Ch 18.6 Specific Caridac Conditions

What is the leading global cause of death in the United States?

Cardiovascular disease (CVD)

Name three examples of cardiovascular conditions.

Angina pectoris, acute myocardial infarction (AMI), heart failure.

What characterizes acute coronary syndromes?

Abrupt reduction in blood flow through one or more coronary arteries, leading to ischemia and possible infarction.

What is ischemia?

Oxygen deprivation to tissues.

What is infarction?

Tissue death due to prolonged lack of blood flow.

What usually causes acute coronary syndromes?

Rupture of atherosclerotic plaque.

What is atherosclerosis?

A condition affecting the inner lining of blood vessels, leading to narrowing and reduced blood flow.

What are nonmodifiable risk factors for coronary heart disease (CHD)?

Factors that cannot be changed, such as age and family history.

What is stable angina?

A predictable, recurrent pattern of chest pain due to insufficient oxygen supply.

What is unstable angina?

A more serious condition with changes in frequency, severity, and duration of chest pain, potentially a warning of impending myocardial infarction.

What causes variant angina?

Coronary artery vasospasm, leading to chest pain at rest.

What is microvascular angina?

Chest discomfort caused by constriction or spasm within the smallest coronary arteries, often underrecognized.

What defines an acute myocardial infarction (AMI)?

Deprivation of blood flow long enough for a portion of cardiac muscle to die.

What is the significance of infarcted tissue in AMI?

It is surrounded by ischemic tissue that is deprived of oxygen but still viable.

What are common symptoms of AMI?

Chest pain, which may radiate to arms, neck, jaw, and may be mistaken for indigestion.

What is a silent myocardial infarction?

An AMI that occurs without typical chest discomfort.

What symptoms might women experience during an AMI?

Discomfort in the back, shoulder, or neck, shortness of breath, weakness, nausea, and vomiting.

What symptoms might older adults experience during an AMI?

Compromised mental status, generalized weakness, syncope, shortness of breath, and abdominal discomfort.

What is the first step in the assessment of a suspected AMI?

Identify whether STEMI is present and notify the medical facility.

What is the recommended position for a patient with ACS?

Semi-Fowler position.

What medications should be administered to a patient with ACS?

Aspirin and oxygen.

What is the importance of cardiac monitoring in ACS management?

To listen for rhythm irregularities and to treat pulseless rhythms as needed.

What should be recorded upon arrival of an ACS patient?

Vital signs.

What is the role of CPR in managing an ACS patient?

To initiate if indicated, especially in cases of pulseless rhythms.

What is the significance of the SAMPLE and OPQRST questions in ACS assessment?

To obtain a thorough history and understand the patient's symptoms.

What does the acronym OPQRST stand for?

Onset, Provocation, Quality, Radiation, Severity, Time.

What does the acronym SAMPLE stand for?

Signs and symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to the present illness.

What is the primary goal of management for ACS patients with STEMI?

To initiate reperfusion therapy as soon as possible.

What can exacerbate the stress response in ACS patients?

Physical and emotional stress, which can increase heart workload and oxygen demand.

What is the first step in managing acute coronary syndromes?

Administer aspirin and oxygen.

What should be maintained for patients with dyspnea or hypoxemia?

SpO2 level at 94% or higher.

When should a 12-lead ECG be obtained?

Within 10 minutes of patient contact.

What are the three categories into which a 12-lead ECG can place a patient?

STEMI, NSTEMI, Normal (nondiagnostic).

What is required for STEMI treatment?

Reperfusion therapy by either Percutaneous coronary intervention (PCI) or fibrinolytic medication.

What is a potential risk of fibrinolytic medication?

Can cause uncontrolled bleeding.

What are key components of an ideal STEMI system?

Trained EMS dispatchers, EMS triage protocols, 12-lead ECG capabilities, and experienced ACLS staff.

What is critical to minimize for patients with STEMI?

