Cardiovascular Emergencies Copyright © Texas Education Agency, 2014. All rights reserved.

Copyright © Texas Education Agency, 2014. All rights reserved. Copyright © Texas Education Agency, 2014. These Materials are copyrighted © and trademarked ™ as the property of the Texas Education Agency (TEA) and may not be reproduced without the express written permission of TEA, except under the following conditions: 1)  Texas public school districts, charter schools, and Education Service Centers may reproduce and use copies of the Materials and Related Materials for the districts’ and schools’ educational use without obtaining permission from TEA. 2)  Residents of the state of Texas may reproduce and use copies of the Materials and Related Materials for individual personal use only, without obtaining written permission of TEA. 3)  Any portion reproduced must be reproduced in its entirety and remain unedited, unaltered and unchanged in any way. 4)  No monetary charge can be made for the reproduced materials or any document containing them; however, a reasonable charge to cover only the cost of reproduction and distribution may be charged. Private entities or persons located in Texas that are not Texas public school districts, Texas Education Service Centers, or Texas charter schools or any entity, whether public or private, educational or non-educational, located outside the state of Texas MUST obtain written approval from TEA and will be required to enter into a license agreement that may involve the payment of a licensing fee or a royalty. For information contact: Office of Copyrights, Trademarks, License Agreements, and Royalties, Texas Education Agency, 1701 N. Congress Ave., Austin, TX 78701-1494; phone 512-463-7004; email: copyrights@tea.state.tx.us. Copyright © Texas Education Agency, 2014. All rights reserved.

Cardiovascular Anatomy and Physiology Review the flow of blood through the heart and through the major vessels. Discuss the cardiovascular system. Review the function of the four chambers of the heart. Deoxygenated blood enters the heart via the vena cava, travels through the right and left chambers, and moves to the lungs, where it receives oxygen. Oxygenated blood returns from the lungs via the pulmonary vein. It travels through the left chambers of the heart and enters the aorta to be pumped out to the body. Copyright © Texas Education Agency, 2014. All rights reserved.

Cardiovascular Anatomy and Physiology Review the cardiac conduction system (the electrical impulses and specialized muscles that cause the heart to contract). The cardiac conduction system allows for a coordinated, rapid depolarization of cardiac cells and is designed to facilitate mechanical contraction. Review the composition of blood (red and white blood cells, platelets, and plasma) and the flow of blood through the arteries, veins, arterioles, venules, and capillaries. Review the names and positions of major blood vessels and discuss the circulation of blood between the heart and the lungs and between the heart and the rest of the body. Copyright © Texas Education Agency, 2014. All rights reserved.

Acute Coronary Syndrome Acute coronary syndrome (ACS) is a blanket term that refers to any time that the heart may not be getting enough oxygen. An EMT should treat all patients with ACS-like signs and symptoms as though they are having a heart problem. Always have a patient describe in his own words how he is feeling. Patients complain of radiation to the left arm more than the right, but either (or both) is possible. Always ask about shortness of breath when evaluating a potential ACS patient. Dyspnea as a singular complaint is common in older patients and in diabetic patients. Chest discomfort, dyspnea, nausea, and anxiety are common symptoms of ACS, but not all ACS patients present with common symptoms. Copyright © Texas Education Agency, 2014. All rights reserved.

Acute Coronary Syndrome There is no such thing as a common finding in ACS. Between one-quarter and one-third do not have the typical presentation of chest discomfort. This is especially true in older patients and women. You may see a patient who complains of difficulty breathing, sudden onset of sweating or a sudden, unusual feeling of fatigue, without chest discomfort. Because of these many possibilities and because of the potentially severe complications of heart problems, it is important to have a high index of suspicion and treat patients with any of these signs and symptoms for cardiac compromise. You should always inquire about onset, provocation, quality, radiation, severity, and time. Copyright © Texas Education Agency, 2014. All rights reserved.

Acute Coronary Syndrome Occasionally, you will see a patient who has both difficulty breathing and hypotension. It may be very difficult to find a good position in this case. The best way to determine the proper position is to ask the patient what position will relieve breathing difficulty without making him weak or lightheaded. Oxygen is especially important if the patient is hypoxic, as reflected in signs and symptoms, including oxygen saturation level. Keep the patient’s oxygen saturation at least at 94%. Note that asthma and other anti-clotting medications are relative contraindications. Some systems may allow the administration of aspirin in these circumstances. Follow local protocol. Copyright © Texas Education Agency, 2014. All rights reserved.

Causes of Cardiac Conditions The majority of cardiovascular emergencies are caused, directly or indirectly, by changes in the inner walls of arteries. Conditions that narrow or block the arteries of the heart are commonly called coronary artery disease (CAD). An aneurysm occurs when weakened sections in the arterial walls dilate and occasionally burst. The two most common sites of aneurysms are the aorta and the brain. Tissues beyond the rupture can be damaged because the oxygenated blood they need is escaping and not reaching them. If a major artery ruptures, death from shock can occur very quickly. Copyright © Texas Education Agency, 2014. All rights reserved.

Causes of Cardiac Conditions Both electrical and mechanical problems can cause the heart to fail. Angina pectoris and acute myocardial infarction result from an interruption of the necessary blood flow to heart muscle. Infarction occurs when this blood supply is fully occluded. Occasionally angina pain can be seen at rest, especially in progressive disease states. Copyright © Texas Education Agency, 2014. All rights reserved.

Causes of Cardiac Conditions Congestive heart failure occurs when the heart cannot pump properly due to damage or a disorder. Pulmonary edema is a common symptom of CHF. When the left ventricle fails and fluid accumulates in the lungs, it is called pulmonary edema. This edema causes a poor exchange of oxygen between the lungs and the bloodstream, and the patient experiences shortness of breath, or dyspnea. When the right side fails, fluids may accumulate in the dependent (lower) extremities, the liver, and the abdomen. Accumulation of fluid in the feet or ankles is known as pedal edema. The abdomen may become noticeably distended. In a bedridden patient, fluid collects in the sacral area of the spine. Copyright © Texas Education Agency, 2014. All rights reserved.