Myocardial infarction

At the basis of this very serious disease is necrosis of some area of cardiac muscle, it is characterised by pains behind the breast bone - extremely strong, can’t be stopped by rest or of nitroglycerin, last for more than 30 minutes (up to several hours). These pains are accompanied by fear of death, dyspnea, acute weakness, BP decrease, etc. Such patient require urgent hospitalisationinto intensive care department, which is equipped with necessary tools for monitoring (automatic constant monitoring) of patient’s state and possible reanimation actions. Within the first days the patient is under strict bed rest.

Pulmonary edema -

isthe most serious manifestation of cardiac failure, when the liquid part of blood transudates through vessel walls and accumulates in alveoli. Thus,to previously mentioned symptoms of cardiac asthma add bubbling breath and excretion of pink foamy sputum.

Help in dyspnea includesplacing the patient in sitting or half-sitting (orthopnea) position, removing constraining clothes, providing access of fresh air, nitroglycerin (in absence of contraindications) or antihypertensive drugs in case of the increased BP on doctor's orders.

Actions for providing help in cardiac asthma and pulmonary edema includes the following.

— Immediately call the doctor.

— Put the patient into position sitting (orthopnea).

— Give the patient nitroglycerin, systolic BP is no less than 100 mm

— Startoxygenotherapy with defoamer through mask or nasal catheter.

— Start active aspiration (suction) of foamy sputum with suction machine.

— When the patient is in sitting position applyvenous tourniquet on both legsat 15 cm below inguinal fold (rubber tubes or cuff from a tonometer) in order to deposit blood in greater circulation and delay its inflow to lungs (venous tourniquets can be applied additionaly on arms).

— It is necessary to check that only veins are blocked - i.e. arterial sphygmus below tourniquet should be preserved and the extremity should become cyanotic, but not white. After 15-20 minutes the tourniquet should be eased. Taking tourniquets off should be donesubsequently and slowly (first from one extremity, after a while from another one).

— To remove part of circulating fluid from blood flow and unload lesser circulation bloodlettting is possible; hot foot baths is also possible.

— On doctor's orders introduce intravenously narcotic analgetics, diuretics, inhibitors of angiotensin converting enzyme(ACE), cardiac glycosides and other necessary medical drugs.