Chest pain is a common and distressing symptom experienced by patients with heart failure. It often occurs due to reduced myocardial oxygen supply, impaired cardiac function, or increased workload on the heart. For nursing students and practicing nurses, understanding non-pharmacological nursing interventions is essential to help reduce pain, improve patient comfort, and support cardiovascular stability.
This comprehensive article explains the pathophysiology of chest pain in heart failure, assessment methods, evidence-based non-pharmacological interventions, nursing care plans, and clinical considerations relevant to nursing practice in the United States.
Understanding Heart Failure
Heart failure is a chronic and progressive condition in which the heart is unable to pump adequate blood to meet the metabolic needs of body tissues (Black & Hawks, 2014). The condition can involve systolic dysfunction, diastolic dysfunction, rhythm abnormalities, or impaired preload and afterload balance (Santoso et al., 2007).
Common Causes of Heart Failure
- Dilated cardiomyopathy
- Ischemic heart disease
- Hypertension
- Valvular disorders
- Arrhythmias
- Post-myocardial infarction damage
In many cases, the average duration of heart failure from diagnosis until advanced-stage symptoms is approximately 37 months (Hwang & Kim, 2016). Early identification improves outcomes, reduces hospitalization, and enhances quality of life.
Clinical Manifestations of Heart Failure
The symptoms of heart failure vary depending on severity, underlying pathology, and compensatory mechanisms. According to Nieminen (2005) and Davis et al. (2000), common clinical manifestations include:
- Dyspnea on exertion
- Pulmonary edema
- Increased jugular venous pressure (JVP)
- Hepatomegaly
- Peripheral edema
- Fatigue and weakness
- Chest pain
Diagnostic Tests
Common diagnostic examinations include:
- Chest X-ray
- 12-lead ECG
- Echocardiography
- Blood tests (BNP, troponin, electrolytes)
- Angiography
- Pulmonary function tests
Chest Pain in Heart Failure
Chest pain in heart failure typically arises from myocardial ischemia caused by poor oxygen supply to the heart muscle. According to Aspiani (2014), the pain often:
- Occurs suddenly
- Persists continuously
- May radiate to the neck, jaw, shoulder, or left arm
- Is accompanied by dyspnea and paleness
Chest pain is an urgent condition because prolonged ischemia can lead to cardiac cell death, worsening heart failure, or myocardial infarction.
Pain Assessment in Heart Failure Patients
Assessment is the first essential step in planning nursing intervention. Nurses should use the PQRST method to determine the characteristics of chest pain:
PQRST Pain Assessment
- P – Provocation: What triggers the pain?
- Q – Quality: Sharp, crushing, burning, or pressure-like?
- R – Region/Radiation: Location and spread of pain
- S – Severity: Pain scale 0–10
- T – Timing: Onset, duration, pattern
Comprehensive pain assessment helps nurses identify deterioration, evaluate intervention outcomes, and implement timely actions.
Non-Pharmacological Nursing Interventions for Chest Pain
Non-pharmacological interventions are effective, economical, and safe methods to reduce chest pain in heart failure patients. These interventions help stabilize breathing, reduce cardiac workload, and promote relaxation.
1. Positioning (Semi-Fowler or High-Fowler Position)
Positioning the patient in Semi-Fowler or High-Fowler position reduces venous return, decreases cardiac workload, and improves lung expansion.
- Decreases preload and eases myocardial oxygen demand
- Promotes relaxation and comfort
- Improves air exchange
2. Deep Breathing Relaxation Techniques
Deep breathing enhances oxygenation, reduces anxiety, and decreases sympathetic nervous system stimulation. According to Agung et al. (2013), deep breathing relaxation effectively lowers chest pain intensity in cardiac patients.
- Encourages slow and controlled breathing
- Improves tissue oxygenation
- Reduces stress response
3. Guided Imagery
This method encourages patients to visualize calming and peaceful scenes to reduce muscle tension and anxiety.
- Helps reframe perception of pain
- Promotes relaxation
- Reduces emotional stress
4. Progressive Muscle Relaxation (PMR)
PMR improves circulation, promotes muscle relaxation, and reduces pain perception.
- Alternating tension and relaxation of muscle groups
- Decreases anxiety-induced chest discomfort
- Improves cardiac efficiency
5. Warm Compress
Warm compress stimulates vasodilation, increases blood flow, and reduces muscle stiffness. Wurangian et al. (2015) found that warm compress therapy significantly helps relieve chest pain.
- Applied for 10 minutes (Millard et al., 2013)
- Improves circulation to the affected area
- Relieves muscle tension around the chest
6. Environmental Management
A calm, quiet environment helps reduce external stressors that may worsen chest pain.
- Reduce noise, dim lights
- Maintain room temperature
- Promote restful sleep
7. Distraction Techniques
Distraction reduces the focus on pain by redirecting the patient’s attention.
- Music therapy
- Conversation or therapeutic communication
- Watching calming videos
Nursing Care Plan (NANDA, NOC, NIC)
Nursing Diagnosis
- Acute Pain related to reduced myocardial oxygen supply
NOC (Nursing Outcomes Classification)
- Pain Level
- Comfort Status
- Cardiac Pump Effectiveness
- Vital Signs Stability
NIC (Nursing Interventions Classification)
- Pain Management
- Relaxation Therapy
- Vital Signs Monitoring
- Positioning
- Environment Management
- Heat Therapy (Warm Compress)
Intervention Table (with Rationales)
| Intervention | Rationale |
|---|---|
| Assess pain characteristics using PQRST | Helps identify severity, progression, and potential cardiac complications |
| Monitor vital signs | Tachycardia, hypertension, or arrhythmias may indicate ischemia |
| Position in Semi-Fowler | Improves ventilation and reduces cardiac workload |
| Provide deep breathing exercises | Increases oxygen supply and reduces sympathetic stimulation |
| Apply warm compress | Promotes vasodilation and reduces muscle tension |
| Teach guided imagery | Helps decrease anxiety and perceived pain intensity |
| Maintain a restful environment | Reduces stress and promotes comfort |
| Encourage gradual activity | Prevents fatigue that increases myocardial oxygen demand |
Clinical Example
A 65-year-old male with congestive heart failure reports sudden chest pain rated 8/10. Vital signs show tachycardia and mild hypertension. The nurse places the patient in High-Fowler position, initiates deep breathing relaxation, applies a warm compress, and reduces environmental noise. After 15 minutes, the patient reports pain reduced to 3/10.
Conclusion
Non-pharmacological nursing interventions play a major role in reducing chest pain in patients with heart failure. Techniques such as positioning, deep breathing, warm compresses, guided imagery, and environment management significantly improve comfort and help stabilize cardiovascular function. These interventions complement medical therapy, enhance patient outcomes, and promote holistic care.
References
- Aspiani, 2014
- Black & Hawks, 2014
- Davis et al., 2000
- Hwang & Kim, 2016
- Millard et al., 2013
- Muttaqin, 2011
- Nieminen, 2005
- Ranitya, 2009
- Rilantono, 2013
- Santoso et al., 2007
- Watson et al., 2000
- Wilkinson & Ahern, 2011
- Wurangian et al., 2015
