1. ANGINA V. MI STS 3/23/2015

2. 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

3. 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

4. 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?

5. ANGINA ONSET & QUALITY OF PAIN Sudden Lasts minutes Spasms Tight/heavy pain Burning

6. ANGINA SIGNS/SYMPTOMS Location of pain: Below the sternum Radiates to jaw, neck, back of arm Shortness of breath Diaphoresis

7. ANGINA HISTORY Age of patient Previous similar episode Previous diagnosis Hypertension Angina

8. WHAT MAKES ANGINA BETTER/WORSE? Better: Rest/little movement Medications Worse: Breathing Position Stress/anxiety

9. MI ONSET & QUALITY OF PAIN Sudden Can last hours Tightness/heaviness Pain not easy to pinpoint Tearing/burning sensation

10. 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

11. MI HISTORY Age of patient Previous similar episode Previous diagnosis Hypertension Angina

12. WHAT MAKES MI BETTER/WORSE? Better: Medications Worse: Breathing Position Stress/anxiety

13. 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

14. 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!

15. 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!

16. SCENARIO Your dispatch is: