1. Cardiovascular Disease
63,400,000 Americans have one or more forms of heart or blood vessel disease
50% of all deaths are cardiovascular disease
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2. 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!
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3. Cardiovascular Disease Risk Factors
Major Uncontrollable
Age
Sex
Race
Heredity
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4. Cardiovascular Disease Risk Factors
Major Controllable
Smoking
High BP
High blood cholesterol
Diabetes
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5. Cardiovascular Disease Risk Factors
Minor Controllable
Obesity
Lack of exercise
Stress
Personality
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6. Cardiovascular Disease
Control risk factors - decrease Coronary Artery Disease and Acute Myocardial Infarction
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7. Coronary Artery Disease
Myocardium (heart muscle) requires continuous oxygen and nutrient supply
Myocardial blood supply passes through coronary arteries
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8. 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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9. Atherosclerotic Plaque Formation
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10. 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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11. 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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12. 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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13. Symptoms -Angina Pectoris
Pain usually associated with 3E’s
Exercise
Eating
Emotion
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14. Symptoms -Angina Pectoris
Pain seldom lasts > 30 minutes
Pain relieved by
Rest
Nitroglycerin
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15. Symptoms -Angina Pectoris
Great anxiety/Fear
Fixation of the body
Pale, ashen, or livid face
Dyspnea (SOB) may be associated
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16. Symptoms -Angina Pectoris
Nausea
Diaphoresis
BP usually up during attack
Dysrhythmia may be present
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17. Angina Pectoris
Following an angina attack there is no residual damage to the myocardium
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18. Acute Myocardial Infarction “Heart Attack”
Inadequate perfusion of myocardium
Death of myocardium
Infarct
Damage to myocardium
Ischemia
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19. Symptoms - AMI Chest Pain - cardinal sign of myocardial infarction
Occurs in 85% of MI’s
Substernal
“Crushing,” “squeezing,” “tight,” “heavy”
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20. 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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21. 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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22. Symptoms - AMI Shortness of breath Weakness, dizziness, fainting
Nausea, vomiting
Pallor and diaphoresis (heavy sweating)
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23. 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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24. Symptoms - AMI
Changes in pulse, BP, respiration are not diagnostic of AMI
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25. Management of Cardiac Chest Pain
Position of Comfort
Patent Airway
High concentration O2
non-rebreather mask lpm
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26. Management of Cardiac Chest Pain
Reassure the patient
Obtain a brief history and physical exam
Aspirin 325mg p.o.
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27. 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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28. 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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29. 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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30. Causes of CHF Coronary Artery Disease
Chronic hypertension (high blood pressure)
AMI
Valvular heart disease
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31. 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
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32. 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
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33. Symptoms of CHF Tachycardia Pulmonary Edema Noisy, labored breathing
Coughing
Rales, wheezing
Pink, frothy sputum
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34. 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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