Being resuscitated is something that the patient is usually totally oblivious to, and whilst the ramifications of the event can be long term, often the first indication that you have been through something is when you regain consciousness and notice pain your the chest.
Of course, if you have received major heart surgery it’s certainly due to that, but otherwise, it’s likely to be the result of having received life-saving CPR.
It’s not uncommon to hear of survivors talking of the broken ribs that they sustained, and whilst I’ve no doubt they would rather have that than the alternative, the pain can be an unsettling experience. It may seem obvious that getting a pummeling to the chest for some minutes will lead to pain, but as stated above, when you are receiving it you are unconscious and when you wake you will most likely have no memory of what took place and consequently the pain can lead to anxiety, thinking that maybe another SCA is imminent.
From anecdotal evidence, it seemed that more information and research is needed and so we developed a short survey to investigate survivors’ experience of post-CPR chest pain.
The results of the survey along with some brief thoughts are shown below.
We asked those that had multiple cardiac arrests during the same “event” to accumulate any timings. For those that have had more than one separate SCA, we asked them to only refer to the first time they received CPR.
The survey was run for 15 days from the 10th January 2022 and 256 responses were received.
There were 2 demographic questions on Age & Gender and they showed that of the responses 59% (151) were female, 40.6% (104) male and 0.4% (1) non-binary. This contrasts with the general population of sudden cardiac arrest survivors where the gender split percentages are reversed. One can only posit that the discrepancy is because of the bias inherent in users of social media platforms such as Facebook.
|20 – 29||2||15||17||6.8%|
|30 – 39||7||19||26||10.2%|
|40 – 49||25||52||77||30.1%|
|50 – 59||46||40||86||33.6%|
|60 – 69||23||20||43||16.8%|
Q: Prior to your SCA did you have angina?
We checked to see whether respondents had experienced chest pain (Angina) before their cardiac arrest to help understand any post-arrest symptoms.
Sudden Cardiac Arrest details
Q: What was the diagnosis of your SCA?
Respondents could select one of the given options listed below. Two things of note are the high proportion of idiopathic (unknown cause) cases (typically less than 10% in the general population), and the low proportion of heart attack (myocardial infarction) numbers (typically 70-80% of cases in the general population).
Q: What was your approximate downtime:
Downtime refers to the time from the person collapsed until they had a return of spontaneous circulation (ROSC).
|10 – 19 mins||70||25.1%|
|3 – 9 mins||62||24.3%|
|20 – 29 mins||37||14.5%|
|< 3 mins||19||7.5%|
|30 – 39 mins||17||6.7%|
|40 – 49 mins||17||6.7%|
|=> 50 mins||6||2.4%|
Q: What was your approximate CPR time?
Respondents were asked to approximate the number of minutes they received CPR for.
|10 – 19 mins||70||27.3%|
|3 – 9 mins||52||20.3%|
|20 – 29 mins||39||15.2%|
|< 3 mins||16||6.3%|
|40 – 49 mins||14||5.5%|
|=> 50 mins||10||3.9%|
Q: Who did you receive CPR from?
Respondents were asked to select all options that applied. We defined a layperson as someone who does not have regular professional CPR* training. *Periodic 1st Aid training does not count.
|Automated CPR machine||35||13.7%|
Q: What treatments did you receive?
This question was asked to determine whether any other treatment factors could be causal factors to the patient’s chest pain.
|Implant in chest e.g. ICD, CRT-D||138||53.9%|
|Per-cutaneous intervention e.g. stent||70||27.3%|
|Implant in abdomen e.g. S-ICD||26||10.1%|
|Surgery e.g. bypass, heart-related operation||23||9%|
Q: Do you have angina?
This was asked to determine whether angina could be a factor in the patient’s chest pain.
Q: Were you given any information about post-CPR chest pain or told what to expect?
Anecdotal evidence suggested that many leave the hospital without much information as to what to expect post-discharge, both as a survivor and any chest pain. The responses show that disappointingly less than 1/3 got any information.
Q: Did you have post-CPR chest pain?
It can be seen from the responses to this question that perhaps unsurprisingly, as a result of receiving CPR the patient should expect some chest pain/discomfort afterwards.
