Blog — Clinical Spanish

Chest pain in Spanish: the assessment questions every nurse needs before paging the cardiologist

A Spanish-speaking patient says “me siento mal del pecho.” That sentence could mean chest pressure, chest fullness, burning, or crushing — and each descriptor points to a different clinical path. The clinical error is asking “does it hurt?” when the patient has pressure. Here is how to get the right answer.

Why “does it hurt?” misses half of ACS presentations in Spanish

Mr. Reyes is 58, diabetic, arriving by private car. His wife says “le está dando como una presión en el pecho desde hace una hora.” You ask him directly: “¿Le duele el pecho?” He says “no, no me duele.” You write “denies chest pain” and start your secondary assessment.

He is having a STEMI. His troponin will come back at 4.2. His LAD is 95% occluded. He did not lie to you. You asked the wrong question.

The classic ACS symptom is described as pressure, squeezing, heaviness, or crushing in the vast majority of patients — not as “pain” by the clinical definition. In Spanish, dolor is the direct translation of pain, and many patients who are experiencing classic angina genuinely do not feel that they are in dolor. They feel presión. They feel apretado. They feel something that les aplasta. When you ask the wrong Spanish word, you get the right answer to the wrong question.

This post covers the vocabulary gap first, then gives you the complete OPQRST adapted for the Spanish-language ACS presentation, the anginal equivalents you must ask about specifically, and the three sentences to say while the 12-lead is printing. For the full structured chest pain assessment approach, see the companion reference at /seo/chest-pain-assessment-in-spanish/.

The six Spanish descriptors for cardiac chest pain

Train yourself to recognize all six. Listen for any of them when a patient mentions the chest. The descriptor shifts your clinical suspicion before a single lab result is back.

1. Presión / me siento presión en el pecho

Clinical meaning: pressure. This is the most common ACS descriptor across all Spanish-speaking backgrounds. A patient who says “siento una presión aquí” while touching their chest is describing classic angina. Do not reframe this as something less urgent because the word “dolor” is absent. Pressure is the symptom.

Variants to recognize: me siento como que algo me presiona (something is pressing on me), presión que va y viene (pressure that comes and goes, consistent with unstable angina), presión que no se va (pressure that won’t go away, consistent with STEMI).

2. Apretado / me siento apretado

Clinical meaning: tightness, squeezing. Apretado comes from apretar (to squeeze, to tighten). A patient saying “me siento apretado del pecho” is describing exactly the squeezing sensation that textbooks describe as classic angina. Common in men with inferior or anterior MI. The fist-over-the-sternum gesture (Levine sign) often accompanies this descriptor — if the patient puts their closed fist on their chest while saying apretado, your pre-test probability for ACS just went up significantly.

3. Me aplasta / algo me aplasta

Clinical meaning: crushing sensation. Aplasta comes from aplastar (to crush, to flatten). “Siento que algo me aplasta el pecho” is a high-specificity ACS descriptor. Patients rarely use this word for musculoskeletal chest pain or GERD. When you hear aplasta, treat it as classic ischemic until proven otherwise.

4. Ardor / me arde el pecho

Clinical meaning: burning. This is the descriptor most likely to lead to clinical error in Spanish-speaking patients. Ardor overlaps heavily with heartburn (which patients may call acidez, reflujo, or “me quema el estómago”), and many patients with ACS who present with burning chest pain have already taken antacids at home without relief. The key differentiating question: “¿Tomó antácido? ¿Le alivio?” (Did you take an antacid? Did it help?) ACS burning that did not respond to antacid treatment is a red flag. Burning that worsens with exertion is another.

Note: some patients with inferior MI describe epigastric burning as the primary symptom. Do not anchor on GERD because the pain is below the sternum.

5. Ahogado / me siento ahogado

Clinical meaning: choking, suffocating sensation in the chest. Ahogado literally means drowning or choking. In the cardiac context, “me siento ahogado del pecho” describes the sense of being unable to get enough air due to chest fullness — common in heart failure decompensation and in right-ventricular MI. Distinguish from dyspnea (falta de aire): ahogado is a chest fullness that restricts breathing from inside; falta de aire is the subjective experience of not getting enough oxygen. Both warrant the 12-lead; they point to different hemodynamic problems.

