Angina & myocardial infarction

Key Sign:

  • Progressive onset of severe, crushing pain in the centre and across the front of chest; the pain might radiate to the shoulders and down the arms (more commonly the left), into the neck and jaw or through to the back

Symptoms include:

  • Shortness of breath
  • Increased respiratory rate
  • Skin becomes pale and clammy
  • Nausea and vomiting are common
  • Pulse might be weak and blood pressure might fall

Management

  • Assess the patient.

Administer 100% oxygen

Flow rate: 15 litres/minute.

Not relevant for children

For adults:

Administer 100% oxygen

Flow rate: 15 litres/minute.

For children:

Not relevant for children


Administer glyceryl trinitrate (GTN) spray, 2 puffs (400 micrograms per metered dose) sublingually, repeated after 3 minutes if chest pain remains.

Not relevant for children

For adults:

Administer glyceryl trinitrate (GTN) spray, 2 puffs (400 micrograms per metered dose) sublingually, repeated after 3 minutes if chest pain remains.

For children:

Not relevant for children


If the patient does not respond to GTN treatment then the priority is to transfer the patient to hospital as an emergency.

  • Call for an ambulance.

Administer aspirin, 300 mg dispersible tablet, orally.

Do not use in children because, rarely, it can cause Reye’s syndrome‡

For adults:

Administer aspirin, 300 mg dispersible tablet, orally.

For children:

Do not use in children because, rarely, it can cause Reye’s syndrome‡


NB:   The aspirin tablet should be chewed or dispersed in water.

If aspirin is given, send a note with the patient to inform the hospital staff.

‡Aspirin is not licensed for use in children under 16 years.

  • If the patient becomes unresponsive, check for signs of life (breathing and circulation), and if there are no signs of life or no normal breathing, initiate basic life support (BLS) and carry out early defibrillation where a defibrillator is available.*
    [Refer to Resuscitation Council (UK) guidance for details of BLS for adults and children.]

*In August 2014 the Scottish Government commenced roll-out of defibrillators to NHS dental practices in Scotland. All dental teams should be trained in the use of these devices.