Explaining MI

medicnick83

medicnick83

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Hi all,

I had a very interesting discussion with a 'newbie' EMT the other day, he is doing ride along shifts with me and my partner and I have to do alot of explaining to him with regards to medical related stuff which I really enjoy because sometimes I actually have to think about what I understand and how to explain it.

Now; he asked me a question which I'm struggling to answer in a way that we both are happy with, so now I'm going to ask for some assistance from you guys.

When a patient is having a MI, he generally experiences the following:

• heaviness in or across the chest.
• pain in the chest, back, jaw, and other areas of the upper body.

There are others signs and symptoms I know but I'm struggling to explain why exactly the patient feels the above 2.

I have quite a few eBooks on Cardiology but I can't seem to find a explanation in those for the above 2.

Thanks for the assistance.
 
Have you checked Google? This is very straight forward stuff.
 
It is an attack of the heart.
 
The lactic acid produced by the ischemic cardiac tissue cause the burning, radiating pain/pressure.
 
Milla3P said:
Have you checked Google? This is very straight forward stuff.
Click to expand...

I know that many times, many things to many Paramedics are very straight forward, but to some, it's not so straight forward and then finding a good way to explain it so he / she / they understand it and REMEMBER IT (FOREVER) is not so easy - many people grasp a concept so easily, others, well, they don't.

epipusher said:
It is an attack of the heart.
Click to expand...

Yeah, in it's most basic form.

Underoath87 said:
The lactic acid produced by the ischemic cardiac tissue cause the burning, radiating pain/pressure.
Click to expand...

I found this last night and shared it with my colleague and he hasn't asked me anything since, so hopefully, discussion is sorted.

 
By the way, not everyone has those symptoms and women tend to have less chest pain than men (based on a very superficial Google search). My mom had an extremely severe MI and her only signs were slight SOB and the fact that she couldn't raise her arms above her head. No chest pain or discomfort whatsoever. If she had been doing physical work, she would have let it pass but this came on after a day of doing nothing.

To follow up, despite her presentation the hospital gave her nitro for when "she felt chest pain"...she ended up with a double bypass for 97% blockage of two of her arteries.
 
ThadeusJ said:
By the way, not everyone has those symptoms and women tend to have less chest pain than men
Click to expand...

Strangely enough, this is one of the questions he asked me, why do men have MORE pain than WOMAN.
 
...women and men do not really experience ACS thaaat differently, and no study has shown that they have "less chest pain" than men (or at least no rigorous study exists). I know our textbooks love this tidbit, but it is a giant Old Wive's Tale.

http://www.ncbi.nlm.nih.gov/pubmed/24275751

http://www.ncbi.nlm.nih.gov/pubmed/19850241

http://doccottlesdesk.blogspot.com/2013/12/women-acs-and-atypical-symptoms-new.html

Basically: chest pain in men and women occur at similar rates for ACS. Women may have more additional symptoms, but no rigorous study has been done which has proven this point.
 
1. Ischemia hurts
2. Visceral pain is generally dull and vague due to the lack of dense innervation by pain receptors
3. Radiation and referral is due to irritation of nearby nerves (I'll let you look those up)
 
Brandon O said:
2. Visceral pain is generally dull and vague due to the lack of dense innervation by pain receptors
3. Radiation and referral is due to irritation of nearby nerves (I'll let you look those up)
Click to expand...

Ahhhhhhhh that makes sense, thanks! Our bodies are not really designed to feel pain in this area, so it is experienced differently than something like an abrasion on the skin (where we have lots of sensory receptors).
 
Yes, exactly. Same principle for most other organs (comes up a lot in the abdomen). That's why appendicitis, for instance, starts dull and diffuse -- and often referred to the origin of its nerve fibers, i.e. the umbilicus -- and then becomes more localized pain only when it begins to irritate the overlying peritoneum (which is well-innervated).
 
I just want to add another story of atypical MI presentation that scared me during my medic hospital time:

~30 yom comes in by BLS, complaining of nausea... Just nausea, nothing else. Apparently his wife called 911 because he "just didn't look right". ED staff agrees that he just doesn't look right, and run a 12 lead - of course he's having a massive MI. About 10 seconds after the cardiologist comes RUNNING into the room, the guy codes.

It was probably less than 10 or 15 minutes between him getting off the BLS stretcher and him coding.

All I could think about was how easy it would have been for the EMT in the back to write it off as BS, not be paying much attention, be sitting in the captain's chair playing on his/her phone instead of sitting on the bench beside the patient, and not even notice him coding in the back of the ambulance (BLS doesn't have pulse ox or any sort of monitoring in my area). I had heard stories like this, but was pretty surprised to see it actually almost happen - apparently it's not just something they tell you in EMT school to scare you.
 
..... Parawhat?
 
Just want to point out that "referred pain" and "radiation" are distinct mechanisms. We tend to use the terms somewhat interchangeably, but they really mean different things.

Pain transmission and modulation is complex stuff.......and boring.
 
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