Chest Pain The Evolution of a Heart Attack

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Chest PainThe Evolution of a Heart Attack

• Presented by
• Scott G. Popowich, CCEMT-P
• EMS Coordinator
• Kodak Rochester Medical Services

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Objectives

• Understand Risk Factors
• Identify Signs and Symptoms
• Understand how a heart attack evolves
• Benefits of Aspirin, indications,
  contraindications
• BLS ALS Treatment / Interventions
• Defibrillation

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Some Causes of Chest Pain

• Pulmonary
• Musculoskeletal
• Esophageal problem
• Gastrointestinal

• Anxiety
• Angina
• Heart Attack

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Risk factors

• Sedentary Life style
• High Blood Pressure
• Elevated Cholesterol
• Genetics / Heredity
• Age

• Diabetes
• Smoking
• Diet
• Stress
• Gender

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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

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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.

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Anxiety Attack vs. Heart Attack
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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.

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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

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Anatomy of a Heart Attack
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Anatomy of a Heart Attack
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About Aspirin

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

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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.

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Aspirin Administration

• Indications
• Chest Pain
• Suspected Acute MI

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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 ?

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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

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ALS Interventions / Treatment

• Baby Aspirin (If not administered by BLS)
• ECG - 12 lead (serial 12 leads)
• Nitroglycerin
• IV Access
• Morphine
• Lots of questions

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Normal 12 Lead EKG

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Abnormal 12 Lead EKG
.
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Chain of Survival

• Early recognition of problem and Early Access to
  care.................911
• Early CPR
• Early Defibrillation
• Early Advanced Life Support

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Surviving a Cardiac Arrest

• 5 survive nationally
• 5-10 survive locally
• NOTE not all heart attacks cause cardiac arrest

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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!

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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

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Questions??