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Coronary thrombosis (myocardial infarction)
A heart attack happens suddenly and while the patient is at rest more frequently than during activity. The four main features are pain of similar distribution to that in angina, shortness of breath, vomiting, and a degree of collapse that may be severe. Sweating, nausea, and a sense of impending death are often associated features.
The pain varies in degree from mild to agonizing, but it is usually severe. The patient is often very restless and tries unsuccessfully to find a position that might ease the pain. Shortness of breath may be severe, and the skin is often grey with a blue tinge, cold, and covered in sweat. Vomiting is common in the early stage and may increase the state of collapse.
In mild attacks, the only symptom may be a continuing anginal type of pain with perhaps slight nausea. It is not unusual for the patient to believe mistakenly that he is suffering from a sudden attack of severe indigestion.
General treatment
The patient must rest at once, preferably in bed, in whatever position is most comfortable until he can be taken to hospital. Exertion of any kind must be forbidden and the nursing attention for complete bed rest provided. Restlessness, often a prominent feature, is usually manageable if adequate pain relief is given. Most patients prefer to lie back propped up by pillows, but some prefer to lean forward in a sitting position to assist breathing. An hourly record of temperature, pulse, and respiration should be kept. Smoking and alcohol should be forbidden.
Specific treatment
Whatever the severity of the attack, it is best to give all cases an initial dose of morphine, 15 mg intramuscularly, at once. If the patient is anxious or tense, give diazepam, 5 mg three times a day, until he can be placed under medical supervision. In serious or moderate attacks, give a further 15 mg of morphine, intramuscularly, 3-4 hours after the initial injection. The injection may be repeated every 4-6 hours as required for pain relief. Get RADIO MEDICAL ADVICE.
Specific problems in heart attacks
If the pulse rate is less than 60 per minute, give the patient atropine 1 mg intramuscularly, and raise the legs. The dose should be repeated after 4 hours, if the pulse rate remains less than 60 per minute. However, should a repeat dose become necessary, get RADIO MEDICAL ADVICE.
If the heart stops beating, get the patient on to a hard flat surface and give heart compression and artificial respiration at once.
If there is obvious breathlessness the patient should sit up. If this problem is associated with noisy, wet breathing and coughing give one 40-mg furosemide tablet, restrict fluids, start a fluid balance chart, and get RADIO MEDICAL ADVICE.
I. Read and translate the text.
II. Discuss the reasons of myocardial infarction
Heat exposure
Excessive heat may affect the body in a variety of ways, resulting in several conditions: heat stroke, heat cramps, and heat exhaustion.