Cardiovascular Disease 63,400,000 Americans have one or more forms of heart or blood vessel disease 50% of all deaths are cardiovascular disease Temple College EMS Program

Cardiovascular Disease Acute Myocardial Infarction (Heart Attack) - leading cause of death in U.S. 1.5 million Americans will have AMI’s this year Of these .5 million will die! 350,000 will die in first two hours! Temple College EMS Program

Cardiovascular Disease Risk Factors Major Uncontrollable Age Sex Race Heredity Temple College EMS Program

Cardiovascular Disease Risk Factors Major Controllable Smoking High BP High blood cholesterol Diabetes Temple College EMS Program

Cardiovascular Disease Risk Factors Minor Controllable Obesity Lack of exercise Stress Personality Temple College EMS Program

Cardiovascular Disease Control risk factors - decrease Coronary Artery Disease and Acute Myocardial Infarction Temple College EMS Program

Coronary Artery Disease Myocardium (heart muscle) requires continuous oxygen and nutrient supply Myocardial blood supply passes through coronary arteries Temple College EMS Program

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) Temple College EMS Program

Atherosclerotic Plaque Formation Temple College EMS Program

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

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 Temple College EMS Program

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 Temple College EMS Program

Symptoms -Angina Pectoris Pain usually associated with 3E’s Exercise Eating Emotion Temple College EMS Program

Symptoms -Angina Pectoris Pain seldom lasts > 30 minutes Pain relieved by Rest Nitroglycerin Temple College EMS Program

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

Symptoms -Angina Pectoris Nausea Diaphoresis BP usually up during attack Dysrhythmia may be present Temple College EMS Program

Angina Pectoris Following an angina attack there is no residual damage to the myocardium Temple College EMS Program

Acute Myocardial Infarction “Heart Attack” Inadequate perfusion of myocardium Death of myocardium Infarct Damage to myocardium Ischemia Temple College EMS Program

Symptoms - AMI Chest Pain - cardinal sign of myocardial infarction Occurs in 85% of MI’s Substernal “Crushing,” “squeezing,” “tight,” “heavy” Temple College EMS Program

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 Temple College EMS Program

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 Temple College EMS Program

Symptoms - AMI Shortness of breath Weakness, dizziness, fainting Nausea, vomiting Pallor and diaphoresis (heavy sweating) Temple College EMS Program

Symptoms - AMI Sense of impending doom Denial 50% of deaths occur in first two hours Average patient waits 3 hours before seeking help Temple College EMS Program

Symptoms - AMI Changes in pulse, BP, respiration are not diagnostic of AMI Temple College EMS Program

Management of Cardiac Chest Pain Position of Comfort Patent Airway High concentration O2 non-rebreather mask 10-15 lpm Temple College EMS Program

Management of Cardiac Chest Pain Reassure the patient Obtain a brief history and physical exam Aspirin 325mg p.o. Temple College EMS Program

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

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 Temple College EMS Program

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 Temple College EMS Program

Causes of CHF Coronary Artery Disease Chronic hypertension (high blood pressure) AMI Valvular heart disease Temple College EMS Program

Symptoms of CHF Dyspnea on exertion Paroxysmal nocturnal dyspnea Weakness Dyspnea Dyspnea on exertion Paroxysmal nocturnal dyspnea Attacks of SOB that usually occur at night that awakens the patient Temple College EMS Program

Symptoms of CHF Orthopnea Abdominal discomfort Difficulty breathing in any position other than standing or sitting Abdominal discomfort Jugular Vein Distention (JVD) Pedal “Pitting” edema in lower extremities Temple College EMS Program

Symptoms of CHF Tachycardia Pulmonary Edema Noisy, labored breathing Coughing Rales, wheezing Pink, frothy sputum Temple College EMS Program

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 Temple College EMS Program