6. Pesado / tengo el pecho pesado

Clinical meaning: heaviness, weight on the chest. “Tengo el pecho pesado” (my chest feels heavy) or “siento como un peso” (I feel like a weight) is another classic anginal descriptor. Common in elderly patients describing a gradual-onset presentation rather than acute onset. Ask about onset and duration: “¿Este peso lo siente desde hace cuánto tiempo? ¿Le comienza al caminar o estando sentado?” (How long have you felt this heaviness? Does it start when you walk, or even sitting still?) Exertional-onset heaviness that resolves with rest is the textbook unstable angina history.

OPQRST adapted for the Spanish ACS presentation

Run OPQRST in the order below. The entire sequence takes under three minutes if you do not stop to interpret — listen, acknowledge, move to the next question. For context, see also the pain scale in Spanish for the numeric severity question.

O — Onset

“¿Cuándo empezó esta sensación? ¿Estaba haciendo algo cuando empezó?”
(When did this sensation start? Were you doing something when it started?)

Do not use the word dolor here — use sensación or malestar (discomfort) to avoid anchoring the patient on the pain framing they may already have rejected.

Listen for:

• “Empezó mientras estaba caminando / subiendo escaleras.” (Started while walking / climbing stairs.) — Exertional onset, unstable angina or NSTEMI.
• “Empezó estando sentado, sin hacer nada.” (Started sitting, doing nothing.) — Rest-onset, higher-risk pattern.
• “Empezó como una hora después de comer.” (Started about an hour after eating.) — This can be GERD or inferior MI; do not anchor on GI etiology without ruling out cardiac first.
• “Me despertó dormido.” (Woke me from sleep.) — Nocturnal chest pain that wakes the patient is a high-risk pattern for Prinzmetal angina or demand ischemia.

Follow up onset with duration: “¿Cuánto tiempo lleva con esto? ¿Ha parado y vuelto, o es continuo?” (How long have you had this? Has it stopped and come back, or is it continuous?) Continuous chest pressure for > 20 minutes = STEMI until proven otherwise.

P — Provocation / Palliation

“¿Algo lo mejora o lo empeora? ¿Mejor al descansar? ¿Peor al moverse o al respirar profundo?”
(Does anything make it better or worse? Better with rest? Worse with movement or deep breathing?)

Listen for:

• “Mejor al descansar.” (Better with rest.) — Classic anginal pattern; supports ischemic etiology.
• “No mejora con nada.” (Nothing helps.) — Persistent despite rest and position change; STEMI pattern.
• “Me duele más al respirar profundo.” (Worse with deep breathing.) — Pleuritic; think PE, pericarditis, or musculoskeletal. Does not rule out cardiac, but shifts differential.
• “Tomé antácido y no me alivio.” (I took an antacid and it didn’t help.) — ACS-pattern burning that did not respond to antacid is a red flag even when the descriptor is ardor.

If the patient took nitroglycerin: “¿Tomó alguna pastilla debajo de la lengua? ¿Le ayudó?” Nitroglycerin-responsive chest pain supports ischemic etiology. Nitroglycerin-unresponsive persistent chest pain is more consistent with completed MI than unstable angina.

Q — Quality

“¿Cómo lo describe? ¿Presión, apretón, ardor, algo que le aplasta, o algo diferente?”
(How would you describe it? Pressure, squeezing, burning, something crushing, or something different?)

Give the patient the menu of cardiac descriptors — do not wait for them to volunteer the right word. The evidence on open-ended versus prompted pain quality questions in Spanish-speaking patients shows higher ACS identification with a prompted list. If the patient says none of those, ask: “¿Me puede señalar con su mano qué está sintiendo?” The Levine sign (closed fist to sternum) transcends language.

R — Radiation

“¿La sensación se va hacia algún otro lugar — al brazo izquierdo, al cuello, a la mandíbula, a la espalda?”
(Does the sensation travel anywhere else — to the left arm, neck, jaw, or back?)

Do not say “¿le irradia?” — irradiar is medical jargon. Use “¿se va hacia?” (does it go toward?) or “¿siente algo en?” (do you feel anything in?). Radiation patterns to recognize:

• Left arm / shoulder: “Al brazo izquierdo o al hombro.” — Classic anterior MI radiation.
• Jaw: “A la mandíbula o los dientes.” — High-specificity for ACS, especially in women and diabetics. Ask specifically because patients rarely volunteer jaw pain as a cardiac symptom.
• Back: “A la espalda, entre los omóplatos.” (To the back, between the shoulder blades.) — Aortic dissection differential; also inferior MI. If the patient has hypertension history and describes tearing back pain, prioritize aortic dissection.
• Epigastric: “Baja hacia el estómago o aquí abajo.” — Inferior MI radiation; anchor bias toward GI is the most common missed-MI error.