Time to treatment, including EMS-to-balloon time and door-to-balloon time.

What should be administered for pain relief in acute coronary syndromes?

Nitroglycerin (NTG) if there are no contraindications.

What position should a stable patient be transported in?

Semi-Fowler position.

What should be done if a patient with chest discomfort refuses care?

Calmly try to persuade the patient and explain the risks of not accepting care.

What is heart failure?

Occurs when the heart cannot pump fast or powerfully enough to empty its chambers.

What are common features of heart failure?

Fatigue, dyspnea, edema, and exercise intolerance.

What is the most common cause of heart failure?

Coronary artery disease (CAD).

What are contributing factors to heart failure?

Thyroid disorders, substance abuse, cancer treatments, and infectious agents.

What can heart failure be identified based on?

Symptom onset, acute versus chronic, and which ventricle is involved.

What conditions can cause heart failure?

Conditions affecting preload, afterload, contractility, and heart rate.

What happens in left ventricular failure?

Blood backs up, causing pulmonary edema as fluid is forced into alveoli.

What are the two types of left ventricular failure?

Systolic failure and diastolic failure.

What causes right ventricular failure?

Inability to overcome high pressure and congestion in pulmonary vessels.

What happens when the right ventricle fails?

Blood backs up, causing pressure rise in the right atrium and congestion in veins and organs.

What are symptoms of right ventricular failure?

Edema, fluid buildup in the abdomen, pleural cavity, and/or pericardial cavity.

What is the role of EMS in managing STEMI?

To ensure timely triage and treatment protocols are followed.

What should be documented if a patient refuses care?

The refusal and efforts made to persuade the patient.

What should be done for patients with suspected myocardial infarction?

Use nonmedical language to explain risks and contact medical direction if necessary.

What is cor pulmonale?

A condition where right ventricular failure occurs due to pulmonary disease.

What can cause right ventricular failure (RVF) without left ventricular failure (LVF)?

Conditions such as right ventricular infarction, pulmonary embolism, pulmonary hypertension, and RVF caused by pulmonary disease.

What are the compensatory mechanisms in heart failure?

Attempts to improve cardiac output (CO) that may worsen heart failure.

How does the sympathetic nervous system respond in heart failure?

It boosts heart rate, increases force of contraction, and constricts blood vessels.

What are the consequences of an accelerated heart rate in heart failure?

Increased oxygen demand, reduced ventricle filling time, and decreased time for coronary artery perfusion.

What happens when blood flow to the kidneys decreases in heart failure?

It stimulates the renin-angiotensin-aldosterone system, promoting vasoconstriction and increased blood volume.

What is the effect of aldosterone in heart failure?

Encourages sodium and water retention, increasing preload.

What is the long-term effect of compensatory mechanisms in heart failure?

They may initially increase CO but eventually lead to heart failure progression and decreased CO.

What are common symptoms of heart failure?

Sudden shortness of breath, trouble sleeping, fatigue, nausea, loss of appetite, restlessness, and jugular venous distension.

What is the recommended position for a patient with heart failure?

Sitting position with feet dangling to decrease work of breathing.

What is a ventricular assist device (VAD)?

A surgically implanted device that acts as an artificial ventricle.

What are the components of a VAD?

Blood pump, tubing, external power source, and alarms.

What types of VADs exist?

Transcutaneous VADs, implantable VADs, LVADs (most common), and RVADs.

What are some complications associated with VADs?

Dysrhythmias, cardiac tamponade, aortic insufficiency, sepsis, device malfunction, thromboembolism, bleeding, heart failure, and infection.

What is cardiac tamponade?

A condition where pericardial fluid buildup compresses the heart, impairing contraction and restricting filling.

What are the signs and symptoms of cardiac tamponade?

Beck triad, cold and pale skin, tachycardia, weak or absent peripheral pulses, and pulsus paradoxus.

What is cardiac shock?

