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ANGINA V. MI STS 3/23/2015 ANGINA PECTORIS Cause: decrease in blood supply to the heart Outcome: no damage to the heart Symptoms: tightness or pressure in the chest Severity: symptoms may be relieved by rest or nitroglycerine within 10-15 minutes ACUTE MYOCARDIAL INFARCTION (MI) Cause: complete blockage of the blood supply to the heart Outcome: damage to the heart Symptoms: • Severe, steady, crushing pain • Radiates to left neck and down left arm • Weak, rapid pulse • Hypotension • Low grade fever Severity: symptoms persist after 15 min; not relieved by nitro VERBAL ASSESSMENT Ask your OPQRST! Consider: • Age of patient • Cause • Onset of pain – sudden/gradual? • Differences in quality of pain • Location • Medical history • Was there trauma involved? • Does anything help/worsen the pain? ANGINA ONSET & QUALITY OF PAIN • Sudden • Lasts minutes • Spasms • Tight/heavy pain • Burning ANGINA SIGNS/SYMPTOMS Location of pain: • Below the sternum • Radiates to jaw, neck, back of arm Shortness of breath Diaphoresis ANGINA HISTORY • Age of patient • Previous similar episode • Previous diagnosis • Hypertension • Angina WHAT MAKES ANGINA BETTER/WORSE? Better: • Rest/little movement • Medications Worse: • Breathing • Position • Stress/anxiety MI ONSET & QUALITY OF PAIN • Sudden • Can last hours • Tightness/heaviness • Pain not easy to pinpoint • Tearing/burning sensation MI SIGNS/SYMPTOMS Location of pain: • Below the sternum • Center of chest • Radiates to jaw, neck, back of arm Shortness of breath Diaphoresis Nausea Syncopal episode/weakness MI HISTORY • Age of patient • Previous similar episode • Previous diagnosis • Hypertension • Angina WHAT MAKES MI BETTER/WORSE? Better: • Medications Worse: • Breathing • Position • Stress/anxiety NITROGLYCERINE What do you do before you give any drug? DICCE it out Check for contraindications What are the indications for nitro? Non-traumatic chest pain What are the contraindications for nitro? 53 BASH • Last dose within 5 min • Taken 3 doses per this episode of pain • Systolic BP <100 mmHg • ALOC • Taken a sexually enhancing drug within 48-72 hours • Head injury HOW TO ADMINISTER NITRO Tablet: • Remove from container and check integrity • Place under pt’s tongue • Instruct pt to allow tablet to dissolve Spray: • One spray sublingually Remember to reassess vitals after 5 min! BOTTOM LINE Realistically, it’s difficult to differentiate between the two, and it’s really not your job to diagnose. Just do what you can and transport ASAP! SCENARIO Your dispatch is:
