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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Treatment

Heart Attack Treatment

Treatment for a heart attack is aimed at increasing blood flow by opening arteries blocked or narrowed by a blood clot.

• Medicines used to achieve this include aspirin, heparin, and clot-busting (thrombolytic) drugs.
  
  
• Other medications can be used to slow the heart rate, which decreases the workload of the heart and reduces pain.
  
  
• Angioplasty is a way of unblocking an artery. Angiography is done first to locate narrowing or blockages. A very thin plastic tube called a catheter is inserted into the artery. A tiny balloon on the end of the catheter is inflated. This expands the artery, providing a wider passage for blood. The balloon is then deflated and removed. Sometimes a small metal scaffold called a stent is placed in the artery to keep it expanded.
  
  
• Surgery may be required if medical treatment is unsuccessful. This could include angioplasty or cardiac bypass.

Angina Treatment

Treatment of angina is directed at relieving chest pain that occurs as the result of reduced blood flow to the heart.

• The medication nitroglycerin is the most widely used treatment. Nitroglycerin dilates (widens) the coronary arteries. It is often taken under the tongue (sublingually).
  
  
• People with known angina may be treated with nitroglycerin for three doses, five minutes apart.
  
  
• If the pain remains, nitroglycerin is given by IV, and the patient is admitted to the hospital and monitored to rule out a heart attack.
  
  
• Long-term treatment after the first episode of angina focuses on reducing risk factors for atherosclerosis and heart disease.

Aortic Dissection Treatment

Suspected aortic dissection often is treated with medications that reduce blood pressure.

• Medications that slow the heart rate and dilate the arteries are the most widely used.
  
  
• Close monitoring is required to avoid lowering the blood pressure too much, which can be dangerous.
  
  
• Surgical repair is required for any dissection that involves the ascending (upward) portion of the aorta.

Pulmonary Embolism Treatment

Anyone with a presumed or documented pulmonary embolism requires admission to the hospital.

• Treatment usually includes supplemental oxygen and medication to prevent further clotting of blood, typically heparin.
  
  
• If the embolism is very large, clot-busting medications are given in some situations to dissolve the clot.
  
  
• Some people undergo surgery to place an umbrella-like filter in a blood vessel to prevent blood clots from the lower extremities from moving to the lungs.

Pneumothorax Treatment

A pneumothorax without symptoms involves six hours of hospital observation and repeat chest x-rays.

• If the size of the pneumothorax remains unchanged, the patient is usually discharged with a follow-up appointment in 24 hours.
  
  
• If the patient develop symptoms or the pneumothorax enlarges, they will be admitted to the hospital. The patient will undergo catheter aspiration or have a chest tube inserted to restore negative pressure in the lung sac.

Perforated Viscus Treatment

Any disruption or perforation of the intestinal tract (viscus) is a potentially life-threatening emergency. Immediate surgery may be required.

Pericarditis Treatment

Viral pericarditis usually improves with 7-21 days of therapy with nonsteroidal anti-inflammatory agents such as aspirin and ibuprofen (for example, Motrin).

Pneumonia Treatment

Pneumonia is treated with antibiotics, and pain medication is given for chest wall tenderness.

Costochondritis Treatment

Costochondritis is usually treated with nonsteroidal anti-inflammatory medication such as ibuprofen.

Esophageal Conditions Treatment

The three major esophageal disorders that cause chest pain; 1) acid reflux (GERD), 2) esophagitis, and 3) esophageal spasm, are treated with antacid therapy; antibiotic, antiviral, or antifungal medication; medication to relax the muscles of the esophagus; or some combination of these.