Angina Pectoris
Angina pectoris, also known simply as angina, is caused by insufficient oxygen being circulated to the heart muscle. This condition results from a spasm of the coronary artery, which allows the heart to function adequately at rest but does not allow enough oxygen-enriched blood to pass through the heart to support sustained exercise. When the body exerts itself, the heart muscle becomes starved for oxygen. The result of this condition is a squeezing, substernal pain that may radiate to the left arm and to the jaw. Angina is differentiated from other forms of heart problems because the pain results from exertion and subsides with rest. Many people who suffer from angina pectoris carry nitroglycerin tablets. If the victim of a suspected angina attack is carrying a bottle of these pills, place one pill under the tongue. Relief will be almost instantaneous. Other first aid procedures include providing supplemental oxygen, reassurance, comfort, monitoring vital signs, and transporting the victim to a medical treatment facility.

Acute Myocardial Infarction
Acute myocardial infarction results when a coronary artery is severely occluded by arteriosclerosis or completely blocked by a clot. The pain associated with myocardial infarction is similar to that of angina pectoris but is longer in duration, not related to exertion or relieved by nitroglycerin, and leads to death of heart-muscle tissue. Other symptoms are sweating, weakness, and nausea. Additionally, although the patient's respirations are usually normal, his pulse rate increases and may be irregular, and his blood pressure falls. The victim may have an overwhelming feeling of doom. Death may result.

First aid for an acute myocardial infarction includes

reassurance and comfort while placing the victim in a semi-sitting position;

loosening of all clothing;
carefully maintaining a log of vital signs, and recording the history and general observations;

continuously monitoring vital signs and being prepared to start CPR;
starting a slow intravenous infusion of 5% dextrose solution in water;
administering oxygen; and
quickly transporting the victim to a medical treatment facility.

Congestive Heart Failure
A heart suffering from prolonged hypertension, valve disease, or heart disease will try to compensate for decreased function by increasing the size of the left ventricular pumping chamber and increasing the heart rate. This condition is known as congestive heart failure. As blood pressure increases, fluid is forced out of the blood vessels and into the lungs, causing pulmonary edema. Pulmonary edema leads to rapid shallow respirations, the appearance of pink frothy bubbles at the nose and mouth and distinctive rattling sounds (known as rales) in the chest. Increased blood pressure may also cause body fluids to pool in the extremities.

Emergency treatment for congestive heart failure is essentially the same as that for acute myocardial infarction. Do not start CPR unless the patient's heart function ceases. If an intravenous line is started, it should be maintained at the slowest rate possible to keep the vein open since an increase in the circulatory volume will make the condition worse. Immediately transport the patient to a medical treatment facility.

CONVULSIONS
Convulsions, or seizures, are a startling and often frightening phenomenon. Convulsions are characterized by severe and uncontrolled muscle spasms or muscle rigidity. Convulsive episodes occur in one to two percent of the general population. Although epilepsy is the most widely known form of seizure activity, there are numerous forms of convulsions that are classified as either central nervous system (CNS) or non-CNS in origin. It is especially important to determine the cause in patients who have no previous seizure history. This determination may require an extensive medical workup in the hospital. Since epilepsy is the most widely known form of seizure activity, this section will highlight epileptic seizure disorders.

Epilepsy, also known as seizures or fits, is a condition characterized by an abnormal focus of activity in the brain that produces severe motor responses or changes in consciousness. Epilepsy may result from head trauma, scarred brain tissue, brain tumors, cerebral arterial occlusion, fever, or a number of other factors. Fortunately, epilepsy can often be controlled by medications.

Grand mal seizure is the more serious type of epilepsy. Grand mal seizure may be3/4but is not always3/4preceded by an aura. The victim soon comes to recognize these auras, which allows him time to lie down and prepare for the seizure's onset. A burst of nerve impulses from the brain causes unconsciousness and generalized muscular contractions, often with loss of bladder and bowel control. The primary dangers in a grand mal seizure are tongue biting and injuries resulting from falls. A period of sleep or mental confusion follows this type of seizure. When full consciousness returns, the victim will have little or no recollection of the attack.

Petit mal seizure is of short duration and is characterized by an altered state of awareness or partial loss of consciousness, and localized muscular contractions. The patient has no warning of the seizure's onset and little or no memory of the attack after it is over.

First aid treatment for both types of epileptic seizure consists of protecting the victim from self-injury. Additional methods of seizure control may be employed under a medical officer's supervision. In all cases, be prepared to provide suction to the victim since the risk of aspiration is significant. Transport the patient to a medical treatment facility once the seizure has ended.

DROWNING
Drowning is a suffocating condition in a water environment. Water seldom enters the lungs in appreciable quantities because, upon contact with fluid, laryngeal spasms occur, and these spasms seal the airway from the mouth and nose passages. To avoid serious damage from the resulting hypoxia, quickly bring the victim to the surface and Immediately even before the victim is pulled to shore start artificial ventilation. Do not interrupt artificial ventilation until the rescuer and the victim are ashore. Once on dry ground, quickly administer an abdominal thrust (Heimlich maneuver) to empty the lungs, and then immediately restart the ventilation until spontaneous breathing returns. Oxygen enrichment is desirable if a mask is available.

Remember that an apparently lifeless person who has been immersed in cold water for a long period of time may be revived if artificial ventilation is started immediately.