Medical Emergencies: Myocardial Infarction, Angina, and Treatments

OBJECTIVES

Upon completion of this lesson, you will be able to:

1. Define a medical emergency.
2. Define myocardial infarction, list nine signs and symptoms, and list eight steps for pre-hospital treatment.
3. Define angina pectoris, list six signs and symptoms, and describe pre-hospital treatment.
4. Define congestive heart failure, list eight signs and symptoms, and four steps for pre-hospital treatment.
5. Define hypertension, list five signs and symptoms and five steps for pre-hospital treatment.
6. List ten signs and symptoms of abdominal pain and list five steps for pre-hospital treatment.

1. Medical Emergency

Definition:
A critical state caused by a wide variety of illnesses whose cause does not include trauma to the body.

Such a state can be caused by germ pathogens (microorganisms), alteration in the functioning of an organ, or foreign substances, such as poisons. In most cases, the problem is not a consequence of trauma.

If the patient presents with atypical vital signs, assume that the patient has a medical emergency.

The most common cardiovascular medical emergencies are:

• Myocardial infarction
• Angina pectoris
• Congestive heart failure
• Cardiac arrest
• Hypertensive emergencies

1.1 Detection

• Medical emergencies can create a situation leading to trauma and may remain unnoticed.
• Always consider the possibility that an underlying medical emergency may have led to the traumatic event.
• Look for signs of altered mental status or unusual symptoms.
• Assess the patient’s medical history for underlying conditions.
  Trauma can induce a medical emergency. Conduct an initial assessment and physical exam and continue monitoring the patient closely.
• Reassess vital signs frequently to identify changes.
• Observe for signs of shock or worsening symptoms.
• Ensure timely transport to an appropriate medical facility.

1.2 Signs of a Medical Emergency

If the patient presents with abnormal vital signs, assume that the patient has a medical emergency. Changes in any of the following can indicate a medical emergency:

• Mental status (unconscious, confused, comatose)
• Heart rate, rhythm and/or quality
• Breathing rate, rhythm, and/or quality
• Skin temperature, colour and/or condition
• Pupil size, symmetry, and reactivity to light
• Condition and colour of the mucous membranes (dryness, paleness, cyanosis)
• Breath scent (alcohol, acetone)
• Muscular activities (spasms and paralysis)
• Nausea or vomiting

In an adult patient, the following conditions may indicate a possible medical emergency:

• Heart rate above 100 or less than 60 bpm.
• Respiratory rate less than 12 or more than 20 rpm.

1.3 Symptoms of a Medical Emergency

Consider all patients’ complaints as valid.
If the patient complains of not feeling well, assume that he/she is having a medical emergency.

• Sudden onset of dizziness or light-headedness
• Persistent fatigue or weakness
• Shortness of breath or difficulty breathing
• Chest or abdominal pain
• Excessive thirst, hunger, or strange taste in the mouth
• Sensation of numbness and tingling
• Sweating or chills without a clear cause

2. Cardiovascular Emergencies

2.1 Heart Function

The heart is a muscle that is oxygenated by the coronary arteries.

• • It pumps blood throughout the body, delivering oxygen and nutrients to tissues and organs.
    Arteriosclerosis is a progressive narrowing of the arteries, in which deposits of fat attach to the internal walls of the arteries, reducing their diameter.
  • This condition decreases blood flow and oxygen supply to critical areas of the body, particularly the heart.
    When the coronary arteries are narrowed, the amount of oxygen supplied to the muscle is reduced, and the patient experiences chest pain. This pain is called angina pectoris.
  • Angina is typically triggered by physical exertion or stress and usually subsides with rest or medication.
    When the coronary arteries are obstructed, oxygen cannot reach the muscle. This part of the muscle then dies, causing a condition called a myocardial infarction. It is the consequence of an occlusion of one or several of the coronary arteries.
  • This condition, commonly known as a heart attack, can cause permanent damage to the heart muscle.
    If the patient loses too much of the heart muscle, the heart will be unable to pump enough blood to supply the rest of the body. This leads to shock and, soon after, death.
  • Early medical intervention is critical to minimize damage and improve the patient’s chances of survival.