Q: Briefly describe your pain
Respondents were asked to use short sentences or phrases to briefly describe how their chest pain felt. The responses have been analysed and grouped into common phrases or themes.
|Pain from broken ribs/sternum||64|
|Sore bruised chest or ribs||53|
|Pain induced by breathing/coughing/sneezing/laughing||51|
|Sharp/stabbing pain to chest/ribs||31|
|Heavyweight on chest||11|
|Beaten up/hit by a truck/run over/kicked||8|
|Heart/chest operation or ICD implantation pain||8|
|Similar to a heart attack||3|
Some representative quotes:
|Pain like nothing else, I could hardly move because of the pain. I dreaded my 14-month-old son seeing me because he wanted a cuddle and it hurt so so much. It was up to 6 months before it was better. Even now 30 years after my first arrest, I can feel that pain in my head…|
|Steady dull pain, but sometimes with movement, it would be a sharp pain|
|The pain I had was due to the 6 cracked ribs as a result of CPR, 7 weeks in I’m still in some discomfort, on discharge I would say on a scale of 0-10 I would say 10, now probably about 3|
|I had chest pains for about 6 months. All I’ve been told is it’s because CPR is brutal. But after an SCA, you just keep thinking it’s your heart or a problem with your stent moving or piercing the artery. So it really affects your anxiety. I think we should be advised more. I know some people get broken ribs. But you don’t think of this because you are unaware of the CPR or being defibrillated|
|Very heavy pain in my chest, couldn’t sit up easily and extreme heavy stinging every time I sneezed or coughed|
|Electric shock-like at times, massive bruise, sudden sharp pain|
Q: How long did your pain last?
As can see from the table below the most common time frame for post-CPR pain to last is between 1 & 3 months with almost a third selecting this. Just over 1/3 said their pain had gone within 4 weeks and 2/3 by the 3-month mark. Almost 14% said that their pain lasted longer than a year and 4.3% had pain that was ongoing or intermittent (variable time frames).
|< 1 week||26||10.2%||16.1%|
|1 – 2 weeks||15||5.9%||22%|
|2 – 4 weeks||34||13.3%||35.3%|
|1 – 3 months||78||30.5%||65.8%|
|3 – 6 months||31||12.1%||77.9%|
|6 – 12 months||6||2.3%||80.2%|
|=> 1 year||35||13.7%|
Q: Were you diagnosed with the following?
This optional question received 220 responses and allowed respondents to select from a range of options that applied to them – including adding their own (other). 36 did not give a response and 14 gave a negative response to receiving a diagnosis.
|Damaged chest cartilage||45||20.5%|
|None or no response||50||19.5%|
Q: Were you given any treatment for the pain?
Q: If you were given treatment, what was it?
We received 136 responses to this question and the overwhelming treatment was painkillers of some sort – which is perhaps unsurprising as there isn’t a great deal else you can do for bruised/cracked/broken chest anatomy. It was interesting to see that some respondents received additional help from physiotherapy and occupational therapy.
For further information on treatments for broken ribs check out this article.
We gave participants a chance to offer up any advice for others going through a similar experience and for any final comments.
Q: Do you have any advice for other experiencing post SCA chest pain?
