CARDIAC DISORDERS: Heart Problems in the Mammo Suite (Part 3)

SERIES OBJECTIVES:

Mammography is a specialty that requires us to be advocates to the public for all manner of health related issues. Breast imaging has a personal and emotional component to it. Our patients trust us, place their faith in us and rely on us to be knowledgeable in many areas of health care.

On the whole we deal with middle aged female patients. Recently it has been shown in clinical trials that this demographic is a dire risk of heart attack and other cardiac disorders simply by not knowing they are at risk. We have a responsibility, not to diagnose, not to treat, but to be able to give cogent, informed advice when asked because she may never ask anyone else.

This month begins a three part series on the hearts of our patients. Although this seems like a topic that does not relate to our specialty, all knowledge is power. Accept the knowledge and use it to edify your life.

PART THREE: ACUTE MYOCARDIAL INFARCTION - HEART ATTACK

OBJECTIVES
Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a medical condition that occurs when the blood supply to a part of the heart is interrupted. The term myocardial infarction is derived from myocardium (the heart muscle) and infarction (tissue death due to oxygen starvation). The phrase "heart attack" is sometimes used incorrectly to describe sudden cardiac death, which may or may not be the result of acute myocardial infarction. A heart attack is different from, but can be the cause of cardiac arrest, which is the stopping of the heartbeat, and cardiac arrhythmia, an abnormal heartbeat. It is also distinct from heart failure, in which the pumping action of the heart is impaired; severe myocardial infarction may lead to heart failure, but not necessarily.

What is a Heart Attack?







Risk Factors:

• A history of vascular disease such as atherosclerotic coronary heart disease and/or angina
• A previous heart attack or stroke
• Any previous episodes of abnormal heart rhythms or syncope
• Older age—especially men over 40 and women over 50
• Smoking
• Excessive alcohol consumption
• The abuse of certain drugs
• High triglyceride levels, high LDL (low-density lipoprotein, "bad cholesterol")
• Low HDL (high density lipoprotein, "good cholesterol")
• Diabetes
• High blood pressure
• Obesity
• Chronically high levels of stress
• Chronic kidney disease

Classic symptoms of acute myocardial infarction include:

• Chest pain (typically radiating to the left arm or left side of the neck)
• Shortness of breath
• Nausea
• Vomiting
• Palpitations
• Sweating
• Anxiety (often described as a sense of impending doom)
• Feeling suddenly ill
• Women often experience different symptoms which can include shortness of breath, weakness, and fatigue
• One third of all myocardial infarctions are silent, without chest pain or other symptoms

Cardiopulmonary Resuscitation:
If a patient in your care loses consciousness, stops breathing and is pulse-less it will be necessary for you to begin life saving procedures until the EMS or the Code Blue teams arrive. For this type of emergency short term CPR only a few easy to remember steps are required. Blow here and Push there is all the drill you should need in a crisis.

CPR

1. CALL

• Check the victim for unresponsiveness
• No response
• Call a code and return to the patient

2. BLOW

• Tilt the head back and listen for breathing
• Pinch nose and cover the mouth with yours and blow until you see the chest rise
• Give 2 breaths
• Each breath should take 1 second

3. PUMP

• If the victim is still not breathing normally, coughing or moving, begin chest compressions
• Push down on the chest 11/2 to 2 inches 30 times right between the nipples

• Pump at the rate of 100/minute, faster than once per second.

CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL HELP ARRIVES
NOTE: This ratio is the same for one-person & two-person CPR. In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing.

SUMMARY
We, as mammographers, largely deal with female patients over the age of 50 years. It has been widely acknowledged that this group of patients is at risk of serious heart problems simply by not being aware they are at risk. Power is knowledge, pass it on!
Heart attack and/or cardiac death is the worst kind of patient distress that can enter our mammography suites. Fear and panic does not help. We must be able to recognize the distress, be ready to help assess the severity of the problem and, when necessary dive in with hands on assistance.