do you know enough about MI symptoms?

UM Review RN, ASN, RN · Oct 8, 2006

i'm so sorry for your loss, diamond meadows. please accept my deepest sympathy. ~angieo

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here is the american heart association list of warning signs for heart attack, stroke, and cardiac arrest.

http://www.americanheart.org/presenter.jhtml?identifier=3053#heart_attack

heart attack, stroke and cardiac arrest warning signs

quick links:

heart attack warning signs

stroke warning signs

cardiac arrest warning signs

act in time

the american heart association and the national heart, lung, and blood institute have launched a new "act in time" campaign to increase people's awareness of heart attack and the importance of calling 9-1-1 immediately at the onset of heart attack symptoms. find the links here.

dial 9-1-1 fast

heart attack and stroke are life-and-death emergencies -- every second counts. if you see or have any of the listed symptoms, immediately call 9-1-1. not all these signs occur in every heart attack or stroke. sometimes they go away and return. if some occur, get help fast! today heart attack and stroke victims can benefit from new medications and treatments unavailable to patients in years past. for example, clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives. but to be effective, these drugs must be given relatively quickly after heart attack or stroke symptoms first appear. so again, don't delay -- get help right away!

statistics

coronary heart disease is america's no. 1 killer. stroke is no. 3 and a leading cause of serious disability. that's why it's so important to reduce your risk factors, know the warning signs, and know how to respond quickly and properly if warning signs occur.

heart attack warning signs

some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. but most heart attacks start slowly, with mild pain or discomfort. often people affected aren't sure what's wrong and wait too long before getting help. here are signs that can mean a heart attack is happening:

chest discomfort. most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. it can feel like uncomfortable pressure, squeezing, fullness or pain.
discomfort in other areas of the upper body. symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
shortness of breath. may occur with or without chest discomfort.
other signs: these may include breaking out in a cold sweat, nausea or lightheadedness

as with men, women's most common heart attack symptom is chest pain or discomfort. but women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

if you or someone you're with has chest discomfort, especially with one or more of the other signs, don't wait longer than a few minutes (no more than 5) before calling for help. call 9-1-1... get to a hospital right away.

calling 9-1-1 is almost always the fastest way to get lifesaving treatment. emergency medical services staff can begin treatment when they arrive -- up to an hour sooner than if someone gets to the hospital by car. the staff are also trained to revive someone whose heart has stopped. patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

if you can't access the emergency medical services (ems), have someone drive you to the hospital right away. if you're the one having symptoms, don't drive yourself, unless you have absolutely no other option.

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stroke warning signs

the american stroke association says these are the warning signs of stroke:

sudden numbness or weakness of the face, arm or leg, especially on one side of the body
sudden confusion, trouble speaking or understanding
sudden trouble seeing in one or both eyes
sudden trouble walking, dizziness, loss of balance or coordination
sudden, severe headache with no known cause

if you or someone with you has one or more of these signs, don't delay! immediately call 9-1-1 or the emergency medical services (ems) number so an ambulance (ideally with advanced life support) can be sent for you. also, check the time so you'll know when the first symptoms appeared. it's very important to take immediate action. if given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

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cardiac arrest strikes immediately and without warning. here are the signs:

sudden loss of responsiveness (no response to tapping on shoulders).
no normal breathing (the victim does not take a normal breath when you tilt the head up and check for at least five seconds).

if these signs of cardiac arrest are present, tell someone to call 9-1-1 and get an aed (if one is available) and you begin cpr immediately.

if you are alone with an adult who has these signs of cardiac arrest, call 9-1-1 and get an aed (if one is available) before you begin cpr.

use an aed as soon as it arrives.

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Trauma Columnist · Oct 8, 2006

I am so sorry for your loss. MI symptoms in females are often overlooked or attributed (wrongly) to a different cause. My mother had her first MI at 58 y/o and the only symptom that she had was jaw pain. She thought she had a dental problem.

cota2k · Oct 8, 2006

Yesterday in the ED our triage nurse nicknamed "Bring 'em back jack", given the name for bringing patients directly back if they are suspiscious, brought back a 67 y/o female that was tired. Began having difficulty walking across a small room, sob after minimal activity. A new onset, no CP, non-diaphoretic, no n/v. EKG was a Mobitz 2 with her rate in the 30's. She was fortunate, seemingly innocent symptoms, and did not come by ambulance. She was admit to ICCU with cardiology and surg consult for pos pacemaker. No this wasn't an MI, but the cardiac symptoms are just so sneaky!

rjflyn, ASN, RN · Oct 8, 2006

I am going to use the anthology as follows.

In females of childbearing age any pain between the navel and the knees involves pregnancy or the reproductive system until proven otherwise. SO it goes any discomfort from the navel to the chin in women over 50 is cardiac until proven otherwise. You notice I did not say pain.

Thankfully the same hormones that make women, female give them protecton against MI that men dont have.