From the 168 responses, there were many common themes within the advice and they have been summarised by the representative answers below:
|Don’t overdo things when lifting. Muscles and ribs need time to heal|
|Try not to panic and don’t be afraid to contact the doctor or heart team. If you are in pain tell staff what you need and when and why you need it.|
|Get a rolled-up towel or cushion and hold it tight to your chest if you need to cough/laugh/sneeze or move|
|Have patience, rest, take it slowly, don’t push it, the pain will go in time, it does get better|
|Yes listen to your body, take plenty of rest and pain relief when necessary|
|Use an ice pack 10 minutes on, 10 minutes off. Get x-rays done if you think any ribs might be broken or sternum broken or cracked. Not much can be done if any breaks or cracks, but at least you will have a diagnosis|
|Focus on the positive, I was so thankful to be alive!|
|Make a log and tell your doctor, I was not told I had broken ribs until 2 months later when I was having shoulder pain that radiated from my chest over and then is when I was told I have multiple breaks|
|Always contact your doctor / cardiac nurse/ rehab team about any pain that you are worried about – they would rather check you out and it is nothing than miss something. I was reassured that some of my pain was normal after CPR & defibrillation. They helped me distinguish what type of pain I was feeling.|
|To understand that it’s normal. It feels very frightening when unsure if it should be happening|
|Don’t rush!! It can take a long time, but small comfort is that they clearly were working hard to keep us with them ☺️& the pain might never fully go away, not all the time, but it certainly gets a lot less & manageable|
|Regular strength workout for upper body|
|Just keep taking painkillers. They do work!|
|Get upright, breathe properly. I slept semi-upright on pillows for a month. NEVER SNEEZE!|
|Don’t panic. It will take months for your body to get over the physical experience of CPR. It took me about 15 months for my body to repair itself.|
|Talk to your GP. I just put up with it, even though I couldn’t manage to get up from lying down because of pain.|
|I think having people reassure me I’m ok was what I needed most. I understand they can’t do a lot to stop the pain but waking from a coma and having no recollection of anything and having that type of chest pain, a lot of reassurance that I’m not about to die again helps more than you realise.|
|It should pass if bruises or fractures. Better that than the alternative of no CPR|
|Try to distinguish between what could be cardiac or musculoskeletal pain, so you are able to deal with it appropriately without all the worry and stress the pain can cause|
|Pain can be a reminder of what happened but it’s also a reminder that you’re in the present. One day you’ll realize that you’ve forgotten the pain was ever there. Be gentle with yourself xoxo|
|I don’t know how the patient would know. I think all SCA patients should be made aware of ongoing cpr pain, then we know why we have pain, and not left thinking it’s heart pain.|
|It does get better, but make sure you do the exercises no matter how painful.|
|Be patient and get Physical Therapy to help make safe movements|
|If you have a clicking in the chest it is from cartilage damage and it takes quite a while to heal if it ever does but we will see!|
|Sleep elevated at first, learn a good method of getting out of bed. Keep a good walking stick in arms reach.|
|Mine was short-lived due to the CABG a few days later but was told, and I completely accepted that, as sore as it was ‘only the lucky ones get to feel the compression pains’. It put it in context for me.|
|Yes, physio slowly strengthens the area and use a topical rub to gently encourage your muscles to relax around the chest.|
|Some pain is to be expected, but be persistent if you are uncomfortable. Those doctors are working FOR YOU. Make them do it.|
|Was told to take paracetamol (NOT Ibuprofen as causes blood-thinning) if painful.|
|Day by day it will improve|
|Use pain killers, get an inclined back support to place in bed to help sleep at night. Don’t be afraid to seek medical attention if you are worried, you are not wasting anyone’s time|
|Insist on X-rays and scans|
|To keep a log of the gains and timings and to keep questioning the medical professionals. It may well be only pain from post CPR but insist on it being checked. Work closely with the cardiac rehabilitation team.|
|If ribs and sternum are fractured avoid twisting the upper torso and lay flat in bed|
|Anyone who survived SCA and was given CPR will have trauma to the ribs and chest. If CPR compressions were done properly it results in broken ribs. I found that Doctors did not tell me about this, so initially, I was guessing if the pain was angina or broken ribs.|
|Regular painkillers, lots of deep breathing even though it’s painful, tie a dressing gown belt to the end of your bed and you can pull yourself up from lying position when you want to sit up, and finally …………. the pain does go eventually 😊|
|Don’t forget to take a deep breath every few minutes to reduce pneumonia chances.|
|This too shall pass! Be gentle with yourself and patient with your body while it’s healing.|
|rest, take your meds and don’t believe anyone who tells you “oh you shouldn’t still be in pain” because they are probably trying to make you feel better.|
|It’s easy to say “don’t panic”, but when you’ve been through such an ordeal with no memory of it. You wonder “why am I getting pains?” This wasn’t explained|
|Try not to obsess over the pain. Find what works for you to relive the pain.|
|Be patient. Just like everything post-SCA, it gets better with time.|
|Comes with the territory — thankful I was alive to feel the pain… Mostly it is temporary and will fade away.|
|Actually, it is the least of your worries.|
|We had ambulances out on a few occasions upon coming home from Papworth due to chest pains which may well have been due to the CPR. Try not to panic at every twinge, I know that’s not easy considering what we’ve been through but none of the call-outs found any issues and one of the discharge notes said anxiety|
|Try not to let it freak you out.|
|Don’t hide your pain, ask for relief. Join support groups. Get counselling as the mental trauma is worse long term than the physical. Wear scarfs – cold air made the pain worse, exercise so you don’t seize up|
Q: Any other comments?
