Ch 16 Cardiovascular Emergencies Flashcards
Acute coronary syndrome
Symptoms caused by myocardial ischemia; includes angina and myocardial infarction
AMI
Acute Myocardial Infarction a.k.a. heart attack; death of the heart muscle following obstruction of blood flow to it; acute in this contest means new/happening now
Angina pectoris
Transient (short lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart; angina
Aorta
Main artery, which receives blood from the left ventricle and delivers it all other arteries that carry blood to the body
Aortic aneurysm
a weakness in the wall of the aorta that makes it susceptible to rupture
Aortic valve
one-way valve that lies between the left ventricle and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects blood into the aorta; one of four heart valves
Artifact
A tracing on an EKG as a result of interference, such as patient movement, rather than electrical activity
Asystole
The complete absence of all heart electrical activity
Atherosclerosis
A disorder in which the cholesterol and calcium build up inside the walls if blood vessels, eventually leading to partial or complete blockage of blood flow
Atrium
One of two (R and L) upper chambers of the heart: incoming
Right atrium: receives blood from the Vena Cava and delivers to the right ventricle
Left atrium: receives blood from pulmonary veins and delivers to Left Ventricle
Automaticity
The ability of the cardiac muscle cells to contract without stimulation from the nervous system; not found in any other cells
Autonomic nervous system
Controls involuntary activities - HR, BP
Bradycardia
Slow heart rate, < 60 bpm
Cardiac arrest
When the heart fails to generate effective and detectable blood flow; pulses are not palpable in cardiac arrest, even if muscular electrical activity continues in the heart
Cardiac output
A measure of volume of blood circulated by the heart in 1 minute = stroke volume X the heart rate
Increased to meet increased metabolic rates
Cardiogenic shock
A state where not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large MI or other conditions
CHF
Congestive heart failure
Disorder where the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs
Coronary arteries
Blood vessels that carry blood and nutrients to the heart
Defibrillate
to shock a fibrillating (chaotically beating) heart with specialized electric current in an attempt to restore a normal, rhythmic beat
Dependent edema
Swelling in the part of the body closes to the ground, caused by collection of fluid in the tissues, a possible sign of CHF
Dilation
Widening of a tubular structure such as a coronary artery
Dissecting aneurysm
When the inner layers of an artery, such as the aorta, become separated, allowing blood (at high pressure) to flow between the layers
Dysrhythmia
irregular or abnormal heart rhythm
Hypertensive emergency
An emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm
Infarction
Death of a body tissue, usually caused by interruption of blood supply
Ischemia
Lack of oxygen that deprives tissues of necessary nutrient, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury may not have occurred yet
Lumen
The inside diameter of an artery or other hollow structure
Myocardium
The heart muscle
Occlusion
A blockage, usually of a tubular structure such as a blood vessel
Parasympathetic nervous system
Controls vegetative functions such as digestion and relaxation
Perfusion
Flow of blood through body/tissues
ROSC
Return of Spontaneous Circulation
The return of a pulse and effective blood flow to the body in a patient who previously was in cardia arrest
Stroke volume
volume of blood ejected with each ventricular contraction
Sympathetic nervous system
Controls active functions such as responding to fear (fight or flight)
Tachycardia
Rapid heart rate, > 100 bpm
Thromboembolism
A blood clot formed within a blood vessel and is floating within the bloodstream
Ventricle
One of two (R and L) lower chambers of the heart: Outgoing
Left ventricle: receives blood from left atrium and delivers blood to the aorta;
Right ventricle: receives blood from the right atrium and pumps it into the pulmonary artery
Ventricular fibrillation
V-Fib
Disorganized, ineffective quivering of the ventricles, resulting in no blood flow and a state of cardiac arrest
Ventricular tachycardia
V-Tach
Rapid heart rhythm in which the electrical impulse begins in the ventricle instead of the atrium, which may result in inadequate blood flow and eventually deteriorate into cardiac arrest
The leading killer of Americans since the 1900s
Heart disease
Explain the flow of blood through the Heart/Lungs
Right atrium receives deoxygenated blood from the vena cava > to the right ventricle > pulmonary artery > to the lungs and receives fresh oxygen > pulmonary vein > left atrium receives oxygenated blood > left ventricle > to the rest of the body through the aorta
Normal electrical impulses begin at the ____
Sinus node; sinoatrial node (SA)
The impulses travel across both atria, stimulating them to contract; controlled by autonomic nervous system
Between the atria and the ventricles, electrical impulses cross a bridge of special electrical tissue called the ____
Atrioventricular node (AV) The signal is slowed for about 1/10 to 2/10 of a second to allow blod time to pass from the atria to the ventricles
Electrical impulses exit the AV node and ____
Spread through both ventricles via the bundle of His, the R and L bundle branches and the Purkinje fibers causing contraction
Other myocardial cells will contract if ____
normal impulses begin at the SA node
Other myocardial cells are capable of creating their of impulses and stimulating contraction of the heart, however ____
They are generated at a slower rate
When does the myocardium require more oxygen?
