Cardiovascular Emergencies - Feb 28 Flashcards
What are the key objectives in studying cardiovascular problems?
Identify/Understand cardiovascular problems in relation to the brain, lungs, and rest of the body
Identify/Understand common cardiovascular medications
Understand/Demonstrate treatments relating to cardiovascular emergencies
Review pathophysiology of cardiac arrest
What is hypertension (HTN)?
Elevated systemic arterial BP diagnosed by +2 diagnostic blood pressures on separate test dates
Systolic >140-160 mmHg
Diastolic >90 mmHg
What are the three types of hypertension?
- Primary
- Secondary
- Malignant/Hypertensive Crisis
What is primary hypertension?
Unknown cause
90% of cases
Self-supporting: HTN damages delicate kidneys
What characterizes secondary hypertension?
Identifiable cause
* Kidney Disease
* Hyperthyroid
* DM (Due to renal damage)
10% of cases
What is malignant/hypertensive crisis?
Sudden and severe rise in BP to ~240 systolic or 140 diastolic
Caused by dysregulation of the autonomic nervous system
What are the symptoms of malignant hypertensive crisis?
- CNS: HA, Photophobia, Blurred vision, Dizziness, CVA, Encephalopathy
- CVS: Angina, ACS
- Renal: Worsening chronic condition, Acute renal failure
- Eyes: Ruptured capillaries
What is the standard care for hypertension?
Symptom management and searching for possible causes
HTN alone is not a medical emergency
What is hypotension?
Condition where blood pressure is too low to maintain adequate perfusion to organs
What is the formula for blood pressure?
BP = Cardiac Output X Peripheral Resistance
What are common symptoms of hypotension?
- SOB
- Orthostatic tachycardia
- Dizziness/fainting
- Tachypnea
What are the two main types of vascular disorders?
- Arteriosclerosis - Thickening, harding of arterial walls
- Atherosclerosis - plaque build up
What is arteriosclerosis?
Chronic disease process of the arterial system characterized by abnormal hardening/thickening of vessel walls
What is atherosclerosis?
A form of arteriosclerosis where hardening and thickening are due to fat deposits
What are common areas affected by atherosclerosis?
- Peripheral vascular disease (PVD)
- Aortic problems
- Cerebrovascular accident (CVA)
- Coronary artery disease (CAD)
What is edema?
Fluid accumulating in interstitial and cavity spaces, often gravity-dependent
What is pitting edema?
A common sign in conditions such as:
* Congestive heart failure
* Liver failure
* Renal failure
* Peripheral vascular disease
What is a thrombus?
A blood clot that adheres to the interior vessel wall, impeding distal blood flow
What are the components of Virchow’s triad?
- Hypercoagulability
- Blood stasis
- Vessel damage
What happens when a thrombus breaks free?
It becomes an embolus, which can cause problems in tiny vasculature
What is the standard treatment for hypotension?
IV NS 500ml bolus to MAX 2000ml, titrating to a systolic of 90 or a MAP of 65
True or False: Hypertension is always considered a medical emergency.
False
Fill in the blank: Blood pressure is maintained by _______ and _______.
[Blood volume] and [Cardiac output]
What are varicose veins?
A distended, tortuous, palpable vein
Caused by damaged valves in veins and results in pooling of blood in vein segments
What can cause varicose veins?
Causes include:
* Trauma
* Hypertension (HTN)
* Pregnancy
Breeding ground for thrombi and stagnant blood coagulation
What is an aneurysm?
An out-pouching of a vessel wall or cardiac chamber.
May be dissecting, leaking, or ruptured
Where do aneurysms most commonly occur?
Most often in the aorta
For abdominal aortic aneurysms (AAA), look for pulsating masses.
What symptoms may indicate an abdominal aortic aneurysm (AAA)?
Symptoms include:
* Midline tearing pain radiating towards the back
* Unexplained syncope
* Unequal distal pulses
75% of AAA patients will not have a pulsating mass
How should suspected aneurysm patients be treated?
Handle very gently as they are at risk of rupturing.
* Administer O2 as needed
* Use IV large bore
* Monitor ECG
* Perform bilateral blood pressure readings
What is anemia?
A reduction in the total number of circulating red blood cells or a decrease in either quantity or quality of hemoglobin.
What are the four general causes of anemia?
Causes include:
* Impaired RBC production
* Increased RBC destruction
* Blood loss
* Combination of any of the above
What is leukemia?
A clonally malignant disorder of the blood-forming organs causing an accumulation of dysfunctional cells and a loss of division regulation.
What is polycythemia?
An increase in the amount of circulating RBCs.
This leads to complications associated with turbulent blood flow and hypertension.
What are the types of hemophilia?
Types include:
* Hemophilia A (classic)
* Hemophilia B (Christmas disease)
* Hemophilia C
* Von Willebrand disease
What is coronary artery disease?
Narrowing of coronary artery leading to decreased oxygen supply.
What are the three ‘I’s associated with coronary artery disease?
The three ‘I’s are:
* Ischemia
* Injury
* Infarct
What is myocardial ischemia?
Insufficient supply of oxygen for the demand of the heart.
