Jump to first page Chapter 10 Cardiac Emergencies

Jump to first page Heart Disease n Affects over 4 million/year in U.S. u ~ 500,000 deaths/year n Atherosclerosis u Plaque (fatty deposits) u Narrowing of arteries n Arteriosclerosis u Stiffing or hardening of artery wall F Loss of arterial elasticity u Calcium deposits u Changes blood flow

Jump to first page CHD Risk Factors n Non-Controllable u Age u Heredity n Controllable u Smoking u Lack of regular exercise u Obesity u Hypertension u High cholesterol & triglycerides

Jump to first page Electrical Malfunctions n Arrhythmias u Bradycardia F Less than 60 beats / minute u Tachycardia F More than 100 beats / minute u Ventricular fibrillation u Pulseless electrical activity u Asystole

Jump to first page Angina Pectoris n Pain in Chest n Oxygen demand transiently exceeds supply n Generally Two (2) Types u Stable angina F Occurs during activity F Usually precipitated by physical or emotional stress Relatively short duration 3-5 minutes or prolonged lasting 15 minutes or more

Jump to first page Angina Pectoris F Usually relieved by rest, nitroglycerin or oxygen u Unstable (Preinfarction angina) F Occurs at rest F Indicates severe atherosclerotic disease F May not respond as well to nitroglycerin or oxygen

Jump to first page Angina Pectoris n Signs and Symptoms u Primarily caused by a build up of lactic acid and CO 2 in the ischemic myocardium u Substernal chest pain or epigastric discomfort (pain, pressure, squeezing or tightness) F 1/3 patients feel pain only in the chest F Radiation to shoulder, arm, neck, jaw, through to back

Jump to first page Angina Pectoris n Associated Signs and Symptoms u Anxiety u Dyspnea u Diaphoresis u Dysrhythmias

Jump to first page Angina Pectoris n Care u Stop activity & rest u Position semi-recumbent u Secure airway u High-flow O 2 u Determine vitals u Place on Cardiac monitor u Questioned as to meds: F How much? F Any relief?

Jump to first page Acute Myocardial Infarction (AMI) n ~1,000,000 MI per year (AHA) n ~ 500,000 deaths u Contributing Factor - delay in seeking medical attention n Nearly 25% of individuals have no prior history of cardiac problems

Jump to first page AMI n Causes u CHD - Coronary Heart Disease u Chronic respiratory problems u Unusual exertion u Severe emotional stress

Jump to first page AMI n Signs and Symptoms u Pain - substernal or epigastric F (usually lasting more than 10 minutes) F Pressure. Squeezing or Tightness F Same radiation u Dyspnea u Diaphoresis u Anxiety or apprehension

Jump to first page AMI n Signs and Symptoms con’t. u Nausea or vomiting u General weakness or malaise u Pallor u Pulse Rate F Bradycardia or tachycardia F Regular or irregular F Weak or bounding

Jump to first page AMI u Respirations F Generally normal or increased F Possible dyspnea u Some patients present with no symptoms at all F ECG changes or F Increased cardiac enzyme levels F Complaint of only general malaise or history of syncope

Jump to first page Care for Heart Attacks n Have person stop all activity & rest n Semi-recumbent position n Assess ABCs n Determine vital signs (frequently) n High-flow O 2 n Maintain body temperature

Jump to first page AMI n Care u Determine meds history u Has the patient been given clot busters F Streptocinase F TPA F Retavaise or Antivaise

Jump to first page Cardiogenic Shock n Shock that remains after correction of existing dysrhythmias, hypovolemia or altered vascular tone u Occurs following extensive AMI u Myocardial damage 40% or more u High mortality (~80%)

Jump to first page Cardiogenic Shock n Signs and Symptoms u Initially same as AMI u As shock develops F Hypotension Systolic pressure 80mmHg or less F Altered mental status F Sinus tachycardia (hearts attempting to compensate) F Diaphoresis n Care u Same as AMI

Jump to first page Congestive Heart Failure n Back pressure of blood into systemic venous circulation causing venous congestion u Causes F LV failure (pulmonary edema) F Pure RV failure F Pulmonary hypertension Affects of COPD

Jump to first page Congestive Heart Failure n Signs and Symptoms u Depends on degree of failure and patient’s general condition F Tachycardia F JVD - engorging or pulsating F Pedal edema F Abdominal distention F Dyspnea F Chest pain (may or may not be present

Jump to first page Congestive Heart Failure n Signs and Symptoms con’t. F Pulmonary edema F Rales F Rhonchi F Blood pressure - normal to slightly elevated F Engorged liver & spleen F Fluid accumulation in serous cavities

Jump to first page Congestive Heart Failure n Signs and Symptoms con’t. u Patient often has history of taking F Digoxin (Lanoxin) F Furosemide (Lasix) n Care u Same as for AMI

Jump to first page Pacemaker Problems n Problems are RARE u Battery failure F Underlying rhythm will occur F Bradycardia or asystole u Run away F Rapid rate of discharge when battery gets low

Jump to first page Pacemaker Problems u Demand Pacemakers F May shut down when patient’s heart rate exceeds limits set by device u Failure to capture F leads become displaced or battery fails results in bradycardia n Care u Same as AMI