2. Early Heart Attack Care For Questions, call Amy Fraulini, MSN, RN Director of Critical Care and Heart Services (740)356-8305 fraulina@somc.org Heart attacks have beginnings

3. Heart Attack: A community problem… with a community solution

5. CountyMortality Rate per 100,000 Adams283.2 Jackson328.0 Lawrence346.8 Pike300.0 Scioto401.2 Greenup, KY332.5 Lewis, KY327.8 Ohio303.1 Kentucky324.4 United States279.2 Source: US CDC Mortality Database BLUE indicates those counties which exceed the state of Ohio’s mortality rate Cardiovascular Disease Mortality Rates

6. Course Outline 1.Anatomy and Physiology 101: Your Heart 2.Who’s at risk for heart disease? 3.A Heart Attack in Progress 4.Concepts of Early Heart Attack Care 5.Recognition and Intervention 6.Delay and Denial 7.You: The Early Heart Attack Caregiver

7. Part 1 Anatomy & Physiology 101: Your Heart

8. Location –Middle of the chest Size –That of a fist Purpose –Pumps blood throughout the body Weight –7 - 12 ounces Capacity –Pumps 1,800 gallons of blood & beats over 100,000 times daily The Human Heart

9. SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY) ANTERIOR R. ATRIAL BRANCH OF R. CORONARY ARTERY RIGHT CORONARY ARTERY ANTERIOR CARDIAC VEINS SMALL CARDIAC VEIN ANTERIOR INTERVENTRICULAR (ANTERIOR DESCENDING) BRANCH OF L. CORONARY ARTERY GREAT CARDIAC VEIN CIRCUMFLEX BRANCH OF L. CORONARY ARTERY L. CORONARY ARTERY The Human Heart & Coronary Arteries

10. GREAT CARDIAC VEIN CIRCUMFLEX BRANCH OF L. CORONARY ARTERY CORONARY SINUS OBLIQUE VEIN OF L. ATRIUM POSTERIOR VEIN OF L. VENTRICLE MIDDLE CARDIAC VEIN SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY) SINOATRIAL (S-A) NODE SMALL CARDIAC VEIN R. CORONARY ARTERY POSTERIOR INTERVENTRICULAR (POSTERIOR DESCENDING) BRANCH OF R. CORONARY ARTERY The Human Heart & Coronary Arteries

11. The Human Heart: Electric Pump

12. Some persons are more likely than others to have a heart attack because of their “risk factors” There are –Factors you can control –Factors you cannot control Who’s at risk for Heart Disease?

13. Smoking High blood pressure High blood cholesterol Overweight and obesity Physical inactivity Diabetes Risk factors we can control:

14. Pre-existing coronary heart disease, including a heart attack, prior angioplasy, bypass surgery, or angina Age Family history of heart disease –A father or brother diagnosed before age 55 –A mother or sister diagnosed before age 65 Risk factors we cannot control:

15. Part 3 A Heart Attack in Progress

16. #1 Killer of Adults BOTH Men and Women 1.1 million Americans suffer a heart attack each year 460,000 of those heart attacks are fatal Hundreds of thousands survive but are left with a damaged heart Heart Attack Facts

17. Sudden, severe pain that stops you in your tracks. Gradual increasing pain with damage occurring over a period of hours. Very early presentation with mild symptoms over hours or days. Some different presentations of heart attack

18. Partial block producing chest pain Area of decreased blood supply Ischemia & Angina Pectoris

19. Coronary Artery Disease

20. Area of Infarct Complete Obstruction: AMI

21. Part 4 Concepts of Early Heart Attack Care

22. Are all heart attacks created equal?

23. Prehospital Cardiac Care Thrombolytic Therapy (clot busters) Angioplasty (preferred treatment with optimal outcomes) Decrease in time to treatment saved heart muscle improvement in quality of life Progress: Heart Attack Treatment

24. Most heart attack patients do not benefit from optimal medical advances……………WHY? Too Little Progress: Heart Attack Recognition

25. in recognizing and responding to the early warning signs of a heart attack Delay

26. Early Care: Recognize & RespondEarly Care: Recognize & Respond –often mild symptoms, usually normal activity Late Care: Obvious Emergency & RespondLate Care: Obvious Emergency & Respond –incapacitating pain, diminished activity Too Late Care: Critical Emergency & RespondToo Late Care: Critical Emergency & Respond –unconscious, CPR, defibrillation, probable death damagefirst two hours85% of the heart damage takes place within the first two hours. Why Early Heart Attack Care?

27. Part 5 Recognition & Intervention

28. Non-Specific Heart Attack Symptoms:Non-Specific Heart Attack Symptoms: –weakness/fatigue –clammy/sweating –nausea/indigestion –dizziness/nervousness –shortness of breath –neck/back/jaw pain –feeling of doom –elbow pain Specific Heart Attack SymptomsSpecific Heart Attack Symptoms –chest discomfort –chest pressure –chest ache –chest burning –chest fullness Early Symptoms of a Heart Attack

29. Part 6 Delay & Denial

30. Denial and Procrastination = Our Heart’s Enemy! Why do we delay?

31. “I’ll just rest a bit” It’s nothing really serious

32. “I don’t have time to be sick” I’m too busy right now

33. “If it turns out to be nothing, I’ll be embarrassed by the fuss made.” I don’t want to be a problem

34. First responders can easily be swayed by patient rationalizations and denials Paramedics BEWARE!

35. “I’ll take something for it” It’s probably heartburn or indigestion

36. “Just walk it off, grin and bear it” I’m strong!

37. “I have no serious medical problems…I exercise.” I’m healthy

38. “Everything will be OK.” I’ll just wait it out

39. Part 7 YOU: The Early Heart Attack Caregiver

40. Spouse Children Parent Co-worker Friend Exercise Partner Anyone who cares about you! Who is the Caregiver?

41. Do you have any chest discomfort? Is it tightness, pressure, pain in the center of your chest? Is the discomfort also in your arms or jaw or neck or throat or back? Are you sick to your stomach? Is the person sweaty or clammy? What were you doing when the symptoms started? Do the symptoms go away with rest? Are you having any shortness of breath? What to ask and look for

42. Be aware of pressure, not necessarily pain, in your chest. Be aware if it increases with activity and subsides with rest. Don’t try to rationalize it away. Be honest with yourself and others. Call 9-1-1 or have someone drive you to the nearest emergency room. Don’t go to your doctors office or wait for an appointment. RecognizeRecognize the subtle danger signs and act on them before damage occurs. Listen to your Heart and be a Winner

43. EMS can begin treatment immediately-even before arrival at the hospital The heart may stop beating during a heart attack. EMS have the equipment needed to start the heart again Heart attack patients have emergency needs that can be met by the EMS….such as oxygen, heart medications, and pain relief treatments EMS are linked to the hospital and doctors to give them needed resources during this critical time Remember to Call 9-1-1 WHY?

44. questions? Any questions? www.somc.org Safety  Quality  Service  Relationships  Performance