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Chest Pain
The Evolution of a Heart Attack
Presented by:
Scott G. Popowich, CCEMT-P
EMS Coordinator
Kodak Rochester Medical Services
Objectives
Understand Risk Factors
Identify Signs and Symptoms
Understand how a heart attack evolves
Benefits of Aspirin, indications, contraindications
BLS & ALS Treatment / Interventions
Defibrillation
Some Causes of Chest Pain
Pulmonary
Musculoskeletal
Esophageal problem
Gastrointestinal
Anxiety
Angina
Heart Attack
Risk factors
Sedentary Life style
High Blood Pressure
Elevated Cholesterol
Genetics / Heredity
Age
Diabetes
Smoking
Diet
Stress
Gender
Signs & Symptoms of a Heart Attack
Chest Pain / Discomfort
Shortness of Breath (SOB)
Neck/Jaw/Arm Pain (esp Lt arm)
Sweating (diaphoresis)
Syncope (fainting)
Anxious/ Nausea/ Vomiting
Denial
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
· 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 510 minutes
Tingling
· 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
Tingling, if present, is usually in the left arm
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
Pain
Tingling is usually present all over the
body
Characteristics of Chest Pain
Dull / aching
Squeezing
Pressure
Tightness
Sharp
Like an elephant sitting
on my chest
Often radiates to
shoulders, arms, upper
abdomen and back.
Anatomy of a Heart Attack
The Coronary Arteries nourish the heart
Plaque build-up narrows these arteries
(arteriosclerosis)
Artery occludes meaning decreased blood flow
to an area of the heart
Insufficient 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
strokes
Aspirin 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
Contraindications
Known allergy – only true contraindication
Patient unresponsive/unable to swallow
Pediatric patients
– Relative contraindications
– These are not absolute and should be considered only if actively occurring
Use caution in patients with hemophilia or other bleeding
disorders
Recent bleeding Gastroduodenal ulcers / gastrointestinal
bleeding or stroke patients ?
BLS Interventions / Treatment
Position of comfort
Vitals
Pulse Oximetry (if available)
Oxygen
Baby Aspirin A dose 324 mg PO –(4 - 81 mg chewable
aspirin tablets)
Lots of questions
Assist Patient with their prescribed nitroglycerin tablets
ALS Interventions / Treatment
Baby Aspirin (If not administered by BLS)
ECG - 12 lead (serial 12 leads)
Nitroglycerin
IV Access
Morphine
Lots of questions
Normal 12 Lead EKG
Abnormal 12 Lead EKG
.
Chain of Survival
Early recognition of problem and Early Access to
care.................911
Early CPR
Early Defibrillation
Early Advanced Life Support
Surviving a Cardiac Arrest
5% survive nationally
5-10% 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 attack
Treat appropriately and according to your level of
training and do not delay care. Time is muscle
Rest until additional help arrives.
Rapid transport to nearest appropriate facility
Know your risk factors and change what you can.
Educate your patient
Questions??