThis patient has new chest pressure, breathlessness, a pulse of 118 and a falling blood pressure.β That is clinically useful even before the underlying cause is known.
When chest pain requires urgent concern
- Chest discomfort is severe, persistent or rapidly worsening.
- The patient describes pressure, tightness or heaviness with associated illness.
- The discomfort radiates to another area.
- The patient becomes sweaty, pale or clammy.
- There is new or significant breathlessness.
- Oxygen saturation is falling.
- Blood pressure is falling.
- The pulse becomes markedly abnormal.
- The patient collapses or becomes confused or less responsive.
- The overall clinical picture is rapidly deteriorating.
Putting the findings together
Example
A patient tells you they have suddenly developed a heavy pressure in the centre of their chest.
They appear pale and clammy and say they feel nauseated.
Their pulse has increased, blood pressure is lower than earlier and they are becoming increasingly breathless.
The concern is not simply βchest pain.β It is the combined pattern of acute chest discomfort, autonomic symptoms, breathlessness and circulatory change.
As a student nurse, recognise the potential seriousness, assess using ABCDE within your competence and obtain urgent registered or emergency support according to local procedures.
Chest-pain assessment errors to avoid
- Trying to diagnose the cause before escalating. Report the clinical picture first.
- Assuming mild pain cannot be serious. Symptom intensity alone does not establish the cause.
- Looking only at the pain score. Assess observations and the whole patient.
- Ignoring breathlessness. Respiratory symptoms can significantly increase concern.
- Ignoring changes in pulse or blood pressure. Circulatory deterioration matters.
- Completing a long history while the patient deteriorates. ABCDE and escalation take priority in an unstable patient.
Recognise β assess β communicate β escalate
Take new chest pain seriously
Identify new discomfort and any associated symptoms or change from baseline.
Use ABCDE + pain history
Assess breathing, circulation, consciousness and the characteristics of the symptom.
Give the whole picture
Report onset, symptoms, observations, trends and associated deterioration clearly.
Recognising Sudden Breathlessness for Student Nurses
Learn how to assess sudden-onset breathlessness, identify associated warning signs and recognise when an abrupt respiratory change may indicate serious deterioration.
Continue to Sudden Breathlessness β