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
Age

Uncontrollable

Sex
Race Heredity

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Cardiovascular Disease Risk Factors

Major
High

Controllable

Smoking

BP High blood cholesterol Diabetes

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Cardiovascular Disease Risk Factors

Minor
Lack

Controllable

Obesity

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
plaque

of lumen

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
More

Angina

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
Death

perfusion of myocardium
of myocardium to myocardium
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Infarct
Damage

Ischemia

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
Patient

0.4mg tablet sublingual

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
Deaths

early ALS back-up

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
Left

begins with left-sided failure.

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
Noisy,

Edema

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 Temple College EMS Program

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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

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