|I was discharged after 3 days and a telephone follow up from the cardiac unit aside no follow up until a heart scan 3 months later.|
|Chest pain was treated in a very dismissive way by the hospital. It was only when I remembered to mention previous Pericarditis that it was checked for and confirmed, then treated. CPR pain was never mentioned or explained, no advice for managing it was given.|
|It was worth the pain to have survived|
|Weirdly there was no external bruising at all despite the internal damage! The pain was a small price to pay for the excellent CPR I received|
|Pain remains chronic but less when well trained|
|If you are reading this it’s quite possible you are a survivor, be very grateful.|
|I was just very thankful I was alive to feel the pain. It was more like pressure than pain for me|
|About 5 months later I developed an impinged shoulder which the physio has said is due to the damage from the CPR.|
|Make sure to participate in cardiac rehabilitation after your heart event. It can make an incredible difference.|
|Be aware it takes a few weeks for ribs to heal. We are all different.|
|I can not ever forget the pain of post-cardiac arrest chest pain, and my first SCA was with a downtime of over 10 minutes. I then had multiple rounds of CPR in the hospital|
|I got out of bed ASAP, in the hospital. The consultant said that pneumonia was one of their greatest worries|
|Was placed in an induced coma following cardiac arrest. No memory of the event, only what people have told me. My memory is clear up to the SCA, however, poor in the initial weeks after.|
|Need global awareness of associated physical, psychological and emotional issues following SCA. I was not told much and didn’t ask. I thought if I wasn’t told it was important, it was not! My experience in the overloaded public health service in NZ. The only follow up was cardiac rehab and really felt the odd bod there, I didn’t relate to the other patient issues. I asked for psychological help but that also was not particularly helpful, had a sense of the psychologist being out of her depth. Really, eventually tried my own research and finding FB groups was the best support. I think many people, including some professionals, are at a loss to know how to relate to someone who has come back from clinical death.|
|Not all CPR is equal. Apparently, the CPR administered to me was perfect so I had a very good outcome. Little to no hypoxia and fractures and bruising was minor. I would not be alive or at least not without any brain injury without good and timely CPR|
|Was never certain if the chest pain was from CPR or surgery, or both|
|My mom also had CPR and went through immense pain. They dismissed her pain after her X-ray looked fine. After missing dialysis due to pain, they did an MRI and discovered she had fractured ribs that were healing. Be your best advocate. My pain was manageable.|
|I can’t thank the NHS enough for saving my life. I will always be eternally grateful. But I do honestly feel like I was pretty much abandoned after. It took five months before I saw the heart failure clinic, and only then did I get any help or answers. Even now, I had problems before Christmas, and my doctor, who told me I’d only had a mild heart attack, has requested an urgent appointment with a cardiologist, over a month now. And still not heard anything. I know how busy everyone in the NHS is, but the aftermath of an SCA is terrifying, and you just can’t get answers when you want them.|
|X-rays 6 months after SCA showed abnormal healing of ribs and sternum|
|Broken ribs are worth it if it means that I lived.|
|You came back from the dead. You got this.|
|According to my family after coming off sedation…I repeatedly (every 2-3 minutes) went in a loop that sounded like this: “Why does my chest hurt so bad? Did I have a heart attack? Did I get CPR? Who did CPR?”|
|I can no longer sleep on my sides due to the amount of pain I get along my sternum post-SCA. If I try to or accidentally roll in my sleep, I wake up in excruciating pain after about 20-30 minutes.|
|I had my 4 SCAs 9 days after open-heart surgery to replace the aortic valve. Now I’ve got a clot in my left arm. So I’m a little beat up. Hard to know what pain comes from what.|
|Hugely grateful to my husband and medics for CPR and all treatment but it’s a huge onslaught on the body and has a massive impact on the mind. But so very lucky to be here. So sorry to put my husband and family through such an awful time. A life-changing event.|
|The problem with post-CPR is you are too scared to do any exercises in case you have another SCA but muscles need stretching to relieve the spasms they have gone into to protect the area. More OT in-hospital situations to show patients what to do.|
