LESSON PLAN

ON
CARDIAC EMERGENCIES

PRESENTED BY
R.SUGANTHI
MSC(N)-II YEAR
 INTRODUCTION
When the heart ceases to beat effectively and breathing
soon ceases, a person is said to have experienced
sudden cardiac death (SCD). In order to meet the
criteria for this diagnosis, the critical circulatory
collapse must be; 1) unexpected, 2) it must relate in
some manner to heart problems, and 3) it should occur
with minimal warning or a complete absence of prelude
symptoms. This means the event occurs proximal to
any warnings, typically within one hour of the start of
any type of cardiac related symptoms.
ANATOMY & PHYSIOLOGY
CORONARY ARTERY
 TERMINOLOGIES
 Preload
 After load
 Stroke volume
 Cardiac output
 Ejection fraction
 Global hypokinesia
 Heart failure
 Ischemia
 Infarction
 CARDIAC EMERGENCY
CONDITIONS
 Angina pectoris
 Myocardial infarction
 Congestive heart failure
 Cardiac tamponade
 Cardiac arrest
 Cardiogenic shock
 RISK FACTORS
 Family h/o CHD
 Diabetic mellitus
 Hypertention
 Hyperlipidemia
 Obesity
 Smoking & alcoholism
 Cold weather
 Emotional stress
 Heavy meals
 ANGINA PECTORIS
DEFINITION:
Cardiac compromise refers to any kind
heart problem. Patient may complaints of chest
pain, flu like symptoms, or dyspnea.
 TYPES OF ANGINA
 Stable angina
 Unstable angina
 Variant angina(prinzmetal’s)
 Microvascular angina
 CAUSES
 Coronary artery spasm
 Blockage of arteries
 Anaemia
 Overactive thyroid gland
 Heart valve disease
 PATHOPHYSIOLOGY
Spasm/ obstruction of coronary artery

Myocardial ischemia

if Reduced oxygen supply to myocardium

continued

Chest pain – angina pectoris

 SIGNS & SYMPTOMS
 Tightness, squeezing, pressure or ache in the chest
 Sudden breathing difficulty
 Chest pain similar to indigestion
 A choking feeling in the throat
 Chest pain radiated to the jaw, teeth or earlobes
 Heaviness, numbness, tingling or ache in the chest
 Dizziness or light headedness
 Nausea, vomiting and perspiration
 Palpitations
 Unexplained tiredness after activity
 DIAGNISTIC TEST
 ECG
 Echocardiogram
 Exercize stress test
 Thallium stress test
 Coronary angiogram
ECG
 CRITICAL MANAGEMENT
 Bed rest
 Comfortable positioning
 Artificial oxygen
 Nitrate glyceryl trinitrate
 Isosorbide dinitrate
 Beta blockers- propranolol, atenolol,
metoprolol, pindolol, oxprenolol.
MYOCARDIAL INFARCTION
DEFINITION:
Myocardial infarction or acute MI commonly
known as heart attack is the interruption of
blood supply to a part of the heart, causing
heart cells to die.
 CAUSES
 Atherosclerosis
 Hyperlipedimea
 Hypertension
 Diabetes
 Obesity & over weight
 Smoking
 Heredity
 PATHOPHYSIOLOGY
Endothelial cell injury & inflammation

Plaque formation

Plaque rupture & thrombogenesis

Reduced blood supply & oxygen demand

Myocardial ischemia

Myocardial cell necrosis

 SIGNS & SYMPTOMS
 Chest discomfort, mild pain
 Coughing
 Crushing chest pain
 Dizziness
 Dyspnea
 Face seems gray
 Feeling of terror that life coming to an end
 Nausea & vomiting
 Restlessness
 Cold & clammy skin
 DIAGNOSTIC TEST
 Focused physical examination(circulation,
breathing, types of pain, consciousness and
general conditions)
 Echo cardiogram
 Blood test (cardiac enzyme)
 Chest x ray
 DIAGNOSTIC TEST
 ECG
 Areas of infarct:
 Anterior infarct: ST elevation inV1-
V4(LAD)
 Septal infarct: VI-V4
 Lateral infarct:AVL,V5-V6
 Inferior:II,III,AVF(RCA)
 Right ventricular:right V4-V6(RCA)
ACUTE MI ECG
OLD MI ECG
 COMPLICATION
 Arrhythmia
 Cardiogenic shock
 Heart failure
 Pulmonary edema
 Pericarditis
 Rupture of atrial or ventricular septum
 Ventricular aneurysm
 Cerebral or pulmonary emboli
 CRITICAL MANAGEMENT
 Early treatment is important
 Position of comfort
 Assure ABC
 High concentration of oxygen
 Reassurance of the patient
 Continous cardiac monitoring
 3 IV’S in the arm
 Sublingual nitroglycerine
 CRITICAL MANAGEMENT
 Morphine sulphate (2-4 mg titrated for pain
relief,decreases blood return to heart, reduce
anxiety and relax smooth muscle in the lungs)
 Thrombolytic therapy(heparine,aspirin 325 mg
P.O, & streptokinase
 Beta blocking agents
 Calcium channel blockers
 CONGESTIVE CARDIAC FAILURE
DEFINITION:

Heart failure also called congestive heart

failure is a disorder where the heart loses its
ability to pump blood efficiently.
 CAUSES
 Coronary artery disease
 Cardiomyopathy
 Hypertension
 Heart valve disease
 Congenital heart disease
 Alcoholism & drug abuse
 PATHOPHYSIOLOGY
Due to above causes

Decreased stroke volume & cardiac output

Activation rennin angiotensin aldosterone system

Sodium & water retention

Expand ECF & ICF

Manifestation of heart failure

 SIGNS & SYMPTOMS
 Fatigue
 Pedal edema
 Increased body weight
 Dyspnea
 Cyanosis
 Diaphoresis
 Pulmonary edema
 Anxiety or confusion secondary to hypoxia
 Engorged pulsatile neck veins
 Enlarged liver & spleen
 DIAGNOSTIC TEST
 Chest x ray
 ECG
 Blood tests
 Echocardiogram
 Stress test
ECG
CHEST XRAY
 CRITICAL MANAGEMENT
 ABC's
 Airway Check and secure
 Breathing Monitor
 Circulation Start advanced life support if needed
 LMNOP's:
 Lasix - Reduce fluid congestion
 Morphine - Decrease stress on myocardium
 Nitroglycerin - Insure cardiac circulation
 Oxygen - Oxygen to heart and brain
 Positioning - Sit person up to avoid lungs filling with
fluid
 CARDIAC TAMPONADE
 Definition:
Cardiac tamponade also known as pericardial
tamponade is an acute type of pericardial effusion
in which fluid accumulates in the
pericardium.
The fluids which can be blood, pus or air in
the pericardial sac, accumulate fast enough and in
sufficient quantity to compress the heart and
restrict blood flow in & out of the ventricles.
 SIGNS & SYMPTOMS
 Pericardial effusion
 Pericarditis
 Heart tumors
 End stage lung cancer
 Dissecting aortic aneurysm
 wound to the heart
 Kidney failure
 Leukemia
 Placement of central lines
 Radiation therapy to chest
 Recent invasive heart surgery
 Systemic lupus erythematous
 PATHOPHYSIOLOGY
Acute pericardial effusion

