CARDIOVASCULAR

EMERGENCIES
Cardiovascular Disease
 63,400,000 Americans have one or
more forms of heart or blood vessel
disease
 50% of all deaths are cardiovascular
disease
Cardiovascular Disease
Acute Myocardial Infarction (Heart
Attack) - leading cause of death in U.S.
 1.5 million Americans will have AMI’s
this year
 Of these .5 million will die!
 350,000 will die in first two hours!
Cardiovascular Disease
Risk Factors
 Major Uncontrollable
 Age
 Sex
 Race
 Heredity
Cardiovascular Disease
Risk Factors
 Major Controllable
 Smoking
 High BP
 High blood cholesterol
 Diabetes
Cardiovascular Disease
Risk Factors
 Minor Controllable
 Obesity
 Lack of exercise
 Stress
 Personality
Cardiovascular Disease

Control risk factors - decrease

Coronary Artery Disease and
Acute Myocardial Infarction
Coronary Artery Disease
 Myocardium (heart muscle) requires
continuous oxygen and nutrient supply
 Myocardial blood supply passes
through coronary arteries
Coronary Artery Disease
 Atherosclerosis
 Narrowing of lumen
 plaque formation - related to Risk Factors
 results in decreased myocardial perfusion
 Poor tissue perfusion causes:
 tissue damage (ischemia)
 tissue death (infarction)
Atherosclerotic Plaque
Formation
 Angina Pectoris
“A choking in the chest”
 Angere - to choke
 Myocardial oxygen
demand exceeds supply
during periods of
increased activity,
exercise, or stressful event
Angina Pectoris
 During stress the myocardium demands
more O2
 Coronary arteries would normally dilate
to supply more blood and O2
 In Angina Pectoris, the coronary arteries
are unable to dilate sufficiently to
increase perfusion
Symptoms -Angina Pectoris
 Pain
 Substernal
 Squeezing/Crushing/Heaviness
 May radiate to arms, shoulders, jaw,
upper back, upper abdomen back
 May be associated with shortness of
breath, nausea, sweating
Symptoms -Angina Pectoris
 Pain usually associated with 3E’s
 Exercise
 Eating
 Emotion
Symptoms -Angina Pectoris
 Pain seldom lasts > 30 minutes
 Pain relieved by
 Rest
 Nitroglycerin
Symptoms -Angina Pectoris
 Great anxiety/Fear
 Fixation of the body
 Pale, ashen, or livid face
 Dyspnea (SOB) may be associated
Symptoms -Angina Pectoris
 Nausea
 Diaphoresis
 BP usually up during attack
 Dysrhythmia may be present
Angina Pectoris
 Following an angina attack there is
no residual damage to the
myocardium
Forms of Angina Pectoris
 Stable Angina
 Occurs with exercise
 Predictable
 Relieved by rest or Nitroglycerin
Forms of Angina Pectoris
 Unstable Angina
 More frequent/severe
 Can occur during rest
 May indicate impending MI
 Requires immediate treatment and
transport to appropriate facility
Acute Myocardial Infarction
“Heart Attack”
 Inadequate perfusion of
myocardium
 Death of myocardium
 Infarct
 Damage to myocardium
 Ischemia
Symptoms - AMI
 Chest Pain - cardinal sign of
myocardial infarction
 Occurs in 85% of MI’s
 Substernal
 “Crushing,” “squeezing,” “tight,”
“heavy”
Symptoms - AMI
 Chest Pain
 May radiate to arms, shoulders, jaw, upper back,
upper abdomen back
 May vary in intensity
 Unaffected by:
 swallowing
 coughing
 deep breathing
 movement
Symptoms - AMI
 Chest Pain
 Unrelieved by rest/nitroglycerin
 Pain lasts longer than angina pain (up
to 12 hours)
 “Silent’ MI
 15% of patients with MI,
 particularly common in elderly and
diabetics
Symptoms - AMI
 Shortness of breath
 Weakness, dizziness, fainting
 Nausea, vomiting
 Pallor and diaphoresis (heavy
sweating)
Symptoms - AMI
 Sense of impending doom
 Denial
 50% of deaths occur in first two hours
 Average patient waits 3 hours before
seeking help
Symptoms - AMI
 Changes in pulse, BP,
respiration are not diagnostic
of AMI
Acute Myocardial Infarction
Early recognition of MI is
critical
Management of Cardiac
Chest Pain
When in doubt, manage
all chest pain as MI
Management of Cardiac
Chest Pain
 Begin management immediately if
angina or MI are suspected.
 Complete the history and physical
exam as you treat.
Management of Cardiac
Chest Pain
 Position of Comfort
 Patent Airway

