Triaging Heart Attacks Over the Phone

By Marci Lawing, RN BSN

For triage nurses, evaluating patients over the phone who may be having a heart attack can be challenging. Not all patients show the same symptoms leading to or during a heart attack, sometimes the symptoms of a heart attack can be rather subtle.  There is even the rarely talked about “silent heart attack”.  That is why it is important for patients to seek medical attention and call their triage nurse. Similarly, it is important for triage nurses to have a system, like the TriageLogic myTriageChecklist, to follow protocols for symptoms that may otherwise be overlooked or dismissed.

Women, in particular, frequently have less common symptoms that can be indicative of a heart attack. Symptoms such as a squeezing or fullness anywhere in the chest, not just on the left side. Sometimes the pain is not focused on the chest at all, rather it can be a pain in the arms, back, neck or jaw. This pain can even wake one from a sound sleep.

Conditions such as heartburn, the flu or stomach ulcers can mimic heart attacks. Unusual sweating and fatigue are other symptoms that often go untreated.

TriageLogic Heart Attack Patients

Sarah, a 45-year-old female in good health. She was under a lot of stress at work and thought the burning pain in her stomach and chest was heartburn. She was more tired than usual and thought she was going through menopause because she seemed to sweat more than she used too.  She treated her symptoms at home for several days before calling her triage nurse. After following the Schmitt-Thompson based protocols in the myTriageChecklist, the TriageLogic nurse told Sarah to go to her physician, who immediately did an EKG, which showed classic changes associated with a myocardial infarction or heart attack.

Eunice, a 76-year-old female, was experiencing severe, constant pain in her elbow. Eunice did not think much of it, since she had no other present symptoms. Her husband finally convinced her to call her triage nurse. After an assessment by a TriageLogic nurse, she was directed to go to the ER, where she found out that she was actually having a heart attack.

Scott, a 58-year-old male with a recent history of a heart attack, called a TriageLogic nurse about mid to upper back pain. He did not think it was related he thought he just over worked it at work. However, because he was having mild shortness of breath with it, his nurse sent him to his physician in order to rule out another heart attack.

Why do people delay seeking medical attention?

We all feel stressed out or tired at times and can often explain away these symptoms. We give excuses like “I was working hard in the yard today”, “I haven’t been sleeping well due to work stress”, or “I ate too late last night and caused heartburn.” No one wants to think that the symptoms they are having could be a life altering heart condition that frequently needs surgery. Denial is a common first reaction.

What do you do if you are the triage nurse that takes a call from a nervous patient with vague symptoms, such as upper abdominal fullness and fatigue? Rule One – any pain between the neck and naval is considered chest pain until proven otherwise! A good triage nurse will start coming up with “working diagnoses” from the second they start talking with the patient. “Multi-thinking” is essential to coming up with the right plan of treatment at the right time to assure your patient has the best outcome. The nurse may think epigastric fullness can be from a heartburn, gas, hiatal hernia, gastritis, or a heart attack. Fatigue, on the other hand, can be from stress, acute or chronic illnesses, or insomnia. Although they may not be related, the triage nurse should always take a moment to think “could these symptoms be related?” They should always think of the most common reason for the symptoms, like gas, to the most urgent, a heart attack.

How does the nurse tell the difference between simple heartburn and a heart attack? She doesn’t! Only blood tests, an EKG and a physician can make that determination. It is the triage nurse’s job to use her protocols, her critical thinking skills, and her nursing knowledge to ask the right questions in order to make an educated decision about the safest disposition at that time for her patient.

Not everyone with these symptoms is experiencing a heart attack, but any unexplained symptoms should be evaluated by a physician.