S — Severity

“En una escala del 0 al 10, donde 10 es lo peor que ha sentido en su vida, ¿cómo califica esta sensación ahorita?”
(On a scale of 0 to 10, where 10 is the worst you have ever felt in your life, how would you rate this sensation right now?)

Note three things about this question:

• Use sensación, not dolor (same reason as onset).
• Anchor to lo peor que ha sentido en su vida — this is the clinical standard. Without the anchor, patients from stoic cultural backgrounds often score 3/10 for what is clearly a 9/10 event.
• Severity alone does not rule in or out ACS. A 2/10 pressure in a 68-year-old diabetic woman deserves the same 12-lead urgency as an 8/10 crushing pain in a 45-year-old man. Do not let low severity score reduce your clinical suspicion when the descriptor and history fit ACS.

For full context on conducting the pain scale across dialect and register variation, see How to ask ‘where exactly does it hurt, on a scale of 0 to 10?’ in Spanish.

T — Timing

“¿Ha tenido esta misma sensación antes? ¿Cuándo fue la última vez? ¿Duró menos tiempo antes, o está peor hoy que otras veces?”
(Have you had this same sensation before? When was the last time? Did it last less time before, or is it worse today than other times?)

Prior chest pain history is a critical risk stratifier. A patient who says “sí, me ha pasado antes pero se fue solo” (yes, this has happened before but it went away on its own) may have had prior episodes of unstable angina they attributed to stress, indigestion, or something transient. Each prior episode that self-resolved is a missed opportunity for intervention that is now presenting as the index ACS.

Ask about prior cardiac history: “¿Ha tenido antes algún infarto, alguna angioplastia, o alguna cirugía del corazón?” (Have you ever had a heart attack, angioplasty, or heart surgery?) Patients may not know the English terms for their procedures; angioplastia and stent are both understood across Spanish-speaking backgrounds.

Anginal equivalents: the presentations that do not say “chest pain”

Women, diabetics, and elderly patients are disproportionately likely to present with anginal equivalents rather than classic chest symptoms — and Spanish-speaking patients in the US are disproportionately represented in the diabetic and elderly categories by population demographics. This means you need to ask about equivalents explicitly when your clinical suspicion exists, regardless of whether the patient volunteered a chest complaint.

Jaw pain

“¿Tiene usted dolor en la mandíbula o en los dientes, sin que sea un problema dental?”
(Do you have pain in your jaw or teeth, without it being a dental problem?)

Jaw pain as an ACS equivalent is among the highest-specificity presentations when combined with other risk factors. The patient will almost always say “it doesn’t feel like a toothache” — in Spanish: “no es como el dolor de muela.” That qualifier is itself informative.

Left arm or shoulder pain

“¿Le duele el brazo izquierdo o el hombro izquierdo en este momento, sin haber hecho nada para lastimárselo?”
(Does your left arm or left shoulder hurt right now, without having injured it?)

The qualifier sin haber hecho nada para lastimárselo (without having done anything to injure it) separates musculoskeletal from referred pain. A patient who says “me duele el brazo izquierdo pero no me golpeé” (my left arm hurts but I did not injure it) is flagging an equivalent.

Unexplained epigastric pain or nausea

“¿Tiene dolor arriba del estómago — aquí, debajo de las costillas — o tiene náuseas fuertes sin razón clara?”
(Do you have pain above the stomach — here, below the ribs — or strong nausea without a clear reason?)

Inferior MI classically presents with epigastric pain and nausea, and the highest missed-MI rate in EDs is in patients who present as “abdominal pain and nausea” with a history of diabetes or hypertension. If you are assessing a diabetic patient over 55 with epigastric pain and nausea, get the 12-lead before the GI workup, not after.

Unexplained profound fatigue

“¿Siente usted un cansancio muy fuerte — como que no tiene fuerzas — sin que tenga una razón clara?”
(Do you feel very strong fatigue — like you have no strength — without a clear reason?)