Severe impairment of heart muscle function leading to decreased CO and tissue perfusion.

What are the most common causes of cardiac shock?

Left ventricular failure (LVF) and acute myocardial infarction (AMI).

What risk factors are associated with cardiac shock?

Older age, anterior myocardial infarction, diabetes, hypertension, multivessel coronary artery disease, previous myocardial infarction, and peripheral vascular disease.

What are the four assessment categories for cardiac shock?

Warm and dry, warm and wet, cool and dry, and cold and wet.

What does 'cold and wet' indicate in cardiac shock assessment?

Cold skin, pulmonary crackles, altered mental status, dyspnea, jugular venous distension, and decreased systolic blood pressure.

What should be monitored in a patient with cardiac shock?

Ensure adequate oxygenation and ventilation, establish vascular access, and continuously monitor ECG.

What is the significance of pulsus paradoxus in cardiac tamponade?

It indicates a drop in blood pressure during inhalation, reflecting impaired heart function.

What is the role of a VAD coordinator in case of pump malfunction?

To assist in making treatment and transport destination decisions.

What is the primary goal of management in cardiac shock?

To strengthen contractility without increasing heart rate, alter preload/afterload, and control dysrhythmias.

What position should a patient be placed in if they are hypotensive?

Supine position.

What position should a patient be placed in if they are experiencing pulmonary congestion?

Sitting position with feet dangling.

What vital signs should be obtained in a patient with cardiac shock?

Vital signs should be obtained and the patient placed on a cardiac monitor.

How soon should a 12-lead ECG be obtained in cardiac shock?

Within 10 minutes of contact.

What types of medications are administered for cardiogenic shock?

Vasoactive IV medications such as Dopamine, Norepinephrine, and Epinephrine.

What should be checked frequently if a vasoactive medication is administered?

IV site and the patient's response.

What is defined as a hypertensive emergency?

An acute elevation of blood pressure to 180/120 mm Hg or higher with evidence of end-organ damage.

What is a hypertensive urgency?

A blood pressure of 180/120 mm Hg or higher without symptoms of end-organ damage.

What are common causes of hypertensive emergencies?

Most cases result from advanced atherosclerosis or arteriosclerosis.

What can persistent elevation of diastolic pressure indicate?

It is indicative of hypertensive disease, which can significantly shorten lifespan and predispose to other medical conditions.

What are some neurologic signs and symptoms to assess in hypertensive emergencies?

Signs may include headache, confusion, or visual disturbances.

What are some additional signs and symptoms of hypertensive emergencies?

Decrease/absence of urine output, nausea/vomiting, tinnitus, nosebleed, and muscle cramps.

What should be done to manage a patient in hypertensive crisis?

Provide supportive care, administer oxygen, establish an IV line, and apply a cardiac monitor.

What medication may be initiated in the field for hypertensive emergencies?

Labetalol, which decreases overall peripheral vascular resistance and prevents reflex tachycardia.

What should be done if a long transport time is unavoidable for a hypertensive patient?

Paramedics may need to initiate drug therapy in the field.

What is endocarditis?

An infection of the inner lining of the heart characterized by inflammation of the endocardium.

Who are at the highest risk for developing endocarditis?

Patients with mitral or aortic valve disease, prosthetic heart valves, congenital heart disease, and right-sided endocarditis.

What are common symptoms of endocarditis?

Symptoms include fever, chills, headache, loss of appetite, weight loss, and muscle and joint aches.

What are Janeway lesions and Osler nodes?

Janeway lesions are painless spots on the palms or soles, while Osler nodes are painful nodules found on fingers or toes, both associated with endocarditis.

What ECG changes may be seen in endocarditis?

ECG changes may include a prolonged PRI, third-degree AV block, or LBBB.

What supportive care should be provided for endocarditis?

Patient comfort, establish IV line, apply cardiac monitor, apply pulse oximeter, and administer oxygen.