1. Chest Pain The Evolution of a Heart Attack Presented by: Scott G. Popowich, CCEMT-P EMS Coordinator Kodak Rochester Medical Services

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

3. Some Causes of Chest Pain Pulmonary Musculoskeletal Esophageal problem Gastrointestinal Anxiety Angina Heart Attack

4. Risk factors Sedentary Life style High Blood Pressure Elevated Cholesterol Genetics / Heredity Age Diabetes Smoking Diet Stress Gender

5. 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

7. 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.

8. Anxiety Attack vs. Heart Attack Heart AttackPanic 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 TinglingTingling, if present, is usually in the left armTingling is usually present all over the body VomitingCommonNausea may be present but vomiting is less common BreathingA 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

9. 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.

10. 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

11. Anatomy of a Heart Attack

12. Anatomy of a Heart Attack

13. 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

14. 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.

16. Aspirin Administration Indications Chest Pain Suspected Acute MI

17. 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 ?

18. 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

19. ALS Interventions / Treatment Baby Aspirin (If not administered by BLS) ECG - 12 lead (serial 12 leads) Nitroglycerin IV Access Morphine Lots of questions

20. Normal 12 Lead EKG

21. Abnormal 12 Lead EKG.

23. Chain of Survival Early recognition of problem and Early Access to care.................911 Early CPR Early Defibrillation Early Advanced Life Support

24. Surviving a Cardiac Arrest 5% survive nationally 5-10% survive locally NOTE: not all heart attacks cause cardiac arrest

25. 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!

27. 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

29. Questions??