Chapter 14A - Cardiovascular Emergencies Flashcards
Perfusion
Means, “to pour through” - so it refers to the pumping of blood through capillary beds. Perfusion supplied cells with O2 and nutrients.
Arteriosclerosis
A condition of hardening of the arteries.
Causes
- aging
- HTN
- cigarettes
Atherosclerosis
One of the types or causes of hardening of the arteries
C. A. B. G.
Coronary artery bypass graft
Or a coronary bypass operation done for clogged arteries in the heart
Acute coronary syndrome
A term than included an acute onset MI or unstable angina pectoris. ACS is the proximate cause if sudden cardiac death in most adult patients.
What is the most common cause of death in the first 2 hours of an MI?
Ventricular fibrillation
Describe the development of atherosclerosis
CAD starts in early childhood. It may take 20-40 years to affect the body noticeably. Usually atherosclerosis must restrict the diameter of the coronary arteries by 50-70% for symptoms to occur.
What causes atherosclerosis?
- Damage to the inner wall of the artery (from oxidation or toxins)
- Followed by build-up plaques and cholesterol within the layers of the arterial wall itself (from high fat diets, especially from saturated or “partially hydrogenated” oils
- Low-density lipo-protein (LDL) - high levels of LDL’s contribute to atherosclerosis because they bring and deposit fat in arteries
- High density lipo-proteins (HDL) - high levels of HDL’s protect against atherosclerosis because they pick up and remove fats from the system
List common causes of chest pain
Myocardial causes
Vascular causes
Pulmonary causes
Gastrointestinal causes
Myocardial causes of chest pain
Angina pectoris
MI
Pericarditis
Vascular causes of chest pain
Acute dissecting aneurysm (a ballooning of the aorta)
Pulmonary causes of chest pain
Acute pulmonary embolus
Pneumonia
Pneumothorax
Pleurisy
Gastrointestinal causes of chest pain
Gastritis Esophagitis (heart burn or gastric reflux, myocardial ischemia may present as abdominal pain or discomfort)
Describe the OPQRST of chest pain
O - when did this chest pain start
P - what where you doing when the pain began? What makes it better? What makes it worse?
Q - what does the pain feel like?
R - where is the pain located? Does the pain go anywhere else?
S - how sever is the pain? Would you rank the pain as mild, moderate, or severe?
T - how long has the pain lasted?
Describe differential diagnosis of things myocardial pain probably isn’t.
Not described as sharp or stabbing
Not usually relatives to exercise or stress
Not made worse by inhalation
Not relieved by rest
Not relieved by NTG or only minimally, and then returns after a few minutes.
Suspect MI anytime…
Fainting - for no know cause, especially if felt chest “discomfort” just before or just after
Sudden weakness - not supported by history
Pulmonary edema - from left-sided failure, due to infarct
Seizure - check ABCs following seizures, they may have just fibrillated - a seizure is a common precursor
List the recognition signs of pulmonary edema
= watery fluid (serum, not mucus) in the alveoli or smaller airways
Typically starts as mild or pronounced agitation, a persistent cough and eventually foam at the mouth.
Describe a silent MI
An MI with no chest pain.
Patient usually has many other s/s of MI just no chest pain. Describe chest discomfort, heaviness, indigestion, heartburn
MI recognition
- chest discomfort, including pain, pressure, squeezing, or an unusual feeling of fullness in the center of the chest. The symptoms may come and go.
- radiates to one or both arms, back, neck, jaw, or abdomen
- sudden onset of SOB, even without chest discomfort
- a cold sweat, nausea, or lightheadedness
S/S of decreased cardiac output or decreased tissue perfusion
Tachypnea
Tachycardia
Pale, cool, clammy skin, followed by a mottled appearance and cyanosis
Delayed capillary refill
Hypotension
ALOC
Cardiac Risk factors
HTN - BP of 150 mmHg has 2x the chance of getting an MI
Cholesterol - with a level of 250 3x the chance of getting MI or CVA
Mitral valve prolapse
Nicotine - a pack a day 2x chance of having MI or CVA
Excess weight - 30 pounds over weight for over 4 years have 2x of MI
Lack of exercise
Implanted devices
Obesity and lack of exercise in youth
Angina pectoris - physiology
Decreased blood supply to a portion of the myocardium leading to temporary ischemia, usually due to atherosclerotic deposits in the coronary arteries
The ischemia leads to hypoxia and leads to anaerobic metabolism which leads to lactic acid production which then leads to substance P cycle
S/S - OPQRST
P - exercise, activity, stress, eating too much
Q - feels like pressure, chest tightness, a weight in the chest, burning
R - usually felt subset am or epigastric - may radiate to jaw, neck, shoulder or arm
S - mild or moderate pain or discomfort
T - sudden onset usually 3-5 min rarely last 10 min
Associated S/S = dyspnea, diaphoretic, n/v, severe apprehension, belching
MI - pathophysiology
Decreased blood supply to a portion of the myocardium leading to ischemia and death of the myocardium usually due to a blood clot (thrombus) in the coronary arteries
MI - S/S
P - same as angina, may have no provoking factor
Q - same as angina
R - same as angina
S - moderate to severe pain
T - sudden onset usually last 30 min or longer.
Associated S/S N/V Diaphoresis Dyspnea, orthopnea Irregular pulse Sudden onset of weakness or light headedness Denial
Left sided CHF - pathophysiology
Chronic weakening if the left ventricle due to failure under excessive workload, old infarction, faulty valves
Caused by chronic hypertension, excessive nicotine use, precious MI, beta blocker use
Left ventricle ejection fraction drop, but right hearts remains the same, excess blood pools in the lungs causing edema (left ventricle cannot handle all the preload, so some backs up into the lungs causing edema)
Left sided CHF - S/S
Slow onset, often over several days (may not be noticed until acute
Dyspnea, SOB, productive cough
Sitting up
Pulmonary edema (mismatch between ventricles - the right is pumping well, the left is not getting rid of as much volume)
Right sided CHF - pathophysiology
Chronic weakening of the right ventricle due to failure under excessive workload, or right ventricular infarction
Caused by chronic respiratory diseases, pulmonary HTN
Right ventricle ejection fraction drops, but venous return remains the same, excess blood pools in the lower extremities, causing dependent edema
Right sided CHF - S/S
Dependent edema
JVD
Liver engorgement (ascites)
Hypertensive crisis - pathophysiology
HTN with risk that prolonged HTN could lead to an aneurysm bursting or to heart failure from the excessive work load (results in end-organ damage such as the brain, heart, or kidney failure)
Hypertensive crisis - s/s
Hypertension with
- angina
- pulmonary edema
- pregnancy
- signs of cerebral edema (headache, blurred vision/visual disturbances, n/v, ams, dizziness, vertigo, tinnitus)
- nosebleed
- CP
- SOB
- abdominal or back pain
Diastolic >120mmHg or > 90 if symptomatic
Hypertensive emergency - pathophysiology
Systolic is >160 or diastolic 94> this is considered to be a medical emergency that must be transported
HTN emergency - s/s
Pulse that is strong bounding Tinnitus Headache Nosebleed N/v
Dissecting aortic aneurysm - pathophysiology
A ballooning of the wall of the artery as a result of a defect, leading to dissecting which thins the number of layers containing the blood pressure and some of the ballooning pushes inward, can decrease aortic blood flow
Dissecting aortic aneurysm - s/s OPQRST
P - lifting heavy weights, straining
Q - tearing, hot, knife like
R - pain from anterior chest, boring through to the back
S - very severe and hits max at time of onset
T - sudden onset
Unequal right and left radial pulses (if thoracic)
Unequal femoral pulses (if AAA)
Unequal BP in right and left arms
