1. By Jenny R. Sheriff, EMT-P, I/C
Heart Blocks and CVD

2. Heart Blocks Can happen anywhere in the electrical system
Delays conduction
The lower in the conduction system, the more deadly the block can be. Blocks will cause EKG abnormalities.

3. AV Blocks Delay in AV conduction and relay First degree
Second degree type I (Wenckenbach)
Second degree type 2
Third degree
The higher the degree of the heart block, the more severe it is.

4. First Degree AV Block Prolonged PRI 1:1 P:QRS Regular rhythm
Benign, no treatment required
PRI will be > or = 0.20 seconds. P will be upright, rhythm will be regular. Caused by a delay in the AV node relay.

6. Mobitz type I AKA, 2nd degree type 1 or Wenckenbach
Regularly irregular
PRI lengthens then drops a beat
R-R shortens
The last heart block that atropine may work with (in cases of bradycardia). The PRI will get longer and longer until a beat is dropped, then the cycle will repeat.

7. Mobitz type II In conducted beats, PRI is the same
Several, uniform P waves for every QRS
Happens further down in the AV
When measuring PRI, those that produce a QRS will all be the same (unlike Wenckenbach, in which the PRI widens until a beat is dropped). The P waves will be uniform in appearance. This block may also produce widened QRS’s if the block occurs close to or in the bundle of His.

8. 3rd degree AV block AKA complete heart block Normal P-P interval
Normal R-R interval
Varying PRI
No communication
In this block, the atria and ventricles are doing their own thing, separately. The atria are marching along at a steady pace, thus the regular P-P interval. The ventricles are marching along at their own steady pace, thus the regular R-R interval. But the AV node is completely blocked, so there is no communication at all between the two.

9. Bundle Branch Blocks One branch has a block Changes on EKG
When one branch is blocked, the other conducts normally, however, the muscle on the blocked side receives only cell-to-cell stimulation until the impulse gets past the block. This slows ventricular conduction on that side, producing 2 separate ventricular contractions.

10. Right Bundle Branch Block (RBBB)
V1 and V2 show the right side of the heart, so a RBBB will be most easily seen in those leads.

11. Left Bundle Branch Block (LBBB)
V5 and V6 show the left side of the heart, so LBBB will be most easily seen in these leads.

12. All together now…

13. Cardiovascular Diseases
Hypertension
CAD
Arteriosclerosis
Atherosclerosis
Angina
CHF
Cardiogenic Shock
AMI
In 2006, CVD was the COD for 34.3% of all deaths nationwide (

14. Hypertension Many causes Systolic >130, diastolic >90
Signs and symptoms
Flushed appearance
Headache
Common meds
Diuretics
ACE inhibitors
Beta Blockers
Calcium Channel blockers
Pre-cursor or symptom of thrombolic stroke. HCTZ, furosemide, lisinopril, enelapril, captopril, metoprolol, atenolol, verapamil

15. Coronary Artery Disease (CAD)
Arteriosclerosis
Thickening of the artery wall (hardening of the arteries)
Causes loss of elasticity
Can be caused by atherosclerosis or hypertension
Atherosclerosis
Fatty deposits or plaque that lines the inside wall of the arteries
Caused by high cholesterol and fat intake
Treatment includes that for underlying conditions. Cholesterol meds include statins (lipitor, zocor, lovastatin). ASA is also a common med. Surgical intervention may be necessary (endarterectomy, angioplasty).Causes also include diabetes and obesity, there can be a genetic predisposition.

17. Angina Pectoris Stable Unstable Prinzmetals’s
AKA chest pain. Can include radiation to jaw or upper extremities and/or nausea/vomiting. May also be accompanied by pallor/diaphoresis. Tx includes O2, ASA, NTG.

18. Stable Angina Exertional Eases or resolves with rest
Caused by increased blood pressure through already diseased arteries

19. Unstable Angina Can happen for no reason Non-exertional
Usually lasts longer than stable angina
Does not resolve w/ rest
Caused by decreased blood flow to the heart due to a clot or other blockage

20. Prinzmetal’s Angina A form of unstable angina
Caused by arterial spasms

21. Congestive Heart Failure
Heart is not pumping effectively
Back pressure of blood
Caused by AMI, HTN
S & S
Pedal edema
SOB
Pillow therapy
HTN
Rales or wheezes may be heard in the lungs. A back-pressure in the pulmonary veins causes increased capillary pressure until fluid leaks through the capillaries and into the alveoli. Treatment includes O2, IV, furosemide, NTG, CPAP. V/S very important, both baseline and repeat. Is common after MI.

22. Cardiogenic Shock Shock d/t low cardiac output
CHF will eventually lead to cardiogenic shock if not treated
SAMPLE history is very important
Same signs of shock as hypovolemic shock (change in mentation, diaphoresis, pallor, cyanosis). Will see pitting edema, hear rales or no lung sounds at all. Hypotension, tachycardia (then, later, bradycardia), labored breathing. Reassess often. NO NTG or CPAP for hypotension! Careful w/ fluids! Call ALS and/or med control.

23. Acute Myocardial Infarction
AKA heart attack
STEMI
Can be diagnosed w/ 12 lead EKG
NSTEMI
Does not produce EKG changes
AKA chemical heart attacki
Tissue injury (ischemia) leads to tissue death (necrosis or infarction)
ST segment elevation can indicate MI. All 12 leads should be xmitted to the hospital. Pre-hospital treatment includes O2, V/S, SAMPLE hx, OPQRST, IV, 12 lead, ASA, NTG. Frequent reassessment. MONA

24. Sudden Cardiac Arrest AHA Chain of Survival Early recognition
Early and effective CPR
Early defibrillation
Meds
The first 3 steps are the most important in cardiac arrest.