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Concerns

Myocardial infarction

Comorbidities

Signs and symptoms

Differential diagnosis

Action

Myocardial Infarction

Irreversible ischemic event, resulting in decreased oxygenated blood supply to the myocardium.

Comorbidities

  • history of angina
  • smoking
  • hyperlipidemia
  • family history of atherosclerosis

Signs and symptoms

  • substernal pain – “crushing”, “heavy”,   “squeezing”, “tight band”
  • radiating pain to the left shoulders, arms, or   mandible
  • confusion, apprehension, fear, flushed or chilled   feeling, sweating, nausea, palpitations
  • hypotension
  • symptoms do not subside with anti-anginal medications
  • symptoms are atypical in women and diabetics

Differential diagnosis

  • spontaneous pneumothorax
  • aortic dissection
  • esophageal rupture
  • panic disorder

Action

  • be calm and reassuring
  • discontinue dental treatment
  • clear the mouth of all foreign objects
  • assess responsiveness
  • place the patient in a slightly upright position
  • evaluate breathing, airway and circulation
  • monitor blood pressure, pulse and respiratory rate every 5 min
  • administer oxygen, 6-8 L/min
  • administer 0.3 mg nitroglycerin sublingually; repeat up to 3 times every 5 minutes
  • consider IM morphine 2 – 4 mg
  • give an aspirin (325 mg), chew and swallow
  • alert emergency medical services (EMS)
  • if patient loses consciousness, initiate CPR (see “Unresponsive and unconscious patient” above)
  • use an automated external defibrillator (AED)

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