This is the most commonly missed ACS equivalent in women. A patient who says “me siento muy débil, sin fuerzas, no sé por qué” in the context of any cardiovascular risk factor warrants a 12-lead. Profound fatigue as an ACS presentation is associated with higher troponin at presentation and longer time-to-diagnosis compared to classic chest pain, precisely because it does not fit the pattern a clinician anchors on.

Unexplained diaphoresis

“¿Está sudando mucho aunque no tenga calor?”
(Are you sweating a lot even though you are not hot?)

Cold, clammy diaphoresis in the absence of fever or exertion is a sympathetic nervous system response to cardiac ischemia. When a patient says “me sude mucho de repente, y se me fue la cara” (I suddenly started sweating a lot and felt pale), with any other ACS risk factor, get the 12-lead. The combination of diaphoresis + nausea + epigastric discomfort in a diabetic patient is a missed inferior MI until proven otherwise.

What to say while the 12-lead is printing

The 12-lead takes 10 seconds to print. In that window, the patient is lying still, exposed, anxious, and waiting. What you say in that window determines whether they stay still, ask questions that interrupt the reading, or grab the leads off in a panic. Three sentences, in this order:

Sentence 1: Name what you are doing and why it is urgent

“Voy a poner unos electrodos en el pecho, los brazos y las piernas — son como antenas que leen la actividad eléctrica del corazón. No duelen, no mandan corriente, solo leen.”
(I am going to place some electrodes on your chest, arms, and legs — they are like antennas that read the heart’s electrical activity. No pain, no electricity, they only read.)

The antenas analogy is universally understood and neutralizes the anxiety of wires being attached. The “no duelen, no mandan corriente” preempts the most common patient fear during initial lead placement.

Sentence 2: Ask for the 10 seconds you need

“Necesito que se quede muy quieto/a por unos 10 segundos — si se mueve, el análisis sale con ruido y tengo que repetirlo.”
(I need you to stay very still for about 10 seconds — if you move, the reading comes out with artifact and I have to repeat it.)

Giving the patient a specific time (10 seconds) and a reason (artifact) gets better compliance than simply saying “no se mueva.” A patient who knows there is an end point to the stillness request cooperates; a patient with an open-ended restraint instruction gets anxious.

Sentence 3: Communicate urgency without causing panic

“Este estudio me da información importante sobre su corazón. Voy a leerlo en seguida y le explico qué encontramos.”
(This study gives me important information about your heart. I am going to read it right away and explain what we find.)

Do not say “vamos a ver si tiene un infarto.” You do not need to name the worst case to communicate urgency. “Información importante sobre su corazón” is urgent enough to get the patient’s cooperation without triggering the fear response that makes patients move, hyperventilate, or pull off leads.

If the ECG shows STEMI: the three things to say in the next 60 seconds

Door-to-balloon time is measured in minutes. The cardiologist is paged. The cath lab is notified. In the middle of all of that, the patient in front of you does not know what is happening. Three sentences, before you leave the room:

1. “Su electrocardiograma muestra que hay un bloqueo en una arteria del corazón. Necesitamos actuar ahora mismo.”
   (Your electrocardiogram shows that there is a blockage in an artery of the heart. We need to act right now.)
   Honest, specific, urgent. Do not say “algo sale raro.” The patient deserves to know what is happening.
2. “Vamos a llevar a un estudio donde podemos abrir esa arteria — es el tratamiento más rápido y más efectivo para esto.”
   (We are going to take you to a study where we can open that artery — it is the fastest and most effective treatment for this.)
   This frames the cath lab as a treatment venue, not a diagnostic unknown. “Abrir la arteria” is the lay-language frame for angioplasty. Use it.
3. “Voy a avisar a su familia ahora mismo. ¿Quiere que llame a alguien?”
   (I am going to notify your family right now. Would you like me to call someone?)
   In a familismo-centered cultural context, the patient’s first concern is often not themselves — it is whether their family knows what is happening. Addressing this explicitly before leaving the room reduces the probability of the patient attempting to call family themselves mid-transport and pulling off monitoring.

If the patient asks “¿me voy a morir?” (Am I going to die?): do not deflect. “Estamos haciendo todo lo posible para que eso no pase. El tratamiento que vamos a hacer es muy efectivo cuando lo hacemos rápido. Ese es el plan ahorita.” (We are doing everything possible to prevent that. The treatment we are going to do is very effective when we do it quickly. That is the plan right now.) This answers the question honestly, provides hope grounded in mechanism, and refocuses the patient on action rather than catastrophizing.

Frequently asked questions