|Need advice/info post-CPR on what to expect once conscious.|
|There should be a lot more information about this as it is probably the second worse trauma to cope with!|
|Rather have Pain and be alive than the alternative!|
|Often hard to tell if the pain is from CPR damage (skeletal/muscular) or if it may be symptoms of heart attack/other heart problems, so can be worrying.|
|In my case, my improving chest pain was disrupted by a second cardiac arrest (CPR and defibrillation) four months after the first. My repaired sternum was not refractured and I had an ICD placed. It took about a year to be pain-free after the first episode|
|Need more info post CPR, I couldn’t find any|
|Be patient, it takes quite a long time to heal|
|Wish I was told more information|
|There needs to be more post-SCA mental health treatment as part of the medical treatment. Being in pain and the life adjustments from pain, a new device and the impact of knowing you nearly died is an incredible weight to bear. It should start to be addressed before you are even discharged from medical care and it is a shame it is not prioritized more. My mental health was terrible for over a year post-SCA and while much better, continues to suffer. There needs to be access to therapists specifically trained in medical trauma and the impact of life-altering medical events and patients need ready, affordable access to these professionals.|
Pain management is about more than just the physical. Being unhappy increases pain perception and recovery time.
|Sometimes I’m not sure if the pain was because of CPR or my heart which makes you feel very vulnerable|
|I had HA and CA a year next week shocked 3 times and had cpr, I still get a lot of pain centre of the chest, no cracked ribs, waiting for a pain clinic referral|
|The medical profession does not pay enough attention to this problem|
|Good CPR will break ribs|
|Good luck. It’s very painful and uncomfortable, but it is also why I am still here. Literally, bet my life on it.|
|Don’t rush back into things. Take your time to heal. Talk to someone (friend, counsel, support group, etc) about your experience. You died and came back. Don’t forget that. And in that action, you are not alone. Tell your story. Live your life.|
|Although CPR was given by a nurse it wasn’t in hospital – she was a passing motorist on the street in which it occurred. Several other people were standing over me but not doing anything. I have continued to have long term chest discomfort as a result of the surgery, not the CPR.|
|I was confused for a while after being in an induced coma following SCA and have some loss of memory so it’s hard to remember exactly|
|Mine wasn’t extreme pain. It faded slowly. The S-ICD hurt way more and took me a long time to recover from|
|28 months out, still get muscular/bone pains in front/sternum of chest.. short bouts – enough to take your breath away…|
|It took a long time for my pain to subside|
|PTSD for quite a while.|
|I was grateful for the pain. The NHS saved my life.|
|I was quite lucky as mine faded away fairly soon. Everyone is different.|
|Being alive was worth the pain!|
|Aftercare has been very poor, GP surgery very unhelpful, could not even get to speak to a doctor for first 2 weeks, only a nurse who would not prescribe adequate pain relief. My wife made a complaint in the end.|
|Always ask questions regarding post-care|
|Still suffering from breathing problems.|
|Had CPR for respiratory arrests as well. CPR over 10 times. I recommend everyone you know including yourself to learn First Aid and how to treat everything post-treatment x|
So there you have it, our little survey on chest pain. We hope you find it useful and if there is interest we may develop some more resources from it.
Thanks go to all those who took part in the survey – getting feedback like this can be extremely helpful to others going through their recovery.
Please leave any comments you have below.
After our first meet-up in February 2015, I realised I was not alone. It was the first time since my cardiac arrest the previous year that I had spoken face-to-face with someone who had experienced what I had. This was also true for my wife, who also happened to be my lifesaver. From that meet-up, the idea of SCA UK was born. Since then, we have achieved a considerable amount, primarily providing information, resources and support to others in a similar situation but also raising the profile of survivorship and the need for better post-discharge care. We are starting to get traction in this, and with the formation of the charity, I genuinely believe we have a bright future ahead and will make a significant difference in the lives of many who join our ranks.