CARDIOVASCULAR EMERGENCIES 1 Cardiovascular Disease 63 400 000

CARDIOVASCULAR EMERGENCIES 1

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 2

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! 3

Cardiovascular Disease Risk Factors • Major Uncontrollable – Age – Sex – Race – Heredity 4

Cardiovascular Disease Risk Factors • Major Controllable – Smoking – High BP – High blood cholesterol – Diabetes 5

Cardiovascular Disease Risk Factors • Minor Controllable – Obesity – Lack of exercise – Stress – Personality 6

Cardiovascular Disease Control risk factors - decrease Coronary Artery Disease and Acute Myocardial Infarction 7

Coronary Artery Disease • Myocardium (heart muscle) requires continuous oxygen and nutrient supply • Myocardial blood supply passes through coronary arteries 8

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) 9

Atherosclerotic Plaque Formation 10

Angina Pectoris “A choking in the chest” • Angere - to choke • Myocardial oxygen demand exceeds supply during periods of increased activity, exercise, or stressful event 11

Angina Pectoris • During stress the myocardium demands more O 2 • Coronary arteries would normally dilate to supply more blood and O 2 • In Angina Pectoris, the coronary arteries are unable to dilate sufficiently to increase perfusion 12

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 13

Symptoms -Angina Pectoris • Pain usually associated with 3 E’s – Exercise – Eating – Emotion 14

Symptoms -Angina Pectoris • Pain seldom lasts > 30 minutes • Pain relieved by – Rest – Nitroglycerin 15

Symptoms -Angina Pectoris • Great anxiety/Fear • Fixation of the body • Pale, ashen, or livid face • Dyspnea (SOB) may be associated 16

Symptoms -Angina Pectoris • Nausea • Diaphoresis • BP usually up during attack • Dysrhythmia may be present 17

Angina Pectoris • Following an angina attack there is no residual damage to the myocardium 18

Forms of Angina Pectoris • Stable Angina – Occurs with exercise – Predictable – Relieved by rest or Nitroglycerin 19

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 20

Acute Myocardial Infarction “Heart Attack” • Inadequate perfusion of myocardium – Death of myocardium • Infarct – Damage to myocardium • Ischemia 21

Symptoms - AMI • Chest Pain - cardinal sign of myocardial infarction – Occurs in 85% of MI’s – Substernal – “Crushing, ” “squeezing, ” “tight, ” “heavy” 22

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 23

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 24

Symptoms - AMI • • Shortness of breath Weakness, dizziness, fainting Nausea, vomiting Pallor and diaphoresis (heavy sweating) 25

Symptoms - AMI • Sense of impending doom • Denial – 50% of deaths occur in first two hours – Average patient waits 3 hours before seeking help 26

Symptoms - AMI • Changes in pulse, BP, respiration are not diagnostic of AMI 27

Acute Myocardial Infarction • Early recognition of MI is critical 28

Management of Cardiac Chest Pain • When in doubt, manage all chest pain as MI 29

Management of Cardiac Chest Pain • Begin management immediately if angina or MI are suspected. • Complete the history and physical exam as you treat. 30

Management of Cardiac Chest Pain • Position of Comfort • Patent Airway • High concentration O 2 – non-rebreather mask 10 -15 lpm 31

Management of Cardiac Chest Pain • Reassure the patient • Obtain a brief history and physical exam • Aspirin 325 mg p. o. 32

Management of Cardiac Chest Pain • Nitroglycerin 0. 4 mg 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 33

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 34

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 35

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 36

Congestive Heart Failure • CHF = Inability of heart to pump blood out as fast as it enters. • May be left-sided, right-sided, or both. 37

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 38

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 39

Causes of CHF • Coronary Artery Disease • Chronic hypertension (high blood pressure) • AMI • Valvular heart disease 40

Symptoms of CHF • Weakness • Dyspnea on exertion • Paroxysmal nocturnal dyspnea – Attacks of SOB that usually occur at night that awakens the patient 41

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 42

Symptoms of CHF • Tachycardia • Pulmonary Edema – Noisy, labored breathing – Coughing – Rales, wheezing – Pink, frothy sputum 43

Management of CHF • • • Sit patient up, let feet dangle Administer high concentration O 2 Assist ventilation as needed Monitor vital signs q 5 -10 minutes Request early ALS back-up 44

Pacemaker Failure • • • Position of comfort Patent airway High Concentration O 2 Assist ventilations as needed ALS Intercept CPR as needed – DO NOT worry about damage to pacemaker 45

Coronary Artery Bypass • • • Position of comfort Patent airway High Concentration O 2 Assist ventilations as needed ALS Intercept CPR as needed – DO NOT worry about damage to sutures/staples or by-passed arteries 46

Implanted Defibrillator • If performing CPR on a patient: – Implanted defibrillator may “fire” – May feel slight “tingle” 47