Chapter 16-cardiovascular Emergencies Flashcards
How does the heart pump?
Vena cava -> right atrium -> fills right ventricle -> contracts, sending blood into the pulmonary artery and pulmonary circulation in the lungs, and airs oxygenated -> gas exchange happens in the alveoli -> blood returns to the heart through the pulmonary vein -> the left side of the heart receives oxygen rich blood through pulmonary vein -> blood enters left atrium and passes to left ventricle -> pumps blood into aorta and then into rest of the body
Automaticity
Allows a cardiac muscle to contract spontaneously without a stimulus from a nerve source
Autonomic nervous system
A part of the brain that controls the functions of the body that do not require a conscious thought, such as the heartbeat, respirations, dilation and constriction of what’s out, digestion of food
Sympathetic nervous system
“Fight or flight” system
Speeds up the heart rate, increases respiratory rate and depth, dilates blood vessels in the muscles, constricts blood vessels in the digestive system
Parasympathetic nervous system
Does the opposite of the sympathetic nervous system.
Slows the heart and respiratory rates, constrict blood vessels in the muscles, dilates blood vessels in the digestive system
Myocardium
Heart muscle
Stroke volume
Volume of blood ejected with each ventricular contraction
Dilation
Widening
Coronary arteries
Blood vessels that supply blood to the heart muscle
Cardiac output
The amount of blood pumped out of the left ventricle in one minute
Heart rate x stroke volume
Perfusion
The constant flow of oxygenated blood to the tissues
Ischemia
Decreased blood flow
Atherosclerosis
A disorder in which calcium and cholesterol buildup and form a plaque inside the walls of the blood vessels, obstructing flow and interfering with their ability to dilate or contract
Occlusion
Blockage
Lumen
The inside diameter of the artery
Thromboembolism
A blood clot floating through blood vessels until it reaches an area too narrow to pass
Acute myocardial infection (AMI)
A classic heart attack
When blockage occurs in the coronary artery
Infarction
Death of a tissue
Cardiac arrest
When the heart fails to generate effective and detectable blood flow
Acute coronary syndrome (ACS)
A group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction
Angina pectoris
Short-lived chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle
What is angial pain like?
Crushing or squeezing. Like someone’s standing on your chest
Signs and symptoms of acute myocardial infarction
- sudden onset of weakness, nausea, and sweating without obvious cause
- chest pain, discomfort, or pressure that is often crushing or squeezing and that does not chase with each breath
- pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck
- irregular heartbeat and Syncope (fainting)
- dyspnea
- nausea/vomiting
- pink, frothy sputum
- sudden death
The pain of an AMI differs from the pain of angina in what three ways?
- It may or may not be caused by exertion but can occur at any time, sometimes when a person is sitting quietly or even sleeping
- it does not resolve in a few minutes: rather, it can last between 30 minutes and several hours
- it may or may not be relieved by rest or nitroglycerin
Physical findings of AMI and cardiac compromise
General appearance
-appears frightened. Skin may be pale or ashen gray because of poor cardiac output and the loss of blood flow
Pulse
-pulse rate increases due to pain, stress fear, or physical injury of the myocardium
BP
-BP may fall as a result of diminished cardiac output and diminished capability of the left ventricle to pump
Respiration
-rate is usually normal unless patient has CHF. Respiratory rate may become rapid and labored with possibly cyanosis and sputum
Mental status
-patients with AMI’s often experience confusion and agitation
Dysrythmia
An irregular or abnormal heart rhythm
What three serious consequences can AMI have?
- sudden death
- cariogenic shock
- congestive heart failure
Ventricular tachycardia
Rapid heart rhythm, usually at rate of 150-200 beats/min. Not enough time is allowed for the left ventricle to fill with blood, therefore not making an adequate pump
Ventricular fibrillation
Disorganized, ineffective quivering of the ventricles. No blood is pumped through the body, and the patient becomes unconscious within seconds. The only way to stop this is to difibrillate the heart
Defibrillate
Means to shock the heart with a specialized electric current in an attempt to stop the chaotic, disorganized contractions of the heart.
Asystole
The absence of all heart electrical activity.
Cariogenic shock
Often caused by heart attack; the heart lacks the proper amount of power to force the proper volume of blood through the circulatory system
CHF
A disorder in which the heart loses part of its ability to effectively pump blood, usually a result the damage of the heart muscle can usually resulting in a back up of fluid in the lungs
Signs and symptoms of cardiogenic shock
- anxiety or restlessness as the brain becomes relatively starved for oxygen “air hunger”
- as the shock continues, the body tries to send blood to the most important organs, such as the brain and heart and away from the less important organs like the skin. Therefore you may see pale, cool, clammy skin
- as shock continues, the pulse rate will get higher for the body trying to compensate for pumped blood
- can also present with rapid and shallow breathing, nausea and vomiting, and a decrease in body temperature
- as the heart and other organs begin to malfunction, the blood pressure will fall below normal
Signs and symptoms of CHF
- The patient finds it easier to breath with sitting up. When lying down, more blood is returned to the right ventricle and lungs causing further congestion
- patient is often agitated
- chest pain may or may not be prevalent
- The patient may have swollen ankles from dependent edema (backup of fluids)
- The patient generally will have a high blood pressure, rapid heart rate, and rapid respirations
- skin is usually pale or cyanotic and sweaty
- The fluid surrounding small airways may produce crackles
- distended neck veins
How to treat a patient with CHF
- Take vital signs and give oxygen.
- Allow patient to be sitting in upright position with legs down
- Be reassuring
- Patients who have had problems with CHF before will usually have specific medications for his treatment, gather these medications and take them to the hospital
- Nitroglycerin may be of value reducing pulmonary Adema if the patient systolic blood pressure is more than 100
Dependent Edema
Swelling of the part of the body closest to the ground
Hypertensive emergency
Usually occurs with the systolic pressure greater than 180 mm HG or a rapid rise in the systolic pressure
Signs and symptoms of a hypertensive emergency
A sudden severe headache, strong bounding pulses, ringing in the ears, nausea and vomiting, dizziness, warm skin, nosebleed, altered mental status
Aortic aneurysm
A weakness in the wall of the aorta
Dissecting aneurysm
Occurs when the inner layers of the aorta become separated, allowing blood to flow between the layers
Artifact
Tracing on an ECG (electrocardiogram) that is the result of interference, such as patient movement, rather than the hearts electrical activity
Automatic implantable cardiac defibrillator
Attached directly to the heart and continuously monitor his heart rhythm, delivering shocks as needed; shocks don’t affect rescuers
Pacemaker
Typically inserted under the skin in the left upper portion of the chest, delivers an electrical impulse to regulate the heartbeat
External defibrillator vest
An alternative to the implantable cardiac defibrillator. This device is a vest with a built-in monitoring electrodes and defibrillation pads, which is one by the patient under his or her clothing
Left ventricular assist devices (LVAD’s)
Are used to enhance the pumping of the left ventricle in patients with severe heart failure or in patients who need a temporary boost due to an MI
