Myocardial infarction

Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a serious, sudden heart condition usually characterized by varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting, and arrhythmias, sometimes causing loss of consciousness. It occurs when a part of the heart muscle is injured, and this part may die because of sudden total interruption of blood flow to the area. It is often a life-threatening medical emergency which demands both immediate attention and activation of the emergency medical services.

First aid

Immediate care

As myocardial infarction is a common medical emergency, the signs are often part of first aid courses. General management in the acute setting is:

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• calling for help as soon as possible
• giving aspirin (162-325 mg), which inhibits formation of further blood clots
• giving the patient nitroglycerin under the tongue if the patient is carrying tablets or liquid spray
• being prepared to administer cardiopulmonary resuscitation (CPR) in case of arrhythmia or cardiac arrest

Since the publication of data showing that the availability of automated external defibrillators (AEDs) in public places may significantly increase chances of survival, many of these have been installed in public buildings, public transport facilities and in non-ambulance emergency vehicles (e.g. police cars and fire engines). AEDs analyze the rhythm and determine whether the arrhythmia is amenable to defibrillation ("shockable").

Related Topics:
Automated external defibrillator - Public transport - Police car - Fire engine - Defibrillation

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Emergency services

Emergency services may recommend the patient to take nitroglycerin tablets or patches, in case these are available, particularly if they had prior heart attacks or angina.

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In an ambulance, an intravenous line is established, and the patient is transported immediately if breathing and pulse are present. Oxygen first aid is provided and the patient is calmed. Close cardiac monitoring (with an electrocardiogram) is initiated if available.

Related Topics:
Ambulance - Intravenous - Oxygen first aid - Electrocardiogram

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If the patient has lost breathing or circulation advanced cardiac life support (including defibrillation) may be necessary and (at the paramedic level) injection of medications may be given per protocol. CPR is performed if there is no satisfactory cardiac output.

Related Topics:
Advanced cardiac life support - Defibrillation - Paramedic - CPR - Cardiac output

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About 20% of patients die before they reach the hospital; the cause of death is often ventricular fibrillation.

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Wilderness first aid

In wilderness first aid, a possible heart attack justifies medical evacuation by the fastest available means, including MEDEVAC, even in the earliest or precursor stages. The patient will rapidly be incapable of further exertion and have to be carried out.

Related Topics:
Wilderness first aid - Evacuation - MEDEVAC

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Air travel

Doctors traveling by commercial aircraft may be able to assist an MI patient by using the on-board first aid kit, which contains basic cardiac drugs used in advanced cardiac life support, and oxygen. Flight attendants are generally aware of the location of these materials. Pilots are required to divert the flight to the nearest airport.

Related Topics:
First aid kit - Advanced cardiac life support - Oxygen

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