Signs and Symptoms
Classic presentation includes chest pressure or tightness that may radiate to the arm, jaw, or back, along with shortness of breath, diaphoresis, nausea, and anxiety. Women, older adults, and patients with diabetes often have atypical symptoms such as fatigue, indigestion, or mild discomfort.
Treatment
Keep the patient calm and at rest, give oxygen if hypoxic (SpO2 below 94 percent), and assist with aspirin (162 to 324 mg chewed) if there is no allergy or active bleeding. Assist with nitroglycerin when prescribed, the systolic blood pressure is adequate (usually above 100 mmHg), and the patient has not taken a phosphodiesterase inhibitor recently.
Transport Priorities
Early recognition and rapid transport to a facility capable of percutaneous coronary intervention save heart muscle. Obtain a 12-lead ECG if your scope allows, and pre-notify the receiving hospital. Reassess vital signs frequently, because arrhythmias and cardiac arrest can develop suddenly.