Chest pain, suspected myocardial infarction, and angina

Not every cardiac emergency in a pharmacy is a cardiac arrest. Someone may present with severe chest pain, sweating, breathlessness, nausea, or a crushing sensation. A heart attack can progress to cardiac arrest, so staff should recognise worrying chest pain early, call for help promptly, and be ready to switch into the arrest response if the person deteriorates.

Heart attack and angina are not the same

• Myocardial infarction (heart attack) occurs when blood flow to part of the heart is blocked. It is an emergency.
• Angina is chest pain from reduced blood flow to the heart. It may settle with rest or prescribed GTN, but persistent or worsening pain can signal a heart attack.
• Cardiac arrest means the person is unresponsive and not breathing normally. That requires CPR and immediate AED use.

Features that should make pharmacy staff think seriously

• Chest pain or pressure that feels crushing, squeezing, or tight
• Pain spreading to the arm, jaw, neck, back, or stomach
• Sweating, pallor, nausea, or sudden breathlessness
• Known angina that is worse than usual or not settling as expected
• Any deterioration in responsiveness or breathing

What to do while waiting for the ambulance

• Call 999 early: do not advise the person to go home, wait for a GP appointment, or drive themselves.
• Help them sit comfortably and rest
• Reassure them and monitor breathing and response
• If they have prescribed GTN for angina, help them use it as directed
• If a heart attack is suspected and there is no aspirin allergy or other contraindication, 300 mg aspirin to chew is the standard first-aid step
• If they become unresponsive and stop breathing normally, switch immediately to the cardiac arrest response

A heart attack is not the same as cardiac arrest, but it can progress to collapse. If the person becomes unresponsive and is not breathing normally, move straight to CPR and AED use.