CARDIOVASCULAR EMERGENCIES

Cardiovascular Disease
63,400,000 Americans have one or more forms of heart or blood vessel disease 50% of all deaths are cardiovascular disease Acute Myocardial Infarction (Heart Attac ! " leadin# cause of death in $%&% '%5 million Americans (ill have AMI)s this year *f these %5 million (ill die+ 350,000 (ill die in first t(o hours+ ,ardiovascular -isease .is /actors 0 Ma1or $ncontrollable A#e &e2 .ace Heredity 0 ,ardiovascular -isease .is /actors Ma1or ,ontrollable &mo in# Hi#h 34 Hi#h blood cholesterol -iabetes 0 Minor ,ontrollable *besity 5ac of e2ercise &tress 4ersonality ,ardiovascular -isease ,ontrol ris factors " decrease ,oronary Artery -isease and Acute Myocardial Infarction ,oronary Artery -isease Myocardium (heart muscle! re6uires continuous o2y#en and nutrient su77ly Myocardial blood su77ly 7asses throu#h coronary arteries Atherosclerosis 8arro(in# of lumen 7la6ue formation " related to .is /actors results in decreased myocardial 7erfusion 4oor tissue 7erfusion causes9 tissue dama#e (ischemia! tissue death (infarction! Atherosclerotic 4la6ue /ormation An#ina 4ectoris :A cho in# in the chest; Angere " to cho e Myocardial o2y#en demand e2ceeds su77ly durin# 7eriods of increased activity, e2ercise, or stressful event -urin# stress the myocardium demands more *< ,oronary arteries (ould normally dilate to su77ly more blood and *< In An#ina 4ectoris, the coronary arteries are unable to dilate sufficiently to increase 7erfusion

Symptoms -Angina Pectoris = 4ain &ubsternal &6uee>in#?,rushin#?Heaviness May radiate to arms, shoulders, 1a(, u77er bac , u77er abdomen bac May be associated (ith shortness of breath, nausea, s(eatin# = 4ain usually associated (ith 3@)s @2ercise @atin# @motion = 4ain seldom lasts A 30 minutes 4ain relieved by .est 8itro#lycerin o Breat an2iety?/ear o /i2ation of the body o 4ale, ashen, or livid face o -ys7nea (&*3! may be associated o 8ausea o -ia7horesis o 34 usually u7 durin# attac o -ysrhythmia may be 7resent " /ollo(in# an an#ina attac there is no residual dama#e to the myocardium Forms o Angina Pectoris = &table An#ina *ccurs (ith e2ercise 4redictable .elieved by rest or 8itro#lycerin = $nstable An#ina More fre6uent?severe ,an occur durin# rest May indicate im7endin# MI .e6uires immediate treatment and trans7ort to a77ro7riate facility Acute Myocardial Infarction :Heart Attac ; " Inade6uate 7erfusion of myocardium 0 -eath of myocardium = Infarct 0 -ama#e to myocardium = Ischemia Symptoms - AMI " ,hest 4ain " cardinal si#n of myocardial infarction *ccurs in C5% of MI)s &ubsternal :,rushin#,; :s6uee>in#,; :ti#ht,; :heavy; May radiate to arms, shoulders, 1a(, u77er bac , u77er abdomen bac May vary in intensity $naffected by9

s(allo(in# cou#hin# dee7 breathin# movement $nrelieved by rest?nitro#lycerin 4ain lasts lon#er than an#ina 7ain (u7 to '< hours! :&ilent) MI o '5% of 7atients (ith MI, o 7articularly common in elderly and diabetics &hortness of breath Dea ness, di>>iness, faintin# 8ausea, vomitin# 4allor and dia7horesis (heavy s(eatin#! &ense of im7endin# doom -enial o 50% of deaths occur in first t(o hours o Avera#e 7atient (aits 3 hours before see in# hel7 C!anges in p"#se$ %P$ respiration are not &iagnostic o AMI' @arly reco#nition of MI is critical Management o Car&iac C!est Pain' Dhen in doubt, mana#e all chest 7ain as MI o 3e#in mana#ement immediately if an#ina or MI are sus7ected% o ,om7lete the history and 7hysical e2am as you treat% o 4osition of ,omfort o 4atent Air(ay o Hi#h concentration *<9 non"rebreather mas '0"'5 l7m o .eassure the 7atient o *btain a brief history and 7hysical e2am o As7irin 3<5m# 7%o% o 8itro#lycerin 0%4m# tablet sublin#ual 4atient should be sittin# or lyin# do(n Has 4t% Ea en nitro#lycerin in last '0 minutesF Is 7ain relievedF HeadacheF Is 34 A G0 systolicF 6 5 minutes until 7ain relieved or three tablets administered o If 7ain is unrelieved by rest, o2y#en, nitro#lycerin or if a chan#e has occurred in 7attern of an#ina, trans7ort immediately o Erans7ort in semi"sittin# 7osition if 34 normal or elevatedH flat if 34 lo( o -o not (al 7atient to the ambulance o -o not use li#hts?siren if 7atient is a(a e, alert, breathin# (ithout distress o Monitor vital si#ns every 5"'0 minutes o .e6uest early A5& bac "u7 -eaths in MI result from arrhythmiaIs ArrhythmiaIs can be 7revented (ith early dru# thera7y o o o o Congestive Heart Failure: Inability of heart to 7um7 blood out as fast as it enters% May be left" sided, ri#ht"sided, or both% " $sually be#ins (ith left"sided failure% o 5eft ventricle fails o 3lood :stac s u7; in lun#s

o Hi#h 7ressure in ca7illary beds o /luid forced out of ca7illaries into alveoli " .i#ht"sided failure most commonly caused by 5eft"sided failure% 3lood :bac s u7; into systemic circulation o -istended nec veins o /luid in abdominal cavity o 4edal edema Ca"ses o C(F o ,oronary Artery -isease o ,hronic hy7ertension (hi#h blood 7ressure! o AMI o Jalvular heart disease Symptoms o C(F o Dea ness o -ys7nea o -ys7nea on e2ertion o 4aro2ysmal nocturnal dys7nea " Attac s of &*3 that usually occur at ni#ht that a(a ens the 7atient o *rtho7nea " -ifficulty breathin# in any 7osition other than standin# or sittin# o Abdominal discomfort o Ku#ular Jein -istention (KJ-! o 4edal :4ittin#; edema in lo(er e2tremities o Eachycardia o 4ulmonary @dema " 8oisy, labored breathin# " ,ou#hin# " .ales, (hee>in# " 4in , frothy s7utum Management o C(F o &it 7atient u7, let feet dan#le o Administer hi#h concentration *< o Assist ventilation as needed o Monitor vital si#ns 6 5"'0 minutes o .e6uest early A5& bac "u7 Pacema)er Fai#"re o 4osition of comfort o 4atent air(ay o Hi#h ,oncentration *< o Assist ventilations as needed o A5& Interce7t o ,4. as needed " -* 8*E (orry about dama#e to 7acema er Coronary Artery %ypass o 4osition of comfort o 4atent air(ay o Hi#h ,oncentration *< o Assist ventilations as needed o A5& Interce7t

o ,4. as needed " -* 8*E (orry about dama#e to sutures?sta7les or by"7assed arteries Imp#ante& De i*ri##ator o If 7erformin# ,4. on a 7atient9 " Im7lanted defibrillator may :fire; " May feel sli#ht :tin#le;