Angina vs. Heart Attack
In angina one of the coronary arteries "hardens". This essentially means that sufficient deposits of fat have built up in an artery to prevent the tissues on the other side of the narrowing from getting an adequate supply of blood. When one of the coronary arteries becomes hardened the blood supply the feeds that part of the heart is reduced so that the heart muscle as a whole has to work harder. This in turn causes pain in the chest, which can spread to the neck, jaw, shoulders, and arms. This pain is called angina. It is typically controlled by prescription medications.
A heart attack is caused when the heart's muscle tissue dies because the oxygen-rich blood supply is cut off. This is usually caused by a blood clot, which gets stuck in a narrowed artery. If enough of the heart tissue is affected then the heart will stop. This is known as cardiac arrest.
In either case the casualty could describe the pain as a heaviness, tightness, or squeezing. They may also just complain of sore arms, an aching jaw, or simply indigestion. Other symptoms may include: denying anything is wrong, fear, pale skin, nausea, vomiting, sweating, shortness of breath, fatigue, shock, unconsciousness, cardiac arrest. (St. John, 5-5 1996).
There is no way a first aider can determine if a casualty is suffering from angina or a heart attack. Only a doctor can determine this. Because of this the treatment is the same in both cases as far as the first aider is concerned.
1. Inform casualty you are first aid trained, and ask if you can assist them.
Everyone has the right not to be touched by others. When you are offering first aid this must be respected. You should always identify yourself as someone who is first aid trained, and then ask if you can help.
Once you have asked the casualty, they can say "Yes" or otherwise indicate their consent, or they can do nothing, but not prevent you from assisting. If a member of the casualty's immediate family is present they can also give consent. If the casualty is a child, and their parents are not around then you can also proceed. In all these cases you have consent or obliged consent to assist.
The casualty also has the right to say "No", which may sound odd, but they may have reasons, which you must respect. If this is the case make them comfortable if they allow it, and tend to others if necessary.
2. Call for medical assistance
When you recognize the signs and symptoms of angina or heart attack you should call for medical assistance, or have a bystander call for assistance. In today's world where most people carry cell phones this should not be a problem, if however you have to leave the casualty make sure they are at rest first.
3. Put casualty in resting position
By putting the casualty in the resting position you reduce the work that the heart has to do. The resting position has the casualty lying on their back, with their head and shoulders raised, and their legs bent at the knees and raised. It is also preferred to cover then with a blanket, coat, etc. to keep them warm.
It is possible that this position may increase the pain so try different positions, but do not delay calling for medical assistance.
4. Make sure casualty is comfortable
The best way to make a casualty comfortable is to loosen tight and restrictive clothing around the neck, chest, and waist. Also reassure the casualty as this will cause them to relax and this before reduces the work the heart has to do.
5. Assist the casualty to take their medication
If the casualty knows they suffer from angina, they will likely carry their medication with them. If the casualty is conscious and specifically requests for your assistance then proceed to do so. In any case always follow the instructions on the container, which includes ensuring the medication is for this patient, and ensuring the medication is administered in the proper way. For example nitroglycerine tablets must be placed under the tongue, not swallowed.
6. If breathing stops start Artificial Respiration (AR). If pulse stops start CPR.
It is not the purpose of this article to teach you either AR or CPR, as both require hands-on training and practice. While no specialized equipment is required for either of these procedures the equipment is available to assist you in training and practicing in the form of face shields, CPR training manikins or dummies, and training devices.
The role of a first aider when encountering a casualty suffering from either angina or a heart attack is primarily the same. Extensive training is available through local chapters of the St.. John Ambulance, Red Cross, and other organizations.
St. John's Ambulance. 1996. Military First Aid – Safety Oriented. National Defense Headquarters. Ottawa.