Treating Chest Pain at Sea

20 January 2009 By Paulo Magalhães Alves, M.D. of MedAire

Due to the varying symptoms of heart attack, when patients complain of chest pain even experienced doctors who can physically see and talk to their patients must rely on thorough tests to accurately diagnose such events. So imagine the problems faced by crewmembers having to assess and treat a possible heart attack at sea.

Without the proper tools and technology, the process could be quite daunting. However, with the right combination of training, equipment and assistance from a telemedicine provider, crews can manage the initial emergency to a successful outcome.

Understanding Chest Pain
Chest pain can arise from the chest structure itself – muscles and bones – as well as from the internal organs, including the esophagus, the lungs and the heart, making it difficult to match the symptoms with an accurate diagnosis.

But, because chest pain is a prominent symptom of heart attack, and heart conditions are often life-threatening, doctors usually try to rule out heart attack first – before contemplating other possible causes of chest pain. Even when not fatal, a heart attack could lead to consequences that may compromise an individual’s quality of life.

How to Communicate with the Patient and Telemedicine Doctor
Whenever possible, crew can assist the telemedicine doctor in confirming his suspicions by asking the patient to characterize the pain, its location, intensity, precipitating and relieving factors and accompanying symptoms.

The telemedicine doctor will use crew responses to assess chest pain patterns. All of these symptoms indicate a heart attack is a real possibility:
-- Chest pressure
-- tightness or heaviness in the center or slightly to the left associated with nausea
-- shortness of breath
-- cold sweats
-- radiation of the discomfort to left shoulder and arm

Many cases, however, will present with atypical symptoms such as abdominal, jaw or back pain.

Treatment Options
Recognizing that time is critical for heart attack victims, doctors typically will manage chest pain cases as heart attack until proven otherwise. Today’s treatment relies on certain drugs and techniques aimed at restoring the compromised blood flow through the obstructed coronary artery. To avoid permanent damage to the heart muscle, treatment should ideally occur within six hours from the onset of symptoms.

The initial treatment for a suspect heart attack will vary on a case-by-case basis, depending on many aspects peculiar to each single case. But something that has a well established value during a cardiac event, a small dose of aspirin -- which won’t do any harm in case of any other condition (provided the patient is not allergic) -- could be extremely valuable in case a heart attack has occured.

One should keep in mind that a guest who complains of chest pain could be a candidate for sudden cardiac arrest. If a heart attack indeed has occurred, the altered electrical properties of the suffering cardiac muscle could lead to fatal ventricular fibrillation. That’s why having an Automated External Defibrillator on board is so important. It won’t treat the heart attack itself, but it’s the right tool in case of this most feared complication of a heart attack.

The introduction of RDT’s Tempus IC remote monitoring device, which records heart rhythms, to the yacht market should make at-sea treatment of chest pain more effective. Data from this remote diagnostic machine is immediately transmitted directly to ground-based doctors, enhancing their diagnostic capabilities as well as helping with case monitoring. For more information, visit

While it's possible for doctors to have a strong suspicion of real heart attack, it's extremely difficult to rule it out, even when there are no typical symptoms. Therefore, in most situations involving serious chest pain, a telemedicine doctor may recommend a diversion or evacuation and will immediately begin seeking out the closest shoreside medical resources to the yacht.

As Vice President Aviation and Maritime Health with MedAire Inc., Paulo M. Alves, M.D. assists with MedLink Global Response Center medical case reviews, staff training, medical industry presentations and client support. He is also a trained cardiologist.