Medical Emergencies
Myocardial Infarction (Heart Attack)
This page discusses Myocardial Infarction. The dental team should always be prepared to manage it correctly if it occurs. Please see the Emergencies - Welcome page if you are not sure about the difference between a Cardiac Arrest and a Myocardial Infarction.
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The video discusses the signs and immediate actions to take if someone is suspected of having a heart attack. It outlines key symptoms to watch for, such as the individual appearing pale, cold, clammy, feeling nauseous, or excessively thirsty. These symptoms may arise suddenly, whether the person was resting or just experienced a shock.
To help the person, the video advises keeping the environment calm and encouraging them to sit on the floor in an upright position. This position can help alleviate breathlessness. To further assist circulation, it suggests placing something beneath their knees to create a 'lazy W' position. If they are able, leaning against a wall is also a suitable option.
If the affected person has a history of heart problems and has been prescribed a GTN (glyceryl trinitrate) spray, the video recommends encouraging them to use it by spraying it under their tongue. Additionally, if they have been advised to take a 300 mg aspirin, they should chew it to help manage the situation.
The video emphasises the importance of having access to a defibrillator. If there is one nearby, it suggests discreetly asking someone to retrieve it but ensuring that it remains out of sight to avoid alarming the person in distress. Finally, it reiterates the need to call for an ambulance promptly, as quick medical intervention is very important for the best chance of recovery.
If you prefer to view this page as didactic information, rather than as a self assessment, click the arrow below.
Didactic Information:
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Myocardial infarction (MI) is caused by loss of the blood supply to the heart muscle, due to a blockage in the coronary arteries. The “infarct” is the dead/dying muscle tissue that results from this lack of perfusion.
It is commonly caused by an atheromatous plaque (a fatty deposit on the artery wall) being dislodged.
Who gets it?
Risk factors include previous/concurrent heart disease, smoking, and high cholesterol. A patient with angina may suffer a heart attack, but many people who have MI’s do not have pre-existing angina.
Signs & Symptoms
The onset is rarely sudden – more often gradual, over a few minutes. Chest pain is the commonest symptom, similar to angina but more severe. The patient may describe it as crushing, and clench their fist over their chest while describing it more….
Pain may radiate into the left arm, the mandible, the neck, back, and stomach.
Additional symptoms include:
Shortness of breath (dyspnoea)
Sweating, clammy pale skin
Nausea and vomiting
Palpitations
MI’s can be entirely painless, especially in older people. Any collapse must be investigated for Signs of Life (breathing, circulation) and CPR instituted as appropriate.
Management
Call an ambulance immediately.
Sit the patient in a position that they feel comfortable – this may be a half-sitting position with knees bent. (Only lie them down if they are unconscious – recovery position if breathing and circulation are OK, or supine prior to CPR if not).
Give high flow oxygen (15 litres / minute) more…
Give sublingual GTN spray if this has not already been given.
Reassure the patient as far as possible to relieve further anxiety.
Give 300 mg Aspirin, crushed or chewed. This will reduce the chance of a clot forming in in the blocked artery.
When the ambulance arrives, inform them of any dental surgical procedure (e.g. extraction) you have done, so the hospital are aware when they give further thrombolytic (clot-busting) medication.
Self Assessment
What is a myocardial infarction (MI), and what usually causes one?
Who is at risk of a MI?
What are the signs and symptoms of a MI?
How would you manage a MI?