Chest PainThe Evolution of a Heart Attack

Presented by:

Scott G. Popowich, CCEMT-P

EMS Coordinator

Kodak Rochester Medical Services

Objectives

Understand Risk FactorsIdentify Signs and SymptomsUnderstand how a heart attack evolvesBenefits of Aspirin, indications, contraindicationsBLS & ALS Treatment / InterventionsDefibrillation

Some Causes of Chest Pain

PulmonaryMusculoskeletalEsophageal problemGastrointestinal

AnxietyAnginaHeart Attack

Risk factors

Sedentary Life styleHigh Blood PressureElevated CholesterolGenetics / HeredityAge

Diabetes Smoking Diet Stress Gender

Signs & Symptoms of a Heart Attack

Chest Pain / DiscomfortShortness of Breath (SOB)Neck/Jaw/Arm Pain (esp Lt arm)Sweating (diaphoresis)Syncope (fainting)Anxious/ Nausea/ VomitingDenial

                                                                                 

                                

Anxiety Attack vs. Heart Attack

People who have panic attacks commonly fear they are having a heart attack. This makes the panic anxiety worse. Some symptoms of panic attack are also experienced during a heart attack so it is understandable that people may mix them up.

Anxiety Attack vs. Heart Attack

  Heart Attack Panic Attack

Pain   May or may not be present  If present, the pain is often described as a crushing feeling (like someone standing on the chest)  The pain is usually located in the central chest and may extend to the left arm, back and neck  Pain, if present, is not usually made worse by breathing or by pressing on the chest  Pain, if present, is usually persistent and lasts longer than 5-10 minutes 

  Any pain is usually described as ‘sharp’  The pain tends to be localized over the heart  Pain is usually made worse by breathing in and out and by pressure on the centre of the chest  Pain usually disappears within about 5-10 minutes

Tingling Tingling, if present, is usually in the left arm Tingling is usually present all over the body

Vomiting Common Nausea may be present but vomiting is less common

Breathing A Heart Attack does not cause you to breathe too quickly or too deeply (hyperventilation) – panic does. With a heart attack you may feel a little short of breath. It is possible however, to have a heart attack and then start panicking. In this case, hyperventilation is a symptom of panic not of the heart attack

Breathing too quickly or too deeply (hyperventilation) is an extremely common panic response which precedes most panic attacks

Characteristics of Chest Pain

Dull / achingSqueezingPressureTightnessSharp

Like an elephant sitting on my chestOften radiates to shoulders, arms, upper abdomen and back.

Anatomy of a Heart Attack

The Coronary Arteries nourish the heartPlaque build-up narrows these arteries (arteriosclerosis)Artery occludes meaning decreased blood flow to an area of the heartInsufficient blood supply results in oxygen deprivation, this causes the symptoms of chest pain and ultimately myocardial infarctions

Anatomy of a Heart Attack

                                

         

                                 

Anatomy of a Heart Attack

About Aspirin

Aspirin (ASA) is acetylsalicylic acid and falls into a class called non-steroidal anti-inflammatory drugs (NSAIDS)Due to aspirin’s blood thinning effect it can reduce coronary heart disease events and strokesAspirin is not benign

Benefits of Aspirin

Living up to its reputation as a 'wonder drug', aspirin has been shown in clinical studies to reduce the rate of heart attacks, strokes and related deaths. The ability of aspirin to prevent blood from clotting (makes the cells 'less sticky') prevents these events from happening. Aspirin also helps even if a heart attack or stroke does occur and often reduces the severity of the event.

                                                                                   

                                               

Aspirin Administration

Indications

Chest Pain Suspected Acute MI

Aspirin Administration

ContraindicationsKnown allergy – only true contraindicationPatient unresponsive/unable to swallowPediatric patients– Relative contraindications

– These are not absolute and should be considered only if actively occurring

Use caution in patients with hemophilia or other bleeding disordersRecent bleeding Gastroduodenal ulcers / gastrointestinal bleeding or stroke patients ?

BLS Interventions / Treatment

Position of comfortVitalsPulse Oximetry (if available)OxygenBaby Aspirin A dose 324 mg PO –(4 - 81 mg chewable aspirin tablets)Lots of questionsAssist Patient with their prescribed nitroglycerin tablets

ALS Interventions / Treatment

Baby Aspirin (If not administered by BLS)ECG - 12 lead (serial 12 leads)NitroglycerinIV AccessMorphineLots of questions

Normal 12 Lead EKG

Abnormal 12 Lead EKG

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Chain of Survival

Early recognition of problem and Early Access to care.................911Early CPREarly DefibrillationEarly Advanced Life Support

Surviving a Cardiac Arrest

5% survive nationally5-10% survive locally

NOTE: not all heart attacks cause cardiac arrest

Defibrillation

When the heart stops beating, chances of survival decrease by 10% for each minute that passes. Survival rates are higher when a defibrillator is used right away. Irreversible brain damage can begin in just 4 minutes!

                                                                                 

                                 

In Conclusion

Remember and recognize the signs and symptoms of a heart attackTreat appropriately and according to your level of training and do not delay care. Time is muscleRest until additional help arrives. Rapid transport to nearest appropriate facilityKnow your risk factors and change what you can. Educate your patient

                                                                                         

                                         

Questions??