Cardiovascular Emergencies: Understanding and Responding to Heart Conditions

CARDIOVASCULAR EMERGENCIES

Cardiovascular Disease • 63,400,000 North Americans have one or more forms of heart or blood vessel disease • 50% of all deaths are cardiovascular disease

Cardiovascular Disease • Acute Myocardial Infarction (Heart Attack) - leading cause of death in U.S. • 1.5 million North Americans will have AMI’s this year • Of these .5 million will die! • 350,000 will die in first two hours!

Cardiovascular Disease Risk Factors • Major Uncontrollable • Age • Sex • Race • Heredity

Cardiovascular Disease Risk Factors • Major Controllable • Smoking • High BP • High blood cholesterol • Diabetes

Cardiovascular Disease Risk Factors • Minor Controllable • Obesity • Lack of exercise • Stress • Personality

Cardiovascular Disease Control risk factors - decrease Coronary Artery Disease and Acute Myocardial Infarction

Coronary Artery Disease • Myocardium (heart muscle) requires continuous oxygen and nutrient supply • Myocardial blood supply passes through coronary arteries

Coronary Artery Disease • Atherosclerosis • Narrowing of lumen • plaque formation - related to Risk Factors • results in decreased myocardial perfusion • Poor tissue perfusion causes: • tissue damage (ischemia) • tissue death (infarction)

Atherosclerotic Plaque Formation

Angina Pectoris“A choking in the chest” • Angere - to choke • Myocardial oxygen demand exceeds supply during periods of increased activity, exercise, or stressful event

Angina Pectoris • During stress the myocardium demands more O2 • Coronary arteries would normally dilate to supply more blood and O2 • In Angina Pectoris, the coronary arteries are unable to dilate sufficiently to increase perfusion

Symptoms -Angina Pectoris • Pain • Substernal • Squeezing/Crushing/Heaviness • May radiate to arms, shoulders, jaw, upper back, upper abdomen back • May be associated with shortness of breath, nausea, sweating

Symptoms -Angina Pectoris • Pain usually associated with 3E’s • Exercise • Eating • Emotion

Symptoms -Angina Pectoris • Pain seldom lasts > 30 minutes • Pain relieved by • Rest • Nitroglycerin

Symptoms -Angina Pectoris • Great anxiety/Fear • Fixation of the body • Pale, ashen, or livid face • Dyspnea (SOB) may be associated

Symptoms -Angina Pectoris • Nausea • Diaphoresis • BP usually up during attack • Dysrhythmia may be present

Angina Pectoris • Following an angina attack there is no residual damage to the myocardium

Forms of Angina Pectoris • Stable Angina • Occurs with exercise • Predictable • Relieved by rest or Nitroglycerin

Forms of Angina Pectoris • Unstable Angina • More frequent/severe • Can occur during rest • May indicate impending MI • Requires immediate treatment and transport to appropriate facility

Acute Myocardial Infarction“Heart Attack” • Inadequate perfusion of myocardium • Death of myocardium • Infarct • Damage to myocardium • Ischemia

Symptoms - AMI • Chest Pain - cardinal sign of myocardial infarction • Occurs in 85% of MI’s • Substernal • “Crushing,” “squeezing,” “tight,” “heavy”

Symptoms - AMI • Chest Pain • May radiate to arms, shoulders, jaw, upper back, upper abdomen back • May vary in intensity • Unaffected by: • swallowing • coughing • deep breathing • movement

Symptoms - AMI • Chest Pain • Unrelieved by rest/nitroglycerin • Pain lasts longer than angina pain (up to 12 hours) • “Silent’ MI • 15% of patients with MI, • particularly common in elderly and diabetics

Symptoms - AMI • Shortness of breath • Weakness, dizziness, fainting • Nausea, vomiting • Pallor and diaphoresis (heavy sweating)

Symptoms - AMI • Sense of impending doom • Denial • 50% of deaths occur in first two hours • Average patient waits 3 hours before seeking help

Symptoms - AMI • Changes in pulse, BP, respiration are not diagnostic of AMI

Acute Myocardial Infarction • Early recognition of MI is critical

Management of Cardiac Chest Pain • When in doubt, manage all chest pain as MI

Management of Cardiac Chest Pain • Begin management immediately if angina or MI are suspected. • Complete the history and physical exam as you treat.

Management of Cardiac Chest Pain • Position of Comfort • Patent Airway • High concentration O2 • non-rebreather mask 10-15 lpm

Management of Cardiac Chest Pain • Reassure the patient • Obtain a brief history and physical exam • Aspirin 325mg p.o.

Management of Cardiac Chest Pain • Nitroglycerin 0.4mg tablet sublingual • Patient should be sitting or lying down • Has Pt. Taken nitroglycerin in last 10 minutes? Is pain relieved? Headache? • Is BP > 90 systolic? • q 5 minutes until pain relieved or three tablets administered

Management of Cardiac Chest Pain • If pain is unrelieved by rest, oxygen, nitroglycerin or if a change has occurred in pattern of angina, transport immediately • Transport in semi-sitting position if BP normal or elevated; flat if BP low

Management of Cardiac Chest Pain • Do not walk patient to the ambulance • Do not use lights/siren if patient is awake, alert, breathing without distress • Monitor vital signs every 5-10 minutes

Management of Cardiac Chest Pain • Request early ALS back-up • Deaths in MI result from arrhythmia's • Arrhythmia's can be prevented with early drug therapy

Congestive Heart Failure • CHF = Inability of heart to pump blood out as fast as it enters. • May be left-sided, right-sided, or both.

Congestive Heart Failure • Usually begins with left-sided failure. • Left ventricle fails • Blood “stacks up” in lungs • High pressure in capillary beds • Fluid forced out of capillaries into alveoli

Congestive Heart Failure • Right-sided failure most commonly caused by Left-sided failure. Blood “backs up” into systemic circulation • Distended neck veins • Fluid in abdominal cavity • Pedal edema

Causes of CHF • Coronary Artery Disease • Chronic hypertension (high blood pressure) • AMI • Valvular heart disease

Symptoms of CHF • Weakness • Dyspnea • Dyspnea on exertion • Paroxysmal nocturnal dyspnea • Attacks of SOB that usually occur at night that awakens the patient

Symptoms of CHF • Orthopnea • Difficulty breathing in any position other than standing or sitting • Abdominal discomfort • Jugular Vein Distention (JVD) • Pedal “Pitting” edema in lower extremities

Symptoms of CHF • Tachycardia • Pulmonary Edema • Noisy, labored breathing • Coughing • Rales, wheezing • Pink, frothy sputum

Management of CHF • Sit patient up, let feet dangle • Administer high concentration O2 • Assist ventilation as needed • Monitor vital signs q 5-10 minutes • Request early ALS back-up

Pacemaker Failure • Position of comfort • Patent airway • High Concentration O2 • Assist ventilations as needed • ALS Intercept • CPR as needed • DO NOT worry about damage to pacemaker

Coronary Artery Bypass • Position of comfort • Patent airway • High Concentration O2 • Assist ventilations as needed • ALS Intercept • CPR as needed • DO NOT worry about damage to sutures/staples or by-passed arteries

Implanted Defibrillator • If performing CPR on a patient: • Implanted defibrillator may “fire” • May feel slight “tingle”

Cardiovascular Emergencies: Understanding and Responding to Heart Conditions