Warning Signs
| Sign | What to Look For |
|---|---|
| Chest pain/pressure | Substernal heaviness, squeezing, or "elephant on the chest" — may radiate to left arm, jaw, neck, back, or epigastric region; typically lasts > 20 minutes and does NOT resolve with rest or nitroglycerin |
| Diaphoresis | Sudden cold, clammy sweat unrelated to room temperature or exertion |
| Nausea/vomiting | May be the primary complaint, especially in inferior wall MI |
| Dyspnea | Sudden shortness of breath, with or without chest pain |
| Pallor | Ashen or gray skin color indicating poor perfusion |
| Anxiety / sense of doom | Intense, unexplained feeling that something is catastrophically wrong |
Atypical Presentations
Women and individuals with diabetes are more likely to present without classic substernal chest pain. Atypical signs include:- Unexplained fatigue or sudden exhaustion
- Back pain (interscapular region)
- Epigastric pain mistaken for indigestion
- Jaw or neck pain without chest discomfort
- Nausea, lightheadedness, or syncope as the primary symptom
What the MT Must Do if Signs Occur During Treatment
- Stop treatment immediately. Do not continue any technique.
- Help the client to a comfortable position. Semi-reclined (45 degrees) is usually best — this reduces cardiac preload and eases breathing. Do NOT have the client lie flat.
- Call 911 immediately. State clearly: "I believe my client is having a heart attack."
- Note the time of symptom onset. This information is critical for the emergency team — reperfusion therapy (PCI or thrombolytics) is time-dependent ("time is muscle").
- Do NOT have the client walk or exert themselves. Any physical effort increases myocardial oxygen demand on an already ischemic heart.
- If the client has prescribed nitroglycerin, assist them in taking it (sublingual). Do NOT administer medication that is not prescribed to the client.
- Stay with the client. Monitor breathing and consciousness until EMS arrives. Be prepared to initiate CPR if the client becomes unresponsive and stops breathing.
Key Takeaways
- Acute MI is an absolute medical emergency and an absolute contraindication to massage therapy — the MT role is recognition and emergency activation, not treatment
- Classic presentation is substernal chest pressure radiating to the left arm or jaw with diaphoresis, but women and diabetics frequently present atypically (fatigue, back pain, nausea without chest pain) — a high index of suspicion is essential
- Time of symptom onset is critical information for the emergency team — reperfusion outcomes depend on speed of intervention
- For the massage therapist's role in post-MI cardiac rehabilitation and recovery, see Post-Myocardial Infarction