RJ

Larry77, RN · Oct 8, 2006

Almost every time I've taken care of a female with an acute MI there were no classic MI s/s...often times GI c/o, low back px, jaw pain (as mentioned earlier), L arm px, and weakness. Pretty much anybody with risk factors in our dept. gets a good ol' EKG.

Medic/Nurse, BSN, RN · Oct 8, 2006

I do hope so. I've "developed" my "MI sixth sense" through a LOT of experience. Get a doc to the bedside. Plug 'em in and line 'em up. A little O2 is only contraindicated in Paraquat ingestion...so I can rule that out pretty quick. Do the EKG, get a set of markers. A little ASA and close monitoring. If its nothing - well. If your patient is "doing it" - I have a better chance of seeing that your life gets saved!

When my beloved grandmother had a heart attack in 1994 - the ink on my paramedic certs was still drying, but... I credit one of my paramedic preceptors with the save. "IF you've got someone old, especially a woman, and they are sick and you don't know why - they are having a BIG OLE MI until you can prove they are not - got it?"

I got it.

I called my nana to go to the market when she told me she was "sick, sick, sick - had vomited and vomited and didn't feel good". Denied SOB, CP, chest pressure, jaw pain, headache - denied everything except for nausea and vomiting (sick). I immediately went to her house (2 blocks) where I found her sitting in the chair (looking like she might just die - yep, that COLOR - and she was also getting a fairly pronounced "bruise" on her forehead - she admitted that she was a bit weak and may have hit her head".)

Well, (this sounds stupid, but if I'd called from home - she'd argue) I left her to go to the local volunteer ambulance (I was a member of) to get supplies and get the dispatcher to sent me a truck/call a crew. I returned to her, placed O2, ASA, AED (Physio LP 500 - I know its an AED, but had a small screen - so I could monitor a Lead II - not really an approved use - this service had NOT transitioned to ALS service at that time). When the ambulance/other crew arrived I told her, "Nana, I'm gonna pick you up and put you on the stretcher - I think you are having a heart attack and we are going to the hospital and other paramedics will meet us soon". She started to protest, deny and weep (a little), but arguing with me is a futile activity - so off we went.

She recovered in spite of the the ER care she received. ("She's not having CP/SOB - I don't see the point of a cardiac work-up"...so I put her on the O2, monitor and insisted on the 12 lead". She had marked ST elevation on the AED and in the ED. Thank God I'm a bit pushy at times).

As a medic/nurse I've seen all kinds of presentations:

36 M - wanted all his teeth pulled "right now" (he had great teeth)

52 M that had posterior neck pain

45 M male that felt if he as being "stabbed" in the stomach

Variety of "older (65+)" folks that felt tired, weak - really NON SPECIFIC

My 40 ish cousin (dad had died at 50ish) c/o shoulder pain/abdomen pain, SOB, diaphoresis - writhing about in pain - did get some relief with Nitro, but his pressure would not hold - well, the ED (same one my nana went to 2 years earlier - 25 miles from home, but the only hospital - I'LL REFRAIN HERE) blew it, the ED doc "didn't think it could possibly be his heart" even with strong hx and some relief with NTG - he as admitted to surgery service (for GB disease) and died that night. His GB was great on autopsy. That was 1996 - Thank God the standard of care has evolved.

ANYWAY: The point is this ... Any clinical suspicion should set the CP process in motion. The cost of being wrong (no cardiac problem) is small - the cost of not properly treating the patient can be DEATH. I'm not advocating:

"EVERYONE ON A MONITOR - YOU DON"T HAVE THE RESOURCES"

but, when something exceeds the super obvious, you have to have a high clinical index of suspicion.

Any patient of certain age with family hx, risk factors that has sx above the knees! Also patients history cocaine, meth, crack or other drug use.

Male greater than 40 with classic sx (CP, SOB, Diaphoresis, etc)

Female (esp. post menopause) with classic or vague sx (esp. vomiting - without any known cause)

Any patient that had a lapse in consciousness.

Many patients with irregular pulses (you'd be surprised how many nurses NEVER palp a pulse - just check the monitor, pulse ox etc)

Patients that just don't look well.

In my experience, only a small % have the classic crushing, pressure pain with SOB. So stay sharp. I've been learning for 16 years and continue to do so. You experience does benefit the patient. Ask the doc's, other nurses - choose to LEARN!

In many patients, I always, at least, get the 12 lead unless I can find a reason NOT to. That is I need a better reason NOT to do something than I need a reason to do it! (That edict came from a medic preceptor too. It has saved me and lots of patients through the years)

Practice Safe. Stay Safe and Keep Learning!

GOOD LUCK!

RunnerRN, BSN, RN · Oct 8, 2006

Awesome above post - very good wake up call. I know in my ED, it is the 45 y/o women w nonspecific NV and tiredness that kills us w hitting our EKG standards. I agree with the MI 6th sense - there are times that I walk into a room and think "there is something not right here."

I think a lot of nurses get into the habit of writing "pt denies cp/sob" like it is some kind of catch all CYA phrase. It would be very interesting to find out how many people come into the ED w the vague complaints, and are having an MI (not the "big fatty MI" that will kill them, but some sort of cardiac event/angina). I think it would be quite scary to find out those numbers.

JentheRN05, RN · Oct 8, 2006

I'm almost ashamed to admit this, but in the last 2 months I have had several tell tail signs of MI. Because of not having insurance coupled with a strong family history of hypertrophic cardiomyopathy, I won't go to the ER. I know I will get diagnosed and no insurance will cover me.

I had an anoymous Xray done of my chest and it showed marked enlargement of my heart. I mean 2x - 3x it's normal size.

I just can't go to the hospital. I know eventually one of these 'events' will kill me (only being 35). But until I get insurance you can not drag me to an ER even though i KNOW whats going on.

I had one last night without any previous reasoning (others I could explain away - stress, over-exertion). This one I was lying in bed at 2am when it happened. I however started with non-obvious signs. Now I have more obvious ones.

How I treat myself at home is the only way I can. Good ole ASA and lots of deep breathing while lying down.

Please don't tell me to go to the ER. I can't afford it - and when I do die, I don't want my family struggling more than they already do.

Antikigirl, ASN, RN · Oct 8, 2006

I have seen a variety of symptoms, especially in women. Some range from a shoulder pain, flank pain, muscle weakness, fatigue, indigestion, chest tighness or pain, flu symptoms, or closer to the typical pains.

With women, you just don't know typically...so best to get EKG's on them and bloodwork to rule it out!

Men can have vague symptoms too. My hubby just had arm pain for a week, but had been hunting and thought it was pulled or strained muscles from the gun. Then one night the pain radiated to his jaw...and we went in fast!!!!! Sure enough...MI in progress. He is fine now thank Goodness..but really...he was unsure what to think because the pain and discomfort were very "ODD" (he is a paramedic and didn't even know how to describe it...just wierd and odd).

UM Review RN, ASN, RN · Oct 8, 2006

I'm almost ashamed to admit this, but in the last 2 months I have had several tell tail signs of MI. Because of not having insurance coupled with a strong family history of hypertrophic cardiomyopathy, I won't go to the ER. I know I will get diagnosed and no insurance will cover me.
I had an anoymous Xray done of my chest and it showed marked enlargement of my heart. I mean 2x - 3x it's normal size.
I just can't go to the hospital. I know eventually one of these 'events' will kill me (only being 35). But until I get insurance you can not drag me to an ER even though i KNOW whats going on.
I had one last night without any previous reasoning (others I could explain away - stress, over-exertion). This one I was lying in bed at 2am when it happened. I however started with non-obvious signs. Now I have more obvious ones.
How I treat myself at home is the only way I can. Good ole ASA and lots of deep breathing while lying down.
Please don't tell me to go to the ER. I can't afford it - and when I do die, I don't want my family struggling more than they already do.

I suggest very strongly that your health, not money, should be your concern right now.

Please see a doctor asap about your symptoms.

Long Term Care Columnist / Guide · Oct 8, 2006

I'm almost ashamed to admit this, but in the last 2 months I have had several tell tail signs of MI. Because of not having insurance coupled with a strong family history of hypertrophic cardiomyopathy, I won't go to the ER. I know I will get diagnosed and no insurance will cover me.
I had an anoymous Xray done of my chest and it showed marked enlargement of my heart. I mean 2x - 3x it's normal size.
I just can't go to the hospital. I know eventually one of these 'events' will kill me (only being 35). But until I get insurance you can not drag me to an ER even though i KNOW whats going on.
I had one last night without any previous reasoning (others I could explain away - stress, over-exertion). This one I was lying in bed at 2am when it happened. I however started with non-obvious signs. Now I have more obvious ones.
How I treat myself at home is the only way I can. Good ole ASA and lots of deep breathing while lying down.
Please don't tell me to go to the ER. I can't afford it - and when I do die, I don't want my family struggling more than they already do.

OK, I won't tell you to go to the ER. I've been uninsured for much of this year myself, and I totally understand what it's like to know you have something that could be disastrous, yet be unable to afford to have it taken care of.

Now.........please think of this: If you become so ill that you a) cannot work, and/or b) become permanently disabled because of your condition, do you not think that will create hardships for your family as well? And while you may not think dying wouldn't be a burden to them, I'm sure they would feel very differently.

Jen, you MUST get help. Surely there is a free or low-cost clinic in your area that could treat you and/or refer you to a hospital that provides charity care. There are also many different drug companies that offer free meds to members of the public who cannot afford them. You can't just let yourself get sicker and sicker, not only because of the danger of dying, but because it will cost MORE in the long run if you don't get treated---after all, you're a nurse, and you know that death isn't always the immediate outcome. And in the meantime, you'll feel awful, and your heart will be that much more compromised.

Please, do NOT delay---get on the phone and find out what help is available in your area. And keep us posted..........we care!