*Cardiac Emergency*
By: Palehorse

Anyone who has ever experienced chest pain knows what a scary experience it is.  Most people assume the worst and think they are having a heart attack.  Not all chest pain is cardiac related, sometimes, it’s caused by respiratory problems or musculoskeletal problems.  This article is for information purposes only and is not intended to replace medical care that is currently available.  In this article we will discuss how to recognize the signs and symptoms of angina pectoris, myocardial infarction, and some methods to determine whether or not the pain experienced is cardiac related or from other cause, and some factors that put you at risk for heart disease.  While this subject can get very confusing and technical, I will try to make it as easy to understand as possible.

The human heart is a smooth muscle containing four chambers.  The two upper chambers are the atria, and the two lower chambers are the ventricles.  These chambers are separated by valves which open and close synchronically to allow the blood to flow through the heart.  There are also large blood vessels coming into and going out of the heart.  These vessels are the pulmonary arteries, the superior and inferior vena cava and the aorta.  Without making this too complicated, blood flows into the heart, then the lungs, then back into the heart, then out of the heart, making its way through all of these vessels and the four chambers of the heart before carrying oxygenated blood throughout the body.  There are also arteries on the heart that feed the heart muscle itself the oxygen it needs to live.  These are called the coronary arteries, and they are the ones we hear about when doctors talk about plaque build up in the vessels of the heart, and these same vessels when blocked, cause heart attacks.

Angina Pectoris is a big term meaning chest pain.  Angina is caused from ischemia, which is a decrease or lack of oxygen, to the heart muscle.  This ischemia can be caused from a partial build up of plaque in the coronary arteries when not enough oxygenated blood is reaching certain areas of the heart.  Plaque is simply fat that has deposited within the artery walls causing an injury response and eventually calcium is deposited forming the plaque.  It continues to build until it occludes the lumen of the artery.  Stenosis, hardening of the arteries, and a host of other heart diseases can also cause angina.  It usually starts while the patient is doing some type of physical activity, whether it’s mowing the lawn, walking in the mall, working in the garden, etc…any activity that raises the heart rate, therefore making the heart work harder and increasing it’s demand for oxygen.  The patient will complain of tightness in the chest.  It can be described many ways but all of the descriptions have a common factor…a pressure, dull, or squeezing type pain versus a sharp, stabbing pain.  They may not be able to describe it and may compare it to a tight band around their chest, an elephant sitting on their chest, being punched in the chest, etc…NOT like a knife sticking in the chest.  Some will not call it pain at all, but more of an uncomfortable pressure or tightness.  Most often the pain or pressure is in the center of the chest behind the sternum.  It may radiate into the patient’s left arm (or possible both arms), neck or jaw, or into the back.  They may feel short of breath, nauseated, and have cool, sweaty, pale skin.  All, some, or none of these symptoms may be present with the chest pain.

A myocardial infarction (MI) is the big term for a heart attack.  This is when one of the coronary arteries has become completely blocked and part of the heart muscle is without oxygen and it dies.  The symptoms are very similar, but the onset of an MI can start while the patient is at rest….sleeping, watching television, etc.  Usually with an MI all of the above symptoms are present.  The patient will have a certain “look”, which can be described as complete agony.  Their skin color will be pasty white and clammy.  Their skin cold and wet.  They may writhe in pain or may be fidgety trying desperately to get comfortable.  Their breathing will be rapid and shallow, perhaps gasping.  Their blood pressure and pulse may be slightly elevated, or may be normal.    Without proper medical equipment and tests, it is nearly impossible to actually diagnose a heart attack.  The emergency room uses three defining factors to determine a heart attack:  EKG, cardiac enzyme test (blood test), and history.  If two of the three of these tests are positive, a cardiac cathetarization may be performed.  If evidence of heart damage is found surgical intervention, including coronary artery bypass, may be indicated.

Sharp stabbing chest pain is usually not indicative of cardiac problems.  Often, but not always, sharp chest pain can be attributed to respiratory problems, such as the patient having had a severe cough for a few days and the chest wall being sore from coughing.  Chronic bronchitis, emphysema and other Chronic Obstructive Pulmonary Diseases (COPD) may cause sharp pain.   It may also be musculoskeletal pain from an injury.  Most cardiac chest pain doesn’t change in severity or location if the patient takes a deep breath or moves in any particular way.  If the patient says the pain is worse on inspiration or on movement, and no other cardiac symptoms are present, chances are good the pain is muscular.  This is not to say sharp chest pain cannot be a symptom of cardiac problems, but most of the time it isn’t.

Diagnosing and treating suspected cardiac problems in a PSHTF scenario will be extremely difficult and will mostly likely be treated symptomatically.  The best thing for this situation is preventative medicine.  Take care of yourself NOW!  Practice good eating and exercise habits.  Know the risk factors for coronary artery disease.  There are nine risk factors associated with Coronary Artery Disease (CAD).  Some can be changed, others cannot.

Modifiable Risk Factors
 *Elevated Blood Lipids (high cholesterol and triglycerides)
 *Lack of exercise

Non-Modifiable Risk Factors
 *Male Gender (sorry guys : )
 *Advanced age
 *Family History of heart diseases
 *Diabetes Mellitus (well controlled reduces risk)

If you have three or more of these risk factors, NOW is the time to take a pro-active stance in your own health care.  Control hypertension with medications and a low sodium diet, stop smoking (I know, easier said than done), control blood lipid levels with medications and a diet low in saturated fat.  If you don’t currently exercise, start.  Simply walking for twenty minutes, three times per week is sufficient.  And lastly, if you are overweight, work to lose the excess pounds by reducing your total fat intake, total calorie intake and exercising.  If you already have a cardiac history and take medication, be sure you have plenty of extra medication on hand to “stash” back, incase you are no longer able to get it.  Remember, medication is not a cure all.  Living a heart healthy life style is still a necessity.

When a person with no previous cardiac history has an initial onset of chest pain, most will deny the problem.  Many will attribute the pain or pressure to gas, indigestion, or heartburn.  They may be exhibiting more signs and symptoms other than the chest pain or pressure, but often don’t realize those symptoms are cardiac related.  Many will take large quantities of antacids trying to alleviate the discomfort, without success.  Fortunately many will call their doctor or EMS before the problem gets too severe, however a small percentage will remain in denial, and experience a massive heart attack, or even death.

In current times, there are many medications and procedures to treat cardiac problems.  In PSHTF time, we will be very limited in what we can do.  One treatment, that will not stop a heart attack, but may help, is taking an aspirin at the onset of the symptoms.  It works because it thins the blood making it easier to circulate. This has become common practice with EMS and emergency rooms across the nation, and even promoted on television.  In most cases this will not hurt the patient, unless they are allergic to or have hypersensitivity to aspirin.  Another treatment that is common for simple chest pain is the administration of Nitroglycerine.  Nitro is a prescription medication and SHOULD NOT be used or administered by untrained persons.  It dilates the blood vessels, making it easier for blood to circulate through the heart.  It can be dangerous if used in excess, causing hypotension (a severe drop in blood pressure).  Again, untrained people SHOULD NOT use Nitroglycerine.  It can and will kill you.

Lastly, learn CardioPulmonary Resuscitation (CPR).  I have never personally seen a case where CPR alone revived a patient in cardiac arrest, but if CPR is initiated within the first four minutes after arrest, the patient maintains a greater chance of resuscitation when EMS arrives than they do without it.  Brain damage begins after four minutes and brain death occurs after eight minutes.  EVERYONE should be trained in CPR, no excuses.

I hope this article was informative in helping you basically understand the heart, chest pain, and heart attack.  It will be a dire situation for someone suffering from cardiac problems in PSHTF time, so be diligent about your health.


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