Heart Attack

[agent 86]

After the recent fright TFB had .....

Rec'd this today from one of my nursing sisters via her nursing friend in a UK hospital.
Interesting and helpful if true. Have no reason to doubt my sister. Medicos out there ???

View attachment HeartAttack.zip

btw Have never uploaded a file to forum before, so hope it works.

 

[emcdonald]

sounds like the powerpoint is suggesting a manouvre called 'valsalva'.

We (paramedics) are instructed to use this manouvre when we receive a patient suffering from narrow complex tachycardia or supra ventricular tachycardia (basically a conscious patient with a very fast heart rate).

Patients in this condition may experience ischamia (lack of oxygen) to the heart due to the frantic pace at which it is contracting. This can result in central chest pain that may be described as the following: crushing, strangling, 'ton of bricks', banding etc and may radiate to the neck, shoulder, back, jaw, temples.

The method of 'coughing' is taken from the previously mentioned valsalva. When a patient coughs, blows against pressure or 'bears down' it increases the interthorasic pressure (pressure in the chest), this, in turn, puts pressue on the inferior vena cava vein. As the vein is compressed blood begins to back up in the vessel, when you let go (stop coughing or stop bearing down) the large bolus of blood is then released at a greater pressure then normal. Baroreceptors (pressure receptors) in the body take this as a sharp rise in blood pressure and thus tell the heart to slow down.

This is all well and good in theory but works on less than 10% of the true cases of SVT and NCT that we receive... Remeber that this manouvre is ONLY effective on the two conditions i mentioned earlier and NOT on most causes of heart attack which include:

 

[emcdonald]

*manual obstruction: a clot or emboli
*arterio sclerosis: hardening of the arteries through plaque deposits (this is not an acute condition)
*cardiomyopathy: disease or illness of the heart

It is also worth noting that even if your chest pain IS rate-related it does not necissarily mean you are having a heart attack. Example, we had a 21 year old female patient with central chest pain, sudden onset that was rate related (pulse rate 190 per minute) she was not having a heart attack, but her heart muscle was fatiguing, not pumping optimally and thus was not getting as much oxygen as it wanted; equalling pain. The valsala manouvre we tried on her slowed her heart rate momentarily to 140, then it returned to it's rate of 190. Definative care was hospitalisation and management with medications.

If you have an onset of chest pain:

*Stop whatever activity you are doing and lie down (if you are having trouble breathing sit up but don't remain on your feet)
* Take deep, slow breaths
* Remain calm
* Determine where the pain is in your chest (front, back, upper, lower)
* Determine the quality of the pain (sharp, blunt, throbbing, crushing)
* Call for help (ambulance, doctor, hospital A & E)

Risk factors include:

* Over 50
* Male
* Overweight / Obesity
* Smokers / Heavy drinkers
* Sedentary lifestyle
* Family History
* High blood pressure
* Elevated Cholesterol levels

Sorry to rant but i don't know that if you are really having a heart attack you will have the peace of mind to be telling yourself to cough deeply repeatedly - you'll be finding it hard enough to breathe as it is.

Any comments / differing opinions welcomed

Cheers e x

 

[duncan_m]

Snopes

Snopes has this to say about it:

http://www.snopes.com/medical/healthyself/coughcpr.asp

 

[agent 86]

emcdonald,

WOW. An here I was thinking your experiance was in a RE office down in Bris.


Thanks Duncan.
Keep the humble old asprin (crushed) in the wallet.
(And having a mob Ph in range in car.)


Better email my sister.

 

[emcdonald]

hey agent86,

my experience was briefly in RE for ljhooker, before that I did a couple of years of Biomedical Science a uni and have been a paramedic on the sunny coast since april last year.

Great idea for a thread though, cardiovascular disease is the number one killer out there.

Cheers, e x

 

[yo yo ma]

Risk factors include:

* Over 50
* Male
* Overweight / Obesity
* Smokers / Heavy drinkers
* Sedentary lifestyle
* Family History
* High blood pressure
* Elevated Cholesterol levels

Add diabetic to this list

I agree that is extremely unlikely for this technique for work... If you experience any prolonged period of chest pain, it should be checked out medically. Especially with any of the above risk factors.
yo