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 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 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: