How Do You Differentiate Between Angina and ACS in Wilderness First Aid?

Question: How do I differentiate between angina and ACS in wilderness first aid? And what do I do if either of them occur?

Survival Med’s Answer: Distinguishing between Angina and Acute Coronary Syndrome (ACS) in wilderness first aid involves understanding their characteristics.

Angina Overview: Angina is a symptom, not a disease, describing chest pain or discomfort due to inadequate blood and oxygen supply to the heart muscle. Two types exist:
- Stable Angina: Predictable and triggered by exertion or stress. Typically relieved by rest or nitroglycerin. Evacuation may not be immediately necessary.
- Unstable Angina: More severe, unpredictable, occurring at rest, and not consistently relieved by rest or medications.
ACS Overview: ACS is a broader term encompassing acute heart conditions resulting from a sudden reduction in blood flow to the heart muscle. It includes unstable angina, NSTEMI, and STEMI. ACS is a medical emergency that can lead to a heart attack, also called a myocardial infarction.
Evacuation Considerations:
- Stable Angina: If the pain aligns with previous episodes and responds to nitroglycerin, evacuation may not be urgent.
- Unstable Angina or ACS: Severe, prolonged, or new symptoms should prompt cautious evacuation, minimizing exertion.

Differentiating without medical tools is challenging, emphasizing the importance of comparing symptoms to previous episodes. If symptoms deviate significantly, erring on the side of caution and initiating evacuation is advisable.