Cardiovascular Emergencies

Acute coronary syndrome (ACS)

Group of symptoms caused by myocardial ischemia (decrease in blood flow to the heart leading to chest pain because of reduced O2 supply)

angina pectoris

Transient (short lived) chest discomfort caused by partial/temporary blockage of blood flow to the heart muscle

Causes of angina

Spasm of an artery, symptom of atherosclerotic coronary artery disease, heart’s need for O2 exceeds its supply

Angina triggers

Physical or emotional stress - when the increase O2 demand goes away, the pain goes away

Angina pain location

Crushing, squeezing in mid-portion of the chest, under the sternum and can radiate to the jaw, arms (left), mid-portion back, epigastrium

Angina duration

3-8 mins, rarely >15 mins

S/sx angina

SOB, nausea, sweating.

Angina tx

Rest, supplemental O2, NTG

Unstable angina

Chest pain without significant increase in myocardial O2 demand - sitting, sleeping

Stable angina

Chest pain after exercising or increased demand on the heart muscle beyond its capacity to increase its own blood flow

What happens during AMI?

Death of cells in areas of the heart where blood flow is obstructed

What happens to dead myocardial cells?

Cannot be revived, turns into scar tissue

List time frames of cell death w/out O2

30 mins - some heart muscles die

2 hrs - 1 half

4-6 hrs - 90%

In-hospital tx for MI

Thrombolytic medication - clot-busting

Angioplasty - mechanical clearing of the coronary artery

What portion of the heart are AMIs more likely to occur in?

Left ventricle - larger, thick-walled, needs more blood and O2

S/sx of AMI

• Appearance: sudden onset of weakness, nausea/vomiting, cold sweat

• Skin: pale, ashen, cynosis

• Pulse: increased HR, dysrhythmia, syncope

• BP: decreased, most have normal or elevated

• RR: normal unless CHF (rapid, labored, frothy sputum), SOB

• Mental status: confusion, agitation, feeling of impending doom

• Feel: Chest pain, pressure - persistent crushing, squeezing, pain/ pressure in lower jaw, arms, back, abdomen, neck

How AMI differs from angina pain

1. May or may not be caused by exertion, can occur any time - sitting/sleeping

2. Doesn’t resolve in a few mins, last 30 mins-hrs

3. May or may not be relieved by rest/NTG

What populations may not experience chest pain with AMI?

Geriatric, women, diabetic

AMI without classic chest pain

Silent myocardial infarction

Damage to the inferior area of the heart often presents with ____________.

Bradycardia

Ventricular tachycardia

Rapid HR: 150-200 bpm. Electrical activity begins in ventricle instead of atrium. Not enough time between beats for lft ventricle to refill w/ blood. Heart pumps less vol + BP decreases. Pt may feel weak/lightheaded → unresponsive. 

Ventricular fibrillation

Disorganized, ineffective quivering ventricles. No blood pumped - unconscious w/in secs. Must defibrillate the heart.

Defibrillation

Shock the heart to stop the chaotic, disorganized contraction of the myocardial cells and allow them to start again in a synchronized manner to restore a normal rhythmic beat