We will focus on the key symptoms and signs you need to be aware of when in the outdoors or even just sitting at home. In the outdoors, there are commonly extraneous circumstances that lead to more concerning outcomes. Backpacking, exertion and weight being carried, decreased oxygen when in high altitudes, and being transported out.
Fitness and Health Check-ups
It is imperative to get a check-up if you are over forty years of age and especially if there are heart issues in the family history. Your Health Care provider may want to do a treadmill stress test and lab work before any intense expedition.
Signs and Symptoms of a typical male
The classic scenario is chest pain over the mid chest (sternum) with or without radiation of that pain or pressure to the neck, shoulder, arm or back. It may or may not continue to the fingers and text book radiation of pain would commonly be the inner aspect of the arm and fourth and fifth finger. However, RARELY is anything textbook. A list of common signs and symptoms are:
- Dull or pressure pain in mid-chest
- A feeling of heaviness in the chest
- Squeezing feeling
- Nausea with or without emesis
- Shortness of Breath
- Arm or Jaw pain
- Anxiety and or pain with breathing
Signs and Symptoms for a female
For the female gender, all of the above can occur, however, it would not be uncommon for pain in the upper abdomen or radiating to back. Excessive fatigue and shortness of breath can also be contributing symptoms. Be advised, there can also be contributing factors that DO NOT make this a cardiac case and one must consider if the person is a smoker, asthmatic and has respiratory issues which can mimic these symptoms.
Common Differential Diagnoses
- Musculoskeletal pain (costochondritis) inflammation to the connection of ribs to the sternum (breast bone)
- Pneumothorax (collapsed lung)
- PE Pulmonary Embolism High risk if long flight, long drive in car, smoker and if on birth control. Video discusses this in more detail.
- Gastri reflux and gastritis
- Aortic Dissection
What to do if miles from no where
- Consider the degree of risk. If one is at high risk for a heart attack, evacuate immediately. Call for help 911, transport out via helicopter, or by any means possible with as little to no exertion for the identified patient.
- Aspirin, which has long been established as a first line intervention of 4 chewable 81 mg aspirin is still a first line treatment. The one-a-day aspirin has recently been revisited and that is beyond the scope of this article. ( IF ALLERGIC DO NOT RISK ASPIRIN ESPECIALLY IF ALLERGY IS ANAPHYLAXSIS)
- Do not eat or drink. One does not want to exacerbate a vomiting situation with could lead to aspiration and even worse a severe dehydration moment.
- If available in your pack, begin charting vitals every fifteen minutes. Even if it is just pulse and respiration, this will help when paramedics or a provider arrives.
- Psychological reassurance and talking the person down. Present reality that there are many causes of chest pain. It may be very unlikely that this is a heart attack, but always err on the side of caution.
- You can try an Antacid ( Tums, Rolaids ) If that relieves the pain, it can give some reassurance that this is gastric, however, it by no means is full proof. DO NOT RELY ON AN ANTACID. Still transport out.
- Try to avoid any inclines when walking out which can stress the heart even more. If possible, shoot for the valleys and no inclines.
- Loosen restrictive clothing and even remove bra. The tightness of a bra and the tightness of a belt can lead to increased anxiety and exacerbate feelings of pressure.
- Remove dentures or any bridges in the mouth. If issues exacerbate quickly, you can be ready for resuscitation.
- Consider having someone run for help but DO NOT leave the person alone. This broaches another topic in terms of psychological awareness and when to save one vs save yourself in an outdoor emergency. To be addressed in a latter video.