Fast Answers for Chest Pain & Heart Rhythm Concerns

Understanding Cardiac Symptoms in the Indian Context

Chest pain, palpitations, and uncontrolled blood pressure are the most common cardiac emergency presentations—yet they span the spectrum from life-threatening heart attacks to harmless anxiety. At Ajuda Hospitals, our dedicated cardiac symptom clinic combines 24/7 emergency triage with advanced diagnostics (ABPM, Holter, troponin) and senior cardiologist oversight to deliver fast, accurate diagnoses.

Indians face early cardiovascular disease—heart attacks strike a decade earlier than Western populations, and 60% of hypertensives remain undiagnosed until complications occur. Atrial fibrillation (causing palpitations and stroke risk) affects 5-7% of adults over 60. Our protocols follow ACC/AHA chest pain guidelines, Indian Hypertension Guidelines 2024, and ESC arrhythmia standards for triage, investigation, and treatment.

Whether you arrive with crushing chest pain at 2 AM, intermittent palpitations worrying you for weeks, or newly discovered high blood pressure, Ajuda's integrated approach provides clarity within hours—not days.

When to Consult Our Cardiac Symptom Specialists

Schedule routine evaluation for intermittent palpitations, borderline high BP, or mild chest discomfort you want clarified.

Our Diagnostic Approach

Rapid Triage & Risk Stratification

Within 10 minutes of arrival, triage nurse assesses:

• Symptom severity: Crushing chest pain vs mild discomfort; continuous palpitations vs occasional skips
• Vital signs: BP, heart rate, oxygen saturation
• Cardiac risk factors: Age, diabetes, smoking, family history, prior heart disease

High-risk patients (chest pain with ECG changes, syncope with palpitations, BP >200/120) fast-tracked to resuscitation bay for immediate intervention.

12-Lead ECG & Cardiac Biomarkers

ECG performed within 10 minutes of chest pain presentation—detects ST-elevation (heart attack), ischemic changes, or dangerous arrhythmias.

Troponin blood test drawn immediately for chest pain—results in 15 minutes using high-sensitivity assay. Elevated troponin indicates myocardial injury (heart attack, myocarditis). Serial troponins at 0-3-6 hours capture evolving damage.

Pro-BNP if breathlessness present—distinguishes heart failure from lung disease.

Ambulatory Blood Pressure Monitoring (ABPM)

For suspected or uncontrolled hypertension, 24-hour ABPM is gold standard:

• Wearable cuff inflates every 15-30 minutes
• Records BP during daily activities, sleep
• Cloud dashboard alerts for dangerous spikes >180/110

Detects:

• Masked Hypertension: Normal in clinic, elevated at home (20% of cases)
• White-Coat Effect: High in clinic due to anxiety, normal otherwise
• Nocturnal Dipping: Healthy 10-20% BP drop during sleep; non-dippers at 2x stroke risk
• Morning Surge: Rapid BP rise upon waking—triggers heart attacks in vulnerable patients

Rhythm Analysis for Palpitations

ECG captures rhythm only during the test—if palpitations intermittent, extended monitoring needed:

• Holter Monitor (24-48 hours): Wearable device records every heartbeat—detects arrhythmia burden, pauses, PVCs
• Event Recorder (7-30 days): Patient-activated when symptoms occur—captures rare episodes
• Smartphone ECG: Instant single-lead tracing when palpitations start—shares with cardiologist via app

Lab tests for palpitations: Thyroid function (hyperthyroidism), electrolytes (low potassium/magnesium), anemia.

Treatment Pathways

Emergency Chest Pain Pathway (Code STEMI)

For suspected heart attack:

1. ECG within 10 minutes → STEMI identified
2. Dual antiplatelets (aspirin + ticagrelor) loaded immediately
3. Cardiologist alerted → cath lab activated
4. Door-to-balloon time <60 minutes for primary angioplasty

For non-STEMI or unstable angina:

• Serial troponins, ECGs every 4 hours
• Heparin, nitrates, beta-blockers
• Cardiology consult within 2 hours
• Admission to CCU; angiography within 24-72 hours based on risk score

For low-risk chest pain:

• 6-hour observation with serial troponins, ECGs
• Stress test or CT coronary angiography before discharge
• Cardiology follow-up in 1 week

Palpitation Diagnostic Workup

First Visit:

• Detailed history: Duration, frequency, triggers (caffeine, exercise, stress)
• 12-lead ECG: Check for baseline arrhythmia, pre-excitation (WPW), long QT
• Labs: Thyroid, electrolytes, hemoglobin
• Echo if murmur present or abnormal ECG

If ECG normal but symptoms recurrent:

• Holter monitor (24-48 hours) captures arrhythmia burden
• Event recorder (2-4 weeks) for rare symptoms
• EP study if syncope or family history of sudden death

Treatment based on findings:

• Benign PVCs/PACs: Reassurance, reduce caffeine, beta-blockers if bothersome
• Atrial Fibrillation: Anticoagulation (stroke prevention), rate control, consider ablation
• SVT (supraventricular tachycardia): Vagal maneuvers, medications, or catheter ablation (curative)
• Ventricular Arrhythmias: ICD implantation, antiarrhythmics, EP ablation

24-Hour ABPM for Hypertension

Indications:

• Newly elevated clinic BP—confirm true hypertension before starting lifelong meds
• Resistant hypertension—uncontrolled on 3+ drugs
• Suspected white-coat effect—anxious patients
• Medication timing optimization—switch doses to evening if morning surge present

Process:

• Cuff fitted to non-dominant arm
• Programmed to inflate every 15 min (day), 30 min (night)
• Patient continues normal activities, sleeps at home
• Return device next day; report within 2 hours

Report details:

• Average daytime, nighttime, 24-hour BP
• BP load (% of readings >140/90)
• Dipping status (normal dipper, non-dipper, reverse dipper)
• Morning surge magnitude

Action: Confirm hypertension diagnosis, adjust medication doses/timing, reassure white-coat patients.

