Chapter 17 Flashcards
what is ischemia
Ischemic heart disease involves a decrease in blood flow to one or more portions of the heart muscle.
Heart-related chest pain usually stems from ischemia, which is decreased blood flow to the heart or inefficient supply of oxygen and nutrients.
what is Atherosclerosis
Atherosclerosis is a disorder in which calcium and cholesterol build up and form a plaque inside the walls of blood vessels.
It can cause complete occlusion or blockage of a coronary artery and other arteries of the body
What is thromboembolism
A thromboembolism is a blood clot that floats through the blood vessels.
a. If it reaches an area too narrow for it to pass, it stops and blocks blood flow at that point.
b. Tissues downstream from the blood clot will suffer from hypoxia.
c. If too much time passes before blood flow is resumed, the tissues will die.
d. This sequence of events is known as acute myocardial infarction (AMI), a classic heart attack.
e. The death of heart muscle can severely diminish the heart’s ability to pump.
What is acute myocardial infarction (AMI)
a classic heart attack
Controllable factors to prevent a heart attack (6)
i. Cigarette smoking
ii. High blood pressure
iii. Elevated cholesterol level
iv. Diabetes
v. Lack of exercise
vi. Obesity
uncontrollable factors to prevent a heart attack (5)
i. Older age
ii. Family history
iii. Race
iv. Ethnicity
v. Male sex
The heart sections
Heart’s job is to pump blood to supply oxygen-enriched red blood cells to tissues.
Divided into left and right sides
Upper chambers (atria) receive incoming blood.
Lower chambers (ventricles) pump outgoing blood.
The right side of the heart receives oxygen-poor blood from the venous circulation.
The left side of the heart receives oxygen-rich blood from the lungs through the pulmonary veins.
What is the aorta
The aorta, the body’s main artery, receives blood ejected from left ventricle.
The heart’s electrical system
The heart’s electrical system controls heart rate and coordinates atria and ventricles.
Electrical impulses start at the SA node.
- Passes from the atria to the ventricles
Automaticity allows spontaneous contraction without a stimulus from a nerve source.
Autonomic nervous system (ANS)
- Autonomic nervous system (ANS) controls involuntary activities.
- The ANS has two parts:
- Sympathetic nervous system
- Parasympathetic nervous system
Blood consists of (4)
- Red blood cells, which carry oxygen
- White blood cells, which fight infection
- Platelets, which help blood to clot
- Plasma, which is the fluid cells float in
Systolic blood pressure
The maximum pressure generated by left ventricle
Diastolic blood pressure
The pressure against artery walls while the left ventricle is at rest
Common pulse points (6)
- The carotid pulse is felt in the neck.
- The femoral pulse is felt in the groin area.
- The brachial pulse is felt on the inside of the upper arm.
- The radial pulse is felt on the thumb side of the wrist.
- The posterior tibial pulse is felt on the inside of the ankle.
- The dorsalis pedis pulse is felt on the top of the foot.
Cardiac output is
Cardiac output is the volume of blood that passes through the heart in 1 minute
Chest pain usually stems from
ischemia
(which is decreased blood flow.
Ischemic heart disease involves a decreased blood flow to one or more portions of the heart.
If blood flow is not restored, the tissue dies.)
What is ischemia
Ischemia is decreased blood flow.
Ischemic heart disease involves a decreased blood flow to one or more portions of the heart.
If blood flow is not restored, the tissue dies
Chest pain usually stems from it
What is angina pectoris?
What is angina pectoris? Angina pectoris—or simply angina—is chest pain or discomfort that keeps coming back. It happens when some part of your heart doesn’t get enough blood and oxygen. Angina can be a symptom of coronary artery disease (CAD)
What is Angina pectoris
Angina pectoris occurs when the heart’s need for oxygen exceeds supply.
- Crushing or squeezing pain
- Does not usually lead to death or permanent heart damage
- Should be taken as a serious warning sign
What is Unstable angina
Unstable angina is a condition in which your heart doesn’t get enough blood flow and oxygen. It may lead to a heart attack. Angina is a type of chest discomfort due to poor blood flow through the blood vessels in the heart called the coronary arteries. You feel a tight band of pain around your chest.
Treat angina patients like AMI (Acute Myocardial Infarction = heart attack) patients
What is Stable angina
Stable angina is chest pain or discomfort that most often occurs with activity or emotional stress. Angina is due to poor blood flow through the blood vessels in the heart called the coronary arteries.
Treat angina patients like AMI (Acute Myocardial Infarction = heart attack) patients
what does AMI (Acute Myocardial Infarction = heart attack) pain signals
AMI pain signals actual death of cells in heart muscle.
Once dead, cells cannot be revived.
“Clot-busting” (thrombolytic) drugs or angioplasty within the first few hours prevents damage.
Immediate transport is essential.
What are the Signs and symptoms of AMI (heart attack)
- Weakness, nausea, sweating
- Chest pain, discomfort, or pressure
- Lower jaw, arm, back, abdomen, or neck pain
- Irregular heartbeat and syncope (fainting)
- Shortness of breath (dyspnea)
- Nausea/vomiting
- Pink, frothy sputum
- Sudden death
AMI (heart attack) pain differs from angina pain
- Not always due to exertion
- Lasts 30 minutes to several hours
- Not always relieved by rest or nitroglycerin
- AMI patients may not realize they are experiencing a heart attack.
AMI (heart attack) and cardiac compromise physical findings
- Fear, nausea, poor circulation
- Faster, irregular, or bradycardic pulse
- Decreased, normal, or elevated blood pressure
- Normal or rapid and labored respirations
- Patients express feelings of impending doom.
Three serious consequences of AMI (heart attack)
- Sudden death
- Cardiogenic shock
- Congestive heart failure (CHF)
Dysrhythmia: heart rhythm abnormalities
- Premature ventricular contractions
- Tachycardia
- Bradycardia
- Ventricular tachycardia
- Ventricular fibrillation
Bradycardia
What is bradycardia? Bradycardia is a slower than normal heart rate. A normal adult resting heart rate is between 60 – 100 beats per minute (bpm). If you have bradycardia, your heart beats fewer than 60 times a minute. Bradycardia (heart rate 40 – 60 bpm) can be normal when you’re sleeping.
Tachycardia
Tachycardia is the medical term for a heart rate over 100 beats a minute. Many types of irregular heart rhythms (arrhythmias) can cause tachycardia. A fast heart rate isn’t always a concern
Defibrillation
the stopping of fibrillation of the heart by administering a controlled electric shock in order to allow restoration of the normal rhythm
AED
- Defibrillation restores cardiac rhythms.
- Can save lives
- Initiate CPR until a defibrillator is available.
Asystole
- Absence of all heart electrical activity
- Reflects a long period of ischemia (decreased blood flow to the heart)
- Nearly all patients will die.
Cardiogenic shock
Cardiogenic shock, also known as cardiac shock, happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs. This is a life-threatening emergency. It is treatable if diagnosed right away, so it’s important to know the warning signs
- Often caused by heart attack
- Heart lacks power to force enough blood through circulatory system.
- Inadequate oxygen to body tissues causes organs to malfunction.
- Recognize shock in its early stages.
congestive heart failure
With congestive heart failure, the heart’s capacity to pump blood cannot keep up with the body’s need. As the heart weakens, blood begins to back up and force liquid through the capillary walls. The term “congestive” refers to the resulting buildup of fluid in the ankles and feet, arms, lungs, and/or other organs.
- Often occurs a few days following heart attack
- Increased heart rate and enlargement of left ventricle no longer make - - up for decreased heart function
- Lungs become congested with fluid.
- May cause dependent edema.
Hypertensive emergencies
Hypertensive emergencies (high blood pressure)
- Systolic pressure greater than 180 mm Hg
Common symptoms
- Sudden, severe headache
- Strong, bounding pulse
- Ringing in the ears
- Nausea and vomiting
- Dizziness
- Warm skin (dry or moist)
- Nosebleed
- Altered mental status
- Sudden pulmonary edema
- If untreated, can lead to stroke or dissecting aortic aneurysm.
- Transport patients quickly and safely.
- Consider ALS assistance.
Aortic aneurysm
Aortic aneurysm is weakness in the wall of the aorta.
- Susceptible to rupture
- Dissecting aneurysm occurs when inner layers of aorta become separated.
- Primary cause: uncontrolled hypertension
Signs and symptoms
- Very sudden chest pain
- Comes on full force
- Different blood pressures
- May be difficult to tell the difference between a dissecting aneurysm and AMI
- Transport patients quickly and safely.
Oxygen saturation less than 95%
apply oxygen via nasal cannula at 4 L/min
Not breathing or inadequate breathing
100% oxygen with bag-mask device
Pulmonary edema
A condition caused by excess fluid in the lungs.
bag-mask device or CPAP
Aspirin
- Prevents blood clots from forming or getting bigger
- 81 mg chewable tablets
- Recommended dose: 162 mg (two tablets) to 324 mg (four tablets)
Nitroglycerin
It prevents and treats chest pain by relaxing your blood vessels.
Available forms
- Sublingual pill
- Sublingual spray
- Skin patch applied to chest
Mechanism of action:
- Relaxes blood vessel walls
- Increases blood flow and oxygen supply to heart
- Decreases workload of heart
- Dilates blood vessels
Side effects:
- Decreased blood pressure
- Severe headache
Contraindications:
- Systolic blood pressure <100 mm Hg
- Head injury
- Use of erectile dysfunction drugs within 24 hours
- Maximum prescribed dose has been given.
ECG
What is an electrocardiogram? An electrocardiogram (ECG) is one of the simplest and fastest tests used to evaluate the heart. Electrodes (small, plastic patches that stick to the skin) are placed at certain spots on the chest, arms, and legs. The electrodes are connected to an ECG machine by lead wires.
- May need to shave body hair
- Rub electrode site with alcohol swab before application.
- Attach electrodes to ECG cables before placement.
- Confirm electrode placement.
Coronary artery bypass graft
Chest or leg blood vessel is sewn from the aorta to a coronary artery beyond the point of obstruction
Percutaneous transluminal coronary angioplasty
A tiny balloon is inflated inside a narrowed coronary artery
Cardiac pacemakers
- Maintain regular cardiac rhythm and rate
- Deliver electrical impulse through wires in direct contact with the myocardium
- Implanted under a heavy muscle or fold of skin in the upper left portion of the chest
- Pacemaker malfunction can cause syncope, dizziness, or weakness due to an excessively slow heart rate.
- Transport patients promptly.
Automatic implantable cardiac defibrillators
- Used by some patients who have survived cardiac arrest due to ventricular fibrillation
- Monitor heart rhythm and shock as needed.
- Treat chest pain patients with these devices like other patients having an AMI.
- Electricity is low so it will not affect rescuers.
External defibrillator vest
- A vest with built-in monitoring electrodes and defibrillation pads worn by the patient
- Attached to a monitor
- Uses high-energy shocks
- Do not touch the patient if devices warns it is about to deliver a shock.
Vest should remain in place while CPR is being performed unless it interferes with compressions.
Left ventricular assist devices (LVADs)
- Used to enhance the pumping of the left ventricle
- Most common ones have an internal pump and external battery pack.
- Most patient will not have a palpable pulse.
- Transport all supplies and battery packs with the patient.
Cardiac Arrest
- The complete cessation of cardiac activity
- Absence of a carotid pulse
- Was terminal before CPR and external defibrillation were developed in the 1960s
- High-quality CPR, early defibrillation, and access to advanced care can improve outcomes.
Advantages of AED use
- Quick delivery of shock
- Easy to operate
- ALS providers do not need to be on scene.
- Remote, adhesive pads safe to use
- Larger pad area = more efficient shocks
- Not all patients in cardiac arrest require shock.
- All patients in cardiac arrest should be analyzed with an AED.
- Asystole indicates no electrical activity.
- Pulseless electrical activity usually refers to a state of cardiac arrest that exists despite an organized electrical complex.
Few cardiac arrest patients survive outside a hospital without a rapid sequence of events
- Early recognition and activation of EMS
- Immediate bystander CPR
- Rapid defibrillation
- Basic and advanced EMS
- ALS and postarrest care
- Recovery
If ALS is not responding and protocols agree, begin transport when:
- The patient regains a pulse.
- 6 to 9 shocks are delivered.
- AED gives three consecutive messages (every 2 min of CPR) advising no shock.
Cardiac arrest during transport
- Stop the vehicle.
- Begin CPR if AED is not immediately available
- Call for ALS support.
- Analyze rhythm.
- Deliver shock, if indicated, and resume CPR.
- Continue resuscitation per local protocol.
Management of Return of Spontaneous Circulation
- Monitor for respirations.
- Provide oxygen via bag-mask device at 10 breaths/min.
- Maintain SpO2 between 95% and 99%.
- Assess blood pressure.
- See if patient can follow simple commands.
- Immediately begin transport if ALS is not en route per local protocol.