During periods of stress of physical exertion
Increased oxygen demand of the heart itself is supplied by ____
dilation of the coronary arteries, which increases blood flow
Blood is supplied to the head and brain by
The right and left carotid arteries
Blood is supplied to the upper extremities by
The right and left subclavian arteries (becomes brachial and divides into radial an ulnar in the arms)
Blood is supplied to the groin, pelvis and legs by
The descending aorta, which divides into the right and left iliac arteries
Blood is supplied to the lower extremities by
The right and left femoral arteries (divides into anterior and posterior tibial arteries and peroneal arteries )
Capillaries
Connect arterioles to venules and are found in all parts of the body; allows for the exchange of nutrients and waste at a cellular level
Venules
The smallest branches of veins
Veins
oxygen-poor blood enters a system of veins; eventually come to the Vena Cavae
Carries blood from the head and arms back to the right atrium
Superior Vena Cava
Carries blood from the kidneys, abdomen and legs back to the right atrium
Inferior Vena Cava
Brittle plaques may sometimes crack, exposing the inside of an atherosclerotic wall, which acts like ____
A torn blood vessel and activates the clotting system and the resulting clot will partially or completely block the lumen of the artery
Major controllable risk factors for AMI
Smoking High blood pressure Elevated cholesterol Elevated blood glucose levels Lack of exercise Obesity
Major uncontrollable risk factors for AMI
Age (older) Family history of atherosclerotic coronary artery disease Race Ethnicity Sex (men)
Angina is most often the result of
Atherosclerotic coronary artery disease
Sometime the result of an arterial spasm
Angina is commonly described as
Crushing, squeezing, “like somebody is standing on my chest”
Angina is commonly felt
In the mid portion of the chest, under the sternum, but may radiate to the jaw, arms (frequently left), and mid-portion of the back or epigastrium (upper mid region of abdomen)
Pain from angina typically lasts
3-8 minutes, rarely longer than 15 minutes
Angina S/S typically subside with administration of
Supplemental oxygen and nitroglycerine, which decrease the need and increase supply of O2 to the heart
Unstable angina
Characterized by pain or discomfort that occurs in response to progressively less exercise or fewer stimuli than originally required to produce it; can lead to AMI if left untreated
Stable angina
Characterized by pain or discomfort that is relieved by things that normally relieve it, such as resting, nitro
AMI is most likely to occur in the
Left ventricle
S/S of AMI
Sudden onset of weakness, nausea, sweating w/o obvious cause
Chest pain, discomfort, pressure that is crushing or squeezing and does not change with breaths
Pain, discomfort or pressure in the lower jaw, arms, back, abdomen, neck
Irregular heartbeat, syncope
Shortness of breath, dyspnea
Nausea/vomiting
Pink frothy sputum (indicates possible pulmonary edema)
Sudden death
In AMI, cells begin to die after ___
30 minutes after blood flow is cut off
In AMI, after 2 hours without blood flow as many as ____ cells in the area can be dead
Half/50%
In AMI, after 4-6 hours without blood flow, as many as ____ cells will be dead
90%
Once dead, heart cells ____
Turn to scar tissue and become a burden to the beating heart, which is why rapid intervention is so critical
Pain from AMI is different from Angina in three ways:
1) it may not be caused by exertion but can occur at any time, sometimes when sleeping or sitting
2) it does not resolve in a few minutes, rather it can last between 30min and several hours
3) it may or may not be relieved by rest or nitroglycerine
Cardiac deinal
People may not seek medical attention because a fear of dying and do not want to face that possibility
Middle aged men are most likely to minimize symptoms
Older people and women experiencing AMI may not ____
Experience any pain but have other common complaints associated with ischemia
“silent MI”
AMI - general appearance
frightened, nausea/vomiting or cold sweats, pale or ashen skin, occasionally cyanosis
AMI - pulse
generally pulse rate increases in response to fear/stress/pain, dysrhythmias are common so you may feel irregularity or slowing of the pulse
Damage to the inferior area in an AMI often presents with ____ (pulse)
bradycardia
AMI - blood pressure
May fall as a result of diminished cardiac output, most patients have normal or possibly elevated BP
AMI - respirations
Usually normal unless patient has CHF, complaint of difficulty breathing is common
In cases of CHF, may become rapid and labored, with higher likelihood of cyanosis and frothy sputum
AMI - mental status
Often experience confusion or agitation, overwhelming feeling of impending doom
Approximately ____ of AMI patients do not reach the hospital alive
40%