Hypertensive Emergency Management

For BP >180/120 with symptoms (chest pain, breathlessness, confusion, vision loss):

• ICU admission immediately
• IV antihypertensives: Nitroprusside, labetalol, nicardipine
• Target: Lower BP by 25% in first hour (not too fast—risk stroke)
• Monitor: ECG, troponin, renal function, fundoscopy
• Transition: Switch to oral meds once stable; 48-72 hour hospitalization

Non-Cardiac Chest Pain Pathway

Once cardiac causes excluded (normal ECG, troponin, echo):

• GERD (reflux): Trial of PPI (omeprazole) for 2-4 weeks
• Musculoskeletal: Reproducible tenderness on chest palpation—NSAIDs, physiotherapy
• Anxiety/Panic: Breathing exercises, stress management, psychiatry referral if severe
• Costochondritis: Anti-inflammatory gel, stretching exercises

70% of ER chest pain is non-cardiac—thorough cardiac workup provides reassurance and avoids repeated ER visits.

Chronic BP & Rhythm Management

Hypertension: Lifestyle counseling (DASH diet, exercise), medication titration every 2-4 weeks until target <130/80. Home BP monitoring, quarterly clinic visits, annual echo/kidney function.

Arrhythmias: Rate/rhythm control medications, anticoagulation for AF, device therapy (pacemaker/ICD) if indicated. EP ablation for symptomatic SVT or AF unresponsive to drugs. Quarterly device checks, annual Holter.

What to Expect: Your Care Journey

Emergency Presentation (Chest Pain / Severe Palpitations)

• Arrive ER → triage within 5 minutes
• ECG within 10 minutes
• IV access, blood drawn (troponin, CBC, electrolytes)
• Cardiologist reviews ECG remotely or in-person
• Decision: Cath lab activation / CCU admission / Observation unit / Discharge with follow-up

Scheduled Palpitation Evaluation

• Arrive at Cardiology OPD
• Detailed history, physical exam (check for murmurs, thyroid enlargement)
• 12-lead ECG, labs ordered
• Holter monitor fitted (wear 24-48 hours, return for removal)
• Follow-up visit 3-7 days later—review Holter report, start treatment if needed

ABPM Appointment

• Arrive at BP Clinic
• Cuff fitted to arm, device in pouch worn over shoulder
• Instructions: Continue normal routine, note sleep/wake times, avoid water immersion
• Return next day same time
• Cuff removed; report generated within 2 hours
• Cardiologist reviews, calls patient with results and medication adjustments

Chest Pain Observation Unit

• Low-risk chest pain patients monitored for 6 hours
• Serial ECGs, troponins at 0-3-6 hours
• If all normal → stress test or CT coronary before discharge
• If abnormal → admit to CCU for angiography

Technology & Innovation

Cloud-Connected Digital Ecosystem

ECG machines auto-upload to PACS → cardiologist receives mobile alert for STEMI or dangerous arrhythmias. ABPM devices sync via Bluetooth → real-time alerts for BP >180/110 → early intervention. Holter recorders upload overnight → AI pre-screens for AF, pauses, VT → cardiologist reviews flagged episodes.

Patient Benefits:

• Faster emergency decisions—no waiting for paper reports
• Remote monitoring for outpatient devices—safety net for home-based tests
• Lifetime digital archive—compare today's rhythm with years-old Holter

Preventing Complications

Undiagnosed cardiac symptoms can lead to:

• Sudden Cardiac Death: Missed dangerous arrhythmias (ventricular tachycardia, long QT)
• Stroke: Undetected atrial fibrillation—5x stroke risk without anticoagulation
• Heart Failure: Chronic uncontrolled hypertension damages heart muscle over 10-15 years
• Unnecessary Anxiety: Non-cardiac chest pain without proper workup → repeated ER visits, poor quality of life

Our Prevention Strategy:

• Zero miss rate for STEMI—every chest pain gets ECG within 10 minutes
• Extended monitoring for palpitations—Holter/event recorders catch intermittent arrhythmias
• ABPM-guided hypertension diagnosis—avoid overtreatment (white-coat) or undertreatment (masked)
• Clear reassurance pathway for non-cardiac chest pain—break ER visit cycle

Why Ajuda for Cardiac Symptom Evaluation?

Take the First Step

Chest pain and palpitations demand expert evaluation—delays can be life-threatening, yet most cases are benign. If you're experiencing cardiac symptoms, don't wait. Walk into our 24/7 ER or book a same-day cardiology consult.

Urgent Evaluation: Call 9010550550 or WhatsApp for immediate triage guidance. Walk-ins welcome 24/7 for chest pain and severe palpitations.

Early, accurate diagnosis prevents heart attacks, strokes, and unnecessary anxiety. Let Ajuda Hospitals be your partner in cardiac symptom management.