2.2 Angina Pectoris

Definition: Chest pain.

This condition is the result of reduced oxygen supply to the heart muscle (myocardium). It can be caused by diseased or narrowed arteries which reduce blood flow. Angina is often brought on by exertion or stress and rarely lasts longer than 3 to 5 minutes.

Signs and symptoms of angina pectoris

• Chest pain or discomfort, often described as pressure, squeezing, or fullness
• Pain radiating to the shoulders, arms, neck, jaw, or back
• Shortness of breath, especially during physical activity
• Nausea, sweating, or dizziness accompanying the chest discomfort
• Fatigue or weakness, especially during or after exertion

It is impossible to distinguish between angina and the pain of a heart attack. Though it does not cause permanent damage to the heart, angina can eventually lead to a heart attack.

Pre-hospital treatment for angina pectoris

• Use universal precautions and ensure the scene is safe.
• Instruct the patient to stop all physical activity and remain calm.
• Place the patient in a comfortable position, typically sitting or semi-reclining.
• Administer oxygen per local protocols if the patient shows signs of hypoxia.
• Assist the patient with prescribed nitroglycerin, following local guidelines.
• Monitor the patient’s vital signs continuously.
• Provide emotional support and reassurance to reduce anxiety.
• Prepare for rapid transport to a medical facility for further evaluation and treatment.

2.3 Myocardial Infarction

Definition:
Literally meaning “death of the heart,” caused by partial or total blockage of blood flow to the heart, leading to death of cardiac muscle tissue.

Myocardial infarction is commonly known as a “heart attack”.

Signs and Symptoms of Myocardial Infarction

• Chest discomfort, such as pain or heaviness. The common location is substernal, radiating to the neck, jaw, left shoulder, and/or left arm.
• Shortness of breath or difficulty breathing.
• Sweating (cold, clammy skin).
• Nausea or vomiting.
• Dizziness or light-headedness.
• Fatigue or unexplained weakness.
• A feeling of impending doom or severe anxiety.
• Rapid or irregular heartbeat (palpitations).

If any of the above signs or symptoms is present, assume that the patient is having or will soon have a myocardial infarction.

Pre-hospital treatment for myocardial infarction

Use universal precautions and secure the scene.

1. Use universal precautions and secure the scene.
2. Instruct the patient to stop all movement.
3. Place the responsive patient in a comfortable position, usually semi-reclining or sitting.
4. Maintain open airway.
5. Administer oxygen per local protocol. If needed, provide artificial ventilation or CPR.
6. Assist with prescribed medication, such as nitroglycerin or aspirin, as directed by local protocols.
7. Loosen restrictive clothing.
8. Maintain body temperature as close to normal as possible.
9. Comfort and reassure the patient to reduce stress and anxiety.
10. Constantly monitor the patient’s vital signs.
11. Prepare for rapid transport to a medical facility for advanced care.

2.4 Congestive Heart Failure

Definition:
A condition of excessive fluid build-up in the lungs and/or other organs due to inadequate pumping of the heart.

This condition is called “congestive” because the fluids congest, or clog, the organs. Congestive heart failure is often a complication of myocardial infarction, and can also be brought on by diseased heart valves, hypertension, and pulmonary diseases such as emphysema.

Signs and symptoms of congestive heart failure:

• Shortness of breath, made worse by lying flat
• Fatigue or weakness during physical activity or at rest
• Rapid heart rate
• Persistent coughing or wheezing, sometimes producing white or pink-tinged mucus
• Anxiety
• Increased respiratory rate
• Normal to high blood pressure
• Jugular vein distension
• Swollen ankles, feet, or abdomen (edema)
• Cyanosis (bluish tint to skin, lips, or nails)

The patient with congestive heart failure may not always experience chest pain.

Pre-hospital treatment for congestive heart failure

Use universal precautions and secure the scene.

Use universal precautions and secure the scene.

• Maintain open airway and monitor breathing.
• Provide artificial ventilation if needed.
• Administer oxygen per local protocol to improve oxygenation.
• Place the responsive patient in a comfortable position, usually sitting upright, to reduce pressure on the lungs.
• Continuously monitor the patient’s vital signs, including heart rate, respiratory rate, and blood pressure.
• Provide emotional support to reduce anxiety and help the patient remain calm.
• Prepare for rapid transport to a medical facility for advanced care.

Transport the patient as soon as possible.

2.5 Hypertension

Definition:
Blood pressure that remains consistently above the normal values.

Signs and Symptoms

• Severe headache
• Blurred vision or double vision
• Dizziness or light-headedness
• Chest pain or discomfort
• Seeing “stars”
• Nosebleed (epistaxis)
• Diastolic blood pressure above 90 mmHg (or per local protocol)
• Tingling in the extremities (fingers or toes)

Pre-hospital treatment for hypertension

Use universal precautions and secure the scene.

1. Maintain open airway.
2. Monitor breathing and ensure oxygenation if required.
3. Place the responsive patient in a comfortable position, usually sitting upright, to reduce blood pressure.
4. Provide emotional support to keep the patient calm and prevent further elevation of blood pressure.
5. Control nosebleed, if present, by pinching the nostrils and tilting the head slightly forward.
6. Transport the patient as soon as available for further evaluation and treatment.

Transport the patient as soon as available.

3. Abdominal Distress

Definition:
A sharp, severe abdominal pain with rapid onset.

Abdominal pain can have sudden onset or build up gradually over a period of time. Severe abdominal pain may not always reflect a serious condition but must always be treated as serious by the MFR until a full diagnosis is made by a doctor.

Causes of abdominal distress

There are multiple causes of abdominal pain, all requiring immediate attention. These disorders have four general causes: inflammation, infection, obstruction, and hemorrhage. These conditions can be brought on by, but are not limited to, the following:

• Acute appendicitis
• Perforated ulcer
• Intestinal obstruction
• Ectopic pregnancy or other gynecological emergencies
• Closed abdominal trauma (ruptures, hemorrhages)

The above list does not include all causes of abdominal pain.

Signs and symptoms of abdominal distress

• Abdominal pain, local or diffuse
• Bloating or distension of the abdomen
• Colicky pain (cramps that occur in waves)
• Nausea and vomiting
• Abdominal tenderness, local or diffuse
• Anxiety, reluctance to move
• Diarrhea or constipation
• Fever or chills (indicating possible infection)
• Vomiting blood
• Blood in stool or black, tarry stools (melena)

Pre-hospital treatment of abdominal distress

Use universal precautions and secure the scene.

• Maintain open airway and prevent aspiration of vomit.
• Have the patient lie in a comfortable position, preferably the left side if nauseated.
• Avoid unnecessary movement to reduce discomfort.
• Administer oxygen per local protocol.
• Treat for shock by keeping the patient warm and monitoring for signs of circulatory collapse.
• Do not give anything by mouth to avoid worsening the condition.
• Keep a vomit sample for analysis (take precautions to prevent contamination).
• Continually monitor vital signs while transporting the patient.
• Ensure rapid transport to a medical facility for further evaluation and treatment.

Transport the patient as soon as possible. 

Conclusion:

Medical emergencies are unpredictable and can escalate rapidly, often putting lives at immediate risk. Recognizing the signs and symptoms early, coupled with effective pre-hospital care, can significantly improve patient outcomes. For instance, studies show that early intervention in myocardial infarction cases can reduce mortality by up to 25%, while timely oxygen administration in congestive heart failure can enhance survival rates by nearly 15%. Similarly, identifying and addressing hypertensive crises promptly can prevent life-threatening complications like stroke or kidney failure in up to 40% of cases.

Equipping yourself with the knowledge to manage conditions such as abdominal distress, angina pectoris, or hypertension empowers you to act decisively in critical moments. Remember, swift action and adherence to proper protocols save lives and improve recovery and quality of life. Staying prepared and vigilant is the first step toward ensuring the best possible outcomes in medical emergencies