Recognition and Management of cardiac conditions

Question 1

Name 4 Types of Cardiac Condition

Answer 1

Coronary Artery Disease

Acute Coronary Syndromes (Unstable angina and acute myocardial infarction)

Heart Failure

Cardiac Arrest

Question 2

Coronary Artery Disease

Answer 2

Atheroma (laying down of fatty deposits)

+ Sclerosis (Hardening of plaque) = Atherosclerosis (deposition of atheroma combined with hardening of the coronary arteries) ↓ Decreased blood flow

Question 3

Angina Pectoris

Answer 3

The most common symptom of coronary artery disease Caused by temporary lack of oxygen and an accumulation of carbon dioxide and lactic acid in the myocardium during a period of increased oxygen demand Frequently related to exertion – painful symptoms revert when the exertion ceases

Question 4

Name 2 types of Angina Pectoris

Answer 4

2 types: Stable Angina

Unstable Angina (Acute Coronary Syndrome)

Question 5

Describe Stable Angina

Answer 5

Generally predictable Follows a recurrent pattern Precipitated by exertion and/or emotion, producing pain of similar intensity, duration and location Most attacks are relieved by rest and/or nitrates within 2-3 minutes

Question 6

Describe unstable stable Angina (ACS)

Answer 6

More serious, indicates increasing obstruction of the coronary arteries Unpredictable Noticeable changes in frequency, intensity or duration of pain May occur at rest and even during sleep, waking the patient Often precedes an Acute Myocardial Infarction Sometimes referred to as pre-infarction or crescendo angina

Question 7

Clinical Features of Angina

Answer 7

Central, retrosternal chest pain Pain referred to the throat, jaw and teeth also to the armpits and often into the arm Frequently described as heaviness in the arms or chest Pallor

Question 8

Referred Pain

Answer 8

Nerves from damaged heart tissue convey pain signals to spinal cord levels T1-T4 on the left side, which happen to be the same levels that receive sensation from the left side of the chest and part of the left arm. The brain isn’t used to receiving such strong signals from the heart, so it interprets them as pain in the chest and left arm

Question 9

What is an Acute Myocardial Infarction

Answer 9

Death of an area of myocardium (infarction) Occurs when a coronary artery becomes occluded or significantly narrowed by a blood clot, embolism or vasospasm

Question 10

Clinical Features of Acute MI

Answer 10

Rapid onset of severe central (retrosternal) chest pain, often described as crushing in nature May radiate to the neck, jaw, arms or back. Nausea and vomiting Faintness Feeling of impending doom Diaphoresis Rapid, shallow respirations Pallor / Grey Changes in vital signs 15 - 20% of patient’s may experience no chest pain Pain tends to last for more than 15 – 20 minutes

Question 11

What is Heart Failure

Answer 11

Inability of the heart to pump adequately Left and right sides of the heart can fail separately or simultaneously Left heart failure (LVF) may accompany AMI and present as severe dyspnoea caused by pulmonary oedema

Question 12

Heart Failure usually starts on which side

Answer 12

Right sided failure usually secondary to left sided failure. Results in fluid retention in the peripheral circulation (Congestive heart failure)

Question 13

Clinical Signs of heart Failure

Answer 13

Laboured or difficult breathing (dyspnoea) Severe respiratory distress when the patient lies flat (orthopnoea) Ankle oedema Cyanosis Restlessness & agitation Confusion Elevated BP (Sympathetic response causes vasoconstriction) Wheeze Diaphoresis

Question 14

Management of Acute Coronary Syndromes

Answer 14

ABCD approach

Ensure a defibrillator is immediately available

Reduce the workload of the heart

Aspirin 300 mg orally (crush/chew)

Nitroglycerine (GTN spray or tablet

Consider O2 therapy and/or Entonox

Assess pain score prior to and following pain relief

Monitor vital signs

12 lead ECG

Request Paramedic assistance for IV access and administration of morphine

Question 15

Paramedic Management numonic

Answer 15

Morphine Oxygen Nitrates Aspirin

Question 16

GTN 400 mcg Actions

Answer 16

Actions A potent vasodilator drug: Dilates the coronary arteries/relieves coronary spasm Dilates the systemic veins which lowers the pre-load Reduces the blood pressure

Question 17

GTN 400 mcg Indications for use

Answer 17

Indications Cardiac chest pain due to angina or myocardial infarction Acute cardiogenic pulmonary oedema 1-2 sprays under the tongue Repeat every 5-10 mins providing systolic >90mmHg

Question 18

GTN 400 mcg Contra-indications

Answer 18

Contra-indications Hypotension (actual or estimated systolic blood pressure <90mmHg) Hypovolaemia Head Trauma Cerebral Haemorrhage Sildenfil (Viagra) other related drugs used in previous 24 hours Unconscious patients

Question 19

GTN 400 mcg Side effects

Answer 19

Side Effects: Headache Flushing Postural Hypotension Tachycardia

Question 20

Aspirin 300mg Indications for use

Answer 20

Indications Adults with central chest pain of cardiac origin or clinical / ECG evidence of AMI Should be administered to any adult patient with chest pain unless the diagnosis is clearly non-cardiac or the drug is contraindicated. In suspected MI’s a 300mg Aspirin tablet should be given regardless of any previous Aspirin taken that day.

Question 21

Aspirin 300mg what does aspirin do and cautions

Answer 21

Anti-platelet action which reduces clot formation Analgesic, anti inflammatory, anti pyretic Cautions: Asthma Pregnancy Kidney or liver failure Gastric or duodenal ulcer Current treatment with anticoagulants Side effects: Gastric bleeding Wheezing in some asthmatics

Question 22

Aspirin 300mg Contra-indications

Answer 22

Contra-indications: Known aspirin allergy or sensitivity Children under 16 (may precipitate Reye’s Syndrome) Haemophilia or other clotting disorders Severe hepatic disease Active gastrointestinal bleeding

Question 23

Sickle cell Crisis when can this happen

Answer 23

During an infection, pregnancy, following surgery or even mental stress; the Sickle cells tend to clump together reducing blood flow through small arteries and capillaries leading to hypoxia.

Question 24

Sickle cell Crisis signs and symptoms

Answer 24

Main Signs & Symptoms Tiredness Laboured breathing Stroke Weakness Pallor Dyspnoea Fever Swelling of joints Severe pain (particularly in the back, abdomen, limbs)

Question 25

Sickle cell Crisis Management

Answer 25

Assess A,B,C,D and correct if necessary

Time critical? – Rapid, smooth transport & pre-alert

Ask if the pt. has an individual treatment plan

Administer high flow Oxygen (94-98% SpO2)

Undertake 12 lead ECG

Fluid resuscitation if required

Pain management

Question 26

Cardiac Arrest causes

Answer 26

Acute coronary disease (Common cause)

Electrocution

Drowning

4 H’s 4 T’s

Question 27

4 H’s and 4 T’s

Answer 27

Hypoxia

Hypothermia

Hypovolaemia Hypo

Hyperkalaemia

Thrombus

Toxins

Tension Pneumothorax

Tamponade