Travel Reference
In-Depth Information
exertion as possible, transported if that can be obtained. Angina at rest is an indication of
severe heart disease and often is a prelude to a more serious event, such as an infarct.
Myocardial Infarction
Myocardial infarction may occur in someone who has had angina, or it may occur in an
individualwhohasneverhadchestpain.Itiscausedbyobstructionofoneofthearteriesto
the heart—the coronary arteries—usually by a blood clot that forms on a ruptured choles-
terolplaqueandresults indeath(necrosis orinfarction) ofpartoftheheartmuscle. Among
persons with coronary artery disease, 50 percent are unaware that they have the problem
until they have a heart attack.
Myocardial infarction is a common cause of sudden death and a major medical emer-
gency. Chest pain is the most common initial symptom and may appear at rest or during
exercise.Thepainresemblesanginapectorisbutisusuallymoresevere,maylastonetosix
hours,andusuallyisnotrelievedbynitroglycerine.Otherfrequentsymptomsandsignsare
nausea,vomiting,difficultyinbreathing,weakness,sweating,pallor,cyanosis,andcoldex-
tremities.Thebloodpressuremaybelow;theheartratemaybeslowandirregular.(Elderly
individuals may have an acute infarction with minimal or no chest pain.)
The person should lie down at once and rest completely. An adult aspirin tablet should
be chewed and swallowed immediately. Nitroglycerine should be tried, although it usually
is ineffective. If the pain is not relieved in ten to fifteen minutes, a strong analgesic should
be administered every two hours until the pain is relieved. If the individual is agitated, a
sedative should be given. If oxygen is available, it should be administered at a flow rate of
fourtosixlitersperminutewithafacemask.Ifthepersonisshortofbreath,coughing,and
can breathe more easily sitting up, sitting should be permitted, preferably supported by a
backrest. (Administration of oxygen should be continued.) Prompt evacuation, preferably
by helicopter, is essential. A physician or advanced emergency medical technician should
accompany the helicopter; cardiac resuscitation may be necessary at any moment.
Cardiac Dyspnea
Cardiac dyspnea is undue shortness of breath caused by heart disease and is indicative
ofheartfailure,inadequatebloodflowtotheheart,oranabnormalrhythm.Dyspneaoccurs
with exercise, but sometimes develops at night. The person awakens with a sense of suf-
focationandfeelscompelledtositupormoveoutintofreshairtoobtainrelief.Theperson
is usually anxious, is breathing fast, and has a rapid heart rate. Crackles indicative of fluid
in the lungs may be heard when listening to the chest.
Questioning usually discloses a history of high blood pressure, angina, a prior heart at-
tack, or a heart murmur. In the few individuals who have no history of cardiac disease, the
heart failure may be the result of an asymptomatic (silent) myocardial infarction, a marked
riseinbloodpressure,ordevelopmentofanabnormalrhythm.Nitroglycerinemaybehelp-
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