Caring for Cardiac Emergencies

1. 13 Caring for Cardiac Emergencies

2. Objectives • Review cardiovascular anatomy and physiology. • Define the following terms: • Angina • Cardiac compromise • Conduction pathway • Heart failure • Myocardial infarction (continued)

3. Objectives • Describe the normal flow of blood through the heart. • Explain common causes of cardiac compromise. • Describe the signs and symptoms of a patient experiencing cardiac compromise. • Differentiate and explain the pathophysiology of angina, myocardial infarction, and heart failure. (continued)

4. Objectives • Explain the appropriate assessment and care for a patient experiencing cardiac compromise. • Demonstrate the ability to appropriately assess and care for a patient experiencing cardiac compromise. • Value the importance of caring for all patients with chest pain as though it were cardiac compromise.

5. Media Slