Date Published

April 14, 2025

Updated For

ALS PCS Version ALS PCS Version 5.3

Question:

What is considered suspected cardiac ischemia? Is it just the presence of chest pain/ discomfort (heaviness or tightness). Are chest palpitations considered a chest discomfort as well?

Answer:

To answer your first question: Cardiac ischemia can be suspected with many different symptoms, not just chest pain/discomfort (heaviness or tightness). Note that chest pain is required for the STEMI bypass and some form of discomfort is required in order to administer nitroglycerin (See Ask MAC Mar 28, 2019). However, suspicion of cardiac ischemia and consideration of ASA and an ECG via the Cardiac Ischemia Medical Directive may be applied with other symptoms including nausea, lightheadedness, shortness of breath on exertion, epigastric and indigestion-type pain, sweating, atraumatic upper extremity pain. This is a non-exhaustive list. The patient’s history of presenting symptoms, general clinical condition and medical history all assist with decision making if there is suspicion of potential cardiac ischemia.

To answer your second question: Chest palpitations (feeling of the heart beating) is not considered chest discomfort. However, the patient may have a feeling of their heart beating (palpitations) AND have some chest discomfort. You would need to consider the whole clinical picture to determine if you suspected cardiac ischemia with palpitations, or not. Example: Young person with a history of SVT has palpitations ongoing for 2 hours which feels like prior episodes of SVT, without any chest discomfort: The clinical context here would not suggest cardiac ischemia.