Chapter 17 Cardiovascular Emergencies (EMT B)

Atherosclerosis

Disorder in which calcium and fatty material called cholesterol build up

Defibrillation

Applying a shock to the heart to reset the rhythm

Acute Coronary Syndrome

angina pectoris (chest pain), and myocardial infarction

• Blood flow to the heart suddenly gets blocked or reduced

Aortic Aneurysm/Dissection

Walls weaken and cause a bleb (bubble expansion out of a vessel)

• Dissection: When the bleb opens and bursts the blood vessel

Pulmonary Edema

Fluid buildup in the lungs

• Treated with the CPAP machine to push liquid out of the lungs into vessels

Thromboembolism

An embolism, but specifically a BLOOD clot embolism

• An Embolism is something like a blood clot, air bubble, or particle that blocks a blood vessel

• You can get this from stagnant blood, like when you sit all day and legs are stagnant

ECG (Electrocardiogram)

Records electrical activity of the heart.

• Shows how fast your heart is beating

• Shows If the rhythm is normal or irregular

Sinoartrial Node

Housed in the right atrium, Is the hearts natural pacemaker

• Controls the hearts rhythm and rate

• Sends electrical signals to make the heart beat

• 60-100 beats per minute

• There is a p wave

Add ons

• Right atrium gets blood from the body → then sends to the right ventricle to the lungs

• left atrium gets blood from the lungs →then sends to left ventricle to the body

Atrioventricular Node

Part of the hearts electrical system that helps control the heartbeat

• Housed lower, right between the atrium and ventricle

• Its pace is 40-60, there is no P wave with AV node

• On the ECG it will look like a dip or pothole, or it’s just flat

What is the rate of the ventricles? (how fast they are beat)

20-40 bpm

ECG electrode placement

• Goal is to obtain the ECG within 10 minutes of first contact with a patient to detect heart problems, investigate symptoms like chest pain, monitor heart health, check pacemaker function

Unstable Angina

Occurs in the absence of a significant increase in oxygen demand

Stable Angina

Occurs in response to exercise or activity that increases demand on the heart muscle

→ Treat angina patients like AMI patients

Acute

Condition that comes on suddenly and is usually severe but short-term

QRS

Ventricles contracts, makes it bigger making a big v shape on a monitor

CHF

Congestive heart failure

Signs

• Shortness of breath

• swelling in the legs, ankles, and feet, fatigue irregular heartbeat

• Rapid or shallow breathing

  Treatment

• Oxygen

• Nitroglycerin

Dependent/Peripheral Edema

When the heart has problems on the right side

• Blood backs up into the rest of the body, especially the limbs

Signs

• Swollen, big hands and feet, think cankles

What must the blood pressure be to give Nitroglycerin?

Systolic pressure of 90

• Remember this is sublingual

AMI

Acute Myocardial Infarction, when blood flow to the heart is suddenly blocked usually by a blood clot (heart attack)

• Most likely to occur in the left ventricle

Signs

• Weakness

• Nausea

• sweating

• chest pain

• discomfort

• Syncope

• lower jaw/arm/back/abdomen/neck pain

• Sputum

Treatment

• Aspirin

• Nitroglycerin

• Oxygen

Dysrhythmia

Heart rhythm abnormalities

Premature Ventricular Abnormalities

A QRS wave without a preceding P-wave or post T-wave

Tachycardia

Heart rate that is over 100 beats per minute

Causes

• Anxiety

• Fever

• Drugs

• Exertion

→ You HAVE to be able to explain why a patient is tachycardic

→ Tachycardic picture provided

Bradycardia

Heart rate less than 60 beats per minute

Causes

• Aging

• Sleep Apnea

• Athletic heart

• SA Node is slow

→example picture

Ventricular Tachycardia

When the ventriculars beat too fast that is life threatening (150-200bpm) → can lead to cardiac arrest

• Ventricles are only supposed to beat 20-40 bpm

• electrical activity starts in the ventricle

• Shockable

Ventricular Fibrillation

Causes ventricles to go buck wild, fibrillate, shake, dance, etc

• No pulse

• Shockable rhythm

• Use AED on these patients

Hypertensive Emergency

When the systolic number is over 180

• For example, a blood pressure of 180/110 could be hypertensive a hypertensive emergency

• you need to be able to explain hypertension situations on a patient

→ do not give a patient nitroglycerin, they may have a bleed

• Hypertension may be supporting blood flow to their brain, if you give nitroglycerin, you may let their internal bleed flow, leading to their death

LVAD

Left Ventricular Assist Device

Pumps blood for the patient, they will have no pulse

• The device creates a continuous blood flow instead of the heart’s normal pumping action (beat-by-beat)

Aortic Aneurysm

Weakness in the wall of the aorta that makes it susceptible to rupture

Cardiac Arrest

When the heart stops beating

• Hearts electrical system malfunctions which causes the blood to stop pumping properly

This is not the same as heart attack, which is caused by a blocked artery. However, a heart attack can lead to cardiac arrest.

Signs

• Person suddenly collapses

• No pulse

• Not breathing

• Unconscious and unresponsive

Ischemia

lack of oxygen that deprives tissue of nutrients, resulting from partial or complete blockage of blood flow.

Stroke Volume

Volume of blood ejected with each ventricular contraction

ROSC

Return of Spontaneous Circulation

The return of pulse and effective blood to the body in a patient who previously was in cardiac arrest

Cardiac Output

Measure of the volume of blood circulated by the heart in 1 minute

• Calculated by multiplying the stroke volume by the heart rate

Dissecting Aortic Aneurysm occurs when?

The inner layers of the aorta become separated

Cardiogenic shock following AMI is caused by what?

Decreased pumping force of the heart muscle

The right coronary artery supplies blood to the?

Right ventricle and inferior wall of the left ventricle

What sign is commonly observed in patients with right-sided heart failure?

Dependent Edema

Angina Pectoris

Chest pain or discomfort that happens when the heart isn’t getting enough oxygen-rich blood

• Feels like pressure, tightness, or squeezing in the chest and can spread to the arms, neck, jaw, or back

• Lasts 3-8 minutes

• usually disappears with rest, supplemental oxygen, or nitroglycerin

The three ways AMI differs from Angina

1. May or may not be caused by exertion and can occur at any time, sometimes when a person is sitting quietly or even sleeping

2. Does not resolve in a few minutes; it can last between 30 minutes and several hours

3. May or may not be relived by rest or nitroglycerin

AMI can have three serious consequences what are they?

1. Sudden death

2. Cardiogenic shock

3. Congestive heart failure

Dysrhythmia

Abnormality of the heart rhythm

Asystole

Absence of all heart electrical activity

Myocardium

Heart muscle

Myocardial Ischemia

Heart muscle isn’t getting enough oxygen-rich blood

• Happens because of narrowed or blocked arteries