CARDIOVASCULAR EMERGENCIES

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CARDIOVASCULAR EMERGENCIES

• EMERGENCY MEDICAL TECHNICIAN - BASIC

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Cardiovascular Disease

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

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Cardiovascular Disease

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

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Cardiovascular Disease Risk Factors

• Major Uncontrollable
• Age
• Sex
• Race
• Heredity

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Cardiovascular Disease Risk Factors

• Major Controllable
• Smoking
• High BP
• High blood cholesterol
• Diabetes

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Cardiovascular Disease Risk Factors

• Minor Controllable
• Obesity
• Lack of exercise
• Stress
• Personality

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Cardiovascular Disease

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

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Coronary Artery Disease

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

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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)

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Atherosclerotic Plaque Formation
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Angina Pectoris A choking in the chest

• Angere - to choke
• Myocardial oxygen demand exceeds supply during
  periods of increased activity, exercise, or
  stressful event

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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

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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

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Symptoms -Angina Pectoris

• Pain usually associated with 3Es
• Exercise
• Eating
• Emotion

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Symptoms -Angina Pectoris

• Pain seldom lasts 30 minutes
• Pain relieved by
• Rest
• Nitroglycerin

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Symptoms -Angina Pectoris

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

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Symptoms -Angina Pectoris

• Nausea
• Diaphoresis
• BP usually up during attack
• Dysrhythmia may be present

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Angina Pectoris

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

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Forms of Angina Pectoris

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

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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

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Acute Myocardial Infarction Heart Attack

• Inadequate perfusion of myocardium
• Death of myocardium
• Infarct
• Damage to myocardium
• Ischemia

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Symptoms - AMI

• Chest Pain - cardinal sign of myocardial
  infarction
• Occurs in 85 of MIs
• Substernal
• Crushing, squeezing, tight, heavy

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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

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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

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Symptoms - AMI

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

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Symptoms - AMI

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

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Symptoms - AMI

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

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Acute Myocardial Infarction

• Early recognition of MI is critical

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Management of Cardiac Chest Pain

• When in doubt, manage all chest pain as MI

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Management of Cardiac Chest Pain

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

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Management of Cardiac Chest Pain

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

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Management of Cardiac Chest Pain

• Reassure the patient
• Obtain a brief history and physical exam
• Aspirin 325mg p.o.

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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

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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

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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

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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

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Congestive Heart Failure

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

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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

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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

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Causes of CHF

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

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Symptoms of CHF

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

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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

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Symptoms of CHF

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

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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

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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

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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

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Implanted Defibrillator

• If performing CPR on a patient
• Implanted defibrillator may fire
• May feel slight tingle