What is the vicious circle of myocardial ischemia?
Decreased O2 → stress on the heart → sympathetic tone → increased workload on the heart → increased oxygen demand → decreased O2
What differentiates a myocardial infarction from angina pectoris?
Tissue death is the key factor that separates a myocardial infarction from angina pectoris.
What causes myocardial infarction?
Causes include:
* Prolonged angina
* Complete obstruction
* Embolism
* Vasospasm
* Thrombus formation
What is a silent myocardial infarction?
An MI without chest pain, only presenting with anginal equivalents.
What are the complications from a myocardial infarction?
Complications include:
* Decreased stroke volume
* Pericarditis
* Cardiac arrest
* Dysrhythmias
* Congestive heart failure (CHF)
* Emboli
What is the SAMPLE method used for?
To take a cardiovascular history.
What are the components of the OPQRST method?
Components include:
* Onset
* Provocation
* Quality
* Radiation
* Severity
* Time
What is peripheral vascular disease?
Involves arteries of extremities and abdominal organs, leading to decreased perfusion.
What symptoms may indicate peripheral vascular disease in extremities?
Symptoms include cramps with exertion.
What is the primary symptom of renal artery blockage in peripheral vascular disease?
Renal insufficiency.
What is Congestive Heart Failure (CHF)?
When the heart can no longer adequately supply demands of the body and/or heart with proper pressure/volume of blood.
What are the causes of decreased cardiac output in CHF?
- Contractility alterations
- Chronic overload (hypertension)
- Previous MI (heart attack)
- Congenital abnormalities
What mechanisms does the heart employ to compensate for CHF?
- Increased contractions (Inotropic)
- Increased heart rate (Chronotropic)
- Increased blood volume
True or False: The compensatory mechanisms in CHF can worsen the condition.
True
What are the two categories of Congestive Heart Failure?
- Left-sided CHF
- Right-sided CHF
What happens in Left-sided CHF?
Blood cannot be moved by the left ventricle and backs up, causing increased atrial resistance and decreased contraction strength.
What are the symptoms of Left-sided CHF?
- Dyspnea (difficulty breathing)
- Orthopnea
- Productive cough/frothy pinkish sputum
- Fatigue
- Lung sounds = crackles/rales and possibly wheezes
What is a classic symptom presentation of a patient with Left-sided CHF?
Woke from rest with SOB at 0400 hrs and SPO2 of 82%.
What is Cor Pulmonale?
Right-sided CHF often occurring secondary to left-sided CHF.
What are the symptoms of Right-sided CHF?
- Jugular vein distention
- Pedal edema
- Sacral edema
- Possible hypotension
- Abdominal distension of liver and spleen
What should be avoided in the treatment of pulmonary edema patients?
Providing fluids
What is a Cerebrovascular Accident (CVA)?
Pathology similar to Atherosclerosis with ischemic brain tissue due to embolism, thrombus, or aneurysm.
What are common signs and symptoms of a CVA?
- Headache
- One-sided weakness or paralysis
- Difficulty speaking, expressive aphasia
- Poor coordination
- Decreased LOC
- Facial droop
- Unequal pupils
What is important for prehospital stroke assessment?
Ensure the last time seen normal is known.
What is a Pulmonary Embolus (PE)?
An embolus that lodges in the pulmonary vasculature, preventing oxygenation.
What are the risk factors for a Pulmonary Embolus?
- Long periods with no movement/sedentary lifestyle
- Vascular/clotting disorders
- Obesity
- Diabetics
- Birth control pills
- Recent history of long bone fractures
- Smoking
What are the causes of a Pulmonary Embolus?
- Thrombi
- Fatty emboli
- Air emboli
- Amniotic fluid
- Tumor cells
What is the acronym for obvious signs of death?
DRIED
What does each letter in the DRIED acronym signify?
- D: Decapitation/Dependent pooling (lividity)
- R: Rigor Mortis
- I: Incinerated
- E: Eviscerated
- D: Decomposition
What medications are in-scope for treatment?
- Oxygen
- IV Saline
- ASA
- Nitroglycerine
- Morphine
- Thrombolytic
- Beta-blockers
- Anti-hypertensive
- Lasix
- Digitalis
What are the signs and symptoms of Cardiac Arrest?
- Unresponsive
- Pulseless
- Apneic
What are common causes of Cardiac Arrest?
- MI
- Hypothermia
- Drowning
- Electrocution
- Trauma
- Overdose
- Environmental poisonings
- Pediatric causes (usually respiratory)
What is Ventricular fibrillation (V-fib)?
A rhythm where multiple areas of the ventricles contract without organization, resulting in no pumping ability.
What is Ventricular tachycardia (V-tach)?
Rapid and usually regular firing of the ventricles; may or may not produce a pulse.
What does Asystole refer to?
A condition of no electrical activity in the heart, also known as ‘flatline’.
What is Pulseless Electrical Activity (PEA)?
A cardiac arrest situation where electrical activity is occurring but muscle cells are not responding.
What is the best approach if in doubt about a cardiac issue?
Treat cardiac until proven otherwise.
