OK so today I want to discuss the topic of heart attacks.  With our patients being elderly, it can be quite common for us to be in a situation where heart attacks happen, and we need to be able to respond quickly.   First I want to discuss what a heart attack is.

What is a Heart Attack?

A Heart attack is caused from a portion of the heart not receiving enough oxygen.   This can happen for a variety of reasons.  It can be caused by an embolus or blood clot that is traveling through the arteries and blocks a portion of the artery.  It can also be caused by a slow build up of cholesterol in the artery, this weakens the artery wall, and can sooner or later dislodge and block the artery, or continue to become more and more dense which can also cause blockage.   Either way,  whats important for us to know is that the problem lies in a portion of the hearts tissue being unoxygenated, (ischemic), due to poor blood supply to the tissues, and more or less the tissue is starting to die.

Assessment of a Heart Attack

The first step to treating a patient for a heart attack is always going to be realizing that the patient is actually having a heart attack.    These are some common signs of a heart attack that you may see in your patients.

Pressure/pain in the chest,   this is the most obvious and common sign of a heart attack.  This can of course be caused by a variety of conditions such as a pulmonary embolism,  heart burn, and sometimes trauma.   Often times for our heart attack patients the pain will be a sudden onset,  the pain often radiates to the left arm but can really radiate anywhere.   Often times female patients will have the pain radiating to their backs, and sometimes they will present as having abdominal pain and not chest pain.  They can be a bit more tricky then male patients.    The pain is often described as crushing pain, or a pressure in the chest.

Increased Breathing Rate:  Often times you will find an increased breathing rate, or shortness of breath in a heart attack victim.     This shortness of breath comes from the lack of oxygen going to the heart.  The patients body goes into overdrive to try and save itself.    So the heart starts pumping faster and harder, and the brain tries to increase oxygen levels in the blood by increasing the respiratory rate.

 Profuse Sweating:  Also called diaphoresis ,  the patients body is working hard to stay alive, also there is a release of adrenaline (epinephrine) that is causing the body to work even harder, even though the patient may be at rest.

Treatment of a Heart Attack

Call 911!!!  Get the Paramedics out there immediately.   There are certain drugs that the paramedics can give that can really help out in a heart attack situation.  Its important to get them there immediately.

 Give that patient 100% oxygen.  You can use a nasal canula at 2/LPM or if its available a nonrebreather mask at 15/LPM.   We want to get this patients blood as oxygenated as possible.   Increased oxygen may help to oxygenate the ischemic tissues.

 Keep the patient calm, do not have the patient exercise in any way shape or form.  Do not walk him to his bed, do not have him do anything except lay down and get comfortable.

 As a CNA you are not able to give a patient medications, however if they are on certain medications, you may assist them with those medications.   If your patient takes nitroglycerine, and or aspirin, and has been told to take these pills by his or her doctor in this type of emergency, you may get the pills and hand them to the patient.   There are certain important things such as blood pressure, allergies, and use of sexually enhancing drugs toconsider when your patient tries to take these meds.   So its best to ask the RN to help, or to make sure the patient  knows what he or she is doing.

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