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

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

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 O 2
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

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