The pressure of the pericardial cavity

Filling volume of the ventricular diastole decreased

Stroke volume decreased

Decreased BP

Extended period without recovery

Cardiogenic shock
 SIGNS & SYMPTOMS
 Dyspnea
 Cyanosis of lips & nails
 Restlessness & anxiety
 Diaphoresis
 Muffled heart sound
 Pulses paradoxus
 Friction rub
 Decreased QRS voltage
 Beck’s triad (three medical signs of low atrial blood
pressure, distended neck veins, & muffled heart
sound)
 DIAGNOSTIC TESTS
 ECG
 Echocardiogram
 Computerizrd tomography
 Magnetic resonance angiogram
ECG
 CRITICAL MANAGEMENT
 Pericardiocentecis:( the removal of fluid from the
pericaridium using needle)
 Pericardiectomy ( the surgical removal of the part
of the pericardium to relieve pressure on the heart)
 Thoracotomy ( a surgical procedure that allows the
draining of blood or blood clots around the heart)
 After surgical intervention, manitanence of IVfluids
to maintain blood pressure
 Medication to increase blood pressure
 Artificial oxygen to reduce stress on heart muscle
 CARDIOGENIC SHOCK
DEFINITION:
Cardiogenic shock is characterized by a
decreased pumping ability of the heart that
causes a shock like state ( global
hypoperfusion) so that failure of heart to
supply enough blood to the vital organs of the
body. As a result blood pressure falls and
organs may begins to fail.
 CAUSES
 Myocardial infarction
 Ventricular tachycardia
 Ventricular fibrillation
 Sudden valvular regurgitation
 Pericardial tamponade
 Pulmonary embolism
 Rupture of the wall of the heart
 SIGNS & SYMPTOMS
 Confusion & anxiety
 Sweating & cold extremities
 Jugular venous distension
 Low pulse pressure
 Low BP (<90/30)
 Tachycardia (week pulse)
 Oliguria
 Fatigue due to hyper ventilation
 Sudden shortness of breath
 Coma if measures are not taken in time to stop the
shock
 DIAGNOSTIC TEST
 ECG
 Vital signs
 Cardiac monitoring
 Echocardiogram
 Chest radiography
 Blood tests
 Swan- ganz catheter
 CRITICAL MANAGEMENT
 Fluid resuscitation to correct hypovolemia or hypotension
 Prompt initiation of pharmacological therapy to maintain blood pressure
and cardiac output
 Early & definite restoration of coronary blood flow
 Correction of acid base & electrolyte abnormalities
 Medications:
 Patient with MI or acute coronary syndrome are given heparine or aspirin
 Ionotropic or vasopressor drugs to maintain mean arterial pressure of 60 or
65 mmhg
 Diureticsto decrease plasma volume and peripheral edema
 Dopamine is the drug of choise to improve cardiac contractility in patients
with hypotension and usually initiated at a rate of 5-10mcg/kg/mt vol
 Norepinephrine is the drug of vasoconstrictor and usually started at a rate
of 0.5 mcg/kg/mt and titrated to maintain an MAP OF 60 mmhg
 Thrombolytic therapy
 CARDIAC ARREST
DEFINITION:
Sudden cardiac arrest is a condition in which
the heart suddenly and unexpectedly stops
beating. If this happens, blood stops flowing to
the brain and other vital organs.
 CAUSES
 Coronary heart disease

 Non ischeamic heart disease

 Trauma
 Aortic rupture
 Gastrointestinal bleeding
 Intracranial hemorrhage
 Drug overdose
 Drowning
 Pulmonary embolism
 SIGNS & SYMPTOMS
 Breathlessness
 Fatigue
 Waking up gasping for breath at night
 Swollen abdomen
 Enlarged liver
 Distented carotid pulse
 Swollen legs & ankle
 Decreased activity tolerance
 Enlarged heart chamber
 DIAGNOSTIC TEST
 ECG
 Chest x ray
 Echocardiogram
 Blood test(CBC, ESR,electrolytes,
BUN/creatinine, glucose, TSH, calcium,
magnesium & phosphorus)
 CRITICAL MANAGEMENT
 Early recognition
 Early CPR
 Early defibrillation
 Medications- epinephrine, atropine,
amiodarone.
ECG
 NURSING MANAGEMENT
 Monitor and document characteristic of pain, noting verbal reports, nonverbal
cues (moaning, crying, grimacing, restlessness, diaphoresis, clutching of chest)
and BP or heart rate changes.
 Obtain full description of pain from patient including location, intensity (using
scale of 0–10), duration, characteristics (dull, crushing, described as “like an
elephant in my chest”), and radiation. Assist patient to quantify pain by
comparing it to other experiences.
 Review history of previous angina, anginal equivalent, or MI pain. Discuss
family history if pertinent.
 Instruct patient to report pain immediately. Provide quiet environment, calm
activities, and comfort measures. Approach patient calmly and confidently.
 Instruct patient to do relaxation techniques: deep and slow breathing, distraction
behaviors, visualization, guided imagery. Assist as needed.
 Check vital signs before and after narcotic medication.
 Administer supplemental oxygen by means of nasal cannula or face mask, as
indicated.
 SUMMARY
 Early Access to Care. Quick contact with emergency care is essential. Call
911 (in most communities) or your local emergency number immediately.
 Early Cardiopulmonary Resuscitation (CPR). Learning CPR is the greatest
gift you can give your family and friends. If performed properly (see below),
CPR can help save a life until emergency medical help arrives.
 Early Defibrillation. In most adults, sudden cardiac death is related to
ventricular fibrillation. Quick defibrillation (delivery of an electrical shock) is
necessary to return the heart rhythm to a normal heartbeat. Many public
places -- such as malls, golf courses, and airports -- have automated external
defibrillators (AEDs; see below) available for use in emergency situations.
 Early Advanced Care. After successful defibrillation, most patients require
hospital care to treat and prevent future events.
 These four steps can increase survival as much as 90% if initiated within the
first minutes after sudden cardiac arrest. Survival decreases by about 10%
each minute long
THANK YOU