2013 CRUZ ROJA OCTOBER GENERAL MEETING

DR. SAM THELIN, CR MEDICAL DIRECTOR

Heart Attack (Also Known As: Myocardial Infarction)

Goal of Presentation: Identify symptoms that could be or lead to a Heart Attack, Learn what actions are needed and what options are available to limit cardiac damage that could result in loss of physical abilities and death.

What is a Heart Attack? Dictionary: death or damage to part of the heart. World Health Organization - Old consensus: two out of three characteristics; chest discomfort, Cardiac Enzyme elevation, or ECG with Q waves. Post 2000: Joint European Society of Cardiology / American College of Cardiology Committee redefines it by myocardial cell death, biochemical markers of myocardial cell death, evidence of myocardial ischemia (ST-T changes), Q waves (loss of electrically functioning cardiac tissue), and imaging that indicates loss of tissue perfusion and cardiac wall motion abnormalities.

Symptoms (clinical presentation): shortness of breath, loss of stamina, sweating, nausea, vomiting, light-headedness, o fainting; discomfort in areas of central chest, epigastric, arm, wrist, jaw, shoulder, neck, back.

- May be 20 minutes, may be less. - Not affected my movement, position, or deep inspiration.

Problems in Identification of Symptoms: May be all, some, or none of the symptoms. Symptoms could be related to other pathologies and confused.

Differential Diagnosis: Angina (stable and unstable), lung bleb, pleuritis, collapsed lung, tension pneumothorax, tear in aorta, precordial catch syndrome, rupture of the

2013 CRUZ ROJA OCTOBER GENERAL MEETING

DR. SAM THELIN, CR MEDICAL DIRECTOR

esophagus, esophagitis, perforating peptic ulcer, pulmonary embolus, pericarditis, or mitral valve prolapse… or “other”.

What happens during a Heart Attack? Ischemia, cardiac muscle weakness, loss of electrical activity, pH changes, etc. Temporary vs. permanent damage and changes. How long does this take?

What is the Reality?: From primary care setting reports, the actual causes of chest pain are: musculoskeletal 36 to 49 %, gastrointestinal 8 to 19 %, pulmonary 5 to 10 %, and psychiatric 8 to 11%. Cardiac is only actually 15 to 18% of the cause.

If it probably is not a Heart Attack, why bother? Embarrassment, inconvenience, cost.

If it is a Heart Attack? What then? Where (Chapala, Guadalajara, USA/Canada)? How (What do I do, who do I call, what can I take, what treatment do I want)? When (Now, minutes, hours, days)? How can I be sure it is a Heart Attack?

HAVE A PLAN ! Have a plan “A” and a plan “B” Treatment:

- Aspirin, oxygen, nitroglycerine, defibrillator. - Angioplasty and stents - Thrombolytics*: Streptokinase (AKA “Cheap-O-Kinase”), Alteplase, Reteplase, Anistreplase, Tenecteplase, etc. Which is the best? tPA vs. Streptokinase *Not functional after two hours when clot hardens.

Aftercare: - After infarction (heart cell death), healing process leaves weak area that takes time to scar. Risk of heart rupture. - Electrical alterations: Blocks, atrial fibrillation. Etc. Warfarin, antidysrrythmics, etc.

How Will YOU be Prepared?

How will you know? What will you do? Where will you go, and How will you get there? Who will help you? Do those that will help you know what you want to do

and where you want to go? Who knows your medical history best and can help doctors treat you?