 High concentration O2
 non-rebreather mask 10-15 lpm
Management of Cardiac
Chest Pain
 Reassure the patient
 Obtain a brief history and physical
exam
 Aspirin 325mg p.o.
Management of Cardiac
Chest Pain
 Nitroglycerin 0.4mg tablet sublingual
 Patient should be sitting or lying down
 Has Pt. Taken nitroglycerin in last 10
minutes? Is pain relieved? Headache?
 Is BP > 90 systolic?
 q 5 minutes until pain relieved or three
tablets administered
Management of Cardiac
Chest Pain
 If pain is unrelieved by rest, oxygen,
nitroglycerin or if a change has
occurred in pattern of angina,
transport immediately
 Transport in semi-sitting position if
BP normal or elevated; flat if BP low
Management of Cardiac
Chest Pain
 Do not walk patient to the ambulance
 Do not use lights/siren if patient is
awake, alert, breathing without distress
 Monitor vital signs every 5-10 minutes
Management of Cardiac
Chest Pain
 Request early ALS back-up
 Deaths in MI result from arrhythmia's
 Arrhythmia's can be prevented with early
drug therapy
Congestive Heart Failure
CHF = Inability of heart to pump
blood out as fast as it enters.
 May be left-sided, right-sided, or
both.
Congestive Heart Failure
 Usually begins with left-sided failure.
 Left ventricle fails
 Blood “stacks up” in lungs
 High pressure in capillary beds
 Fluid forced out of capillaries into alveoli
Congestive Heart Failure
 Right-sided failure most commonly
caused by Left-sided failure. Blood
“backs up” into systemic circulation
 Distended neck veins
 Fluid in abdominal cavity
 Pedal edema
Causes of CHF
 Coronary Artery Disease
 Chronic hypertension (high blood
pressure)
 AMI
 Valvular heart disease
Symptoms of CHF
 Weakness
 Dyspnea
 Dyspnea on exertion
 Paroxysmal nocturnal dyspnea
 Attacks of SOB that usually occur at
night that awakens the patient
Symptoms of CHF
 Orthopnea
 Difficulty breathing in any position other
than standing or sitting
 Abdominal discomfort
 Jugular Vein Distention (JVD)
 Pedal “Pitting” edema in lower
extremities
Symptoms of CHF
 Tachycardia
 Pulmonary Edema
 Noisy, labored breathing
 Coughing
 Rales, wheezing
 Pink, frothy sputum
Management of CHF
 Sit patient up, let feet dangle
 Administer high concentration O2

 Assist ventilation as needed

 Monitor vital signs q 5-10 minutes
 Request early ALS back-up
Pacemaker Failure
 Position of comfort
 Patent airway

 High Concentration O2

 Assist ventilations as needed

 ALS Intercept
 CPR as needed
 DO NOT worry about damage to
pacemaker
Coronary Artery Bypass
 Position of comfort
 Patent airway

 High Concentration O2

 Assist ventilations as needed

 ALS Intercept
 CPR as needed
 DO NOT worry about damage to
sutures/staples or by-passed arteries
Implanted Defibrillator
 If performing CPR on a patient:
 Implanted defibrillator may “fire”
 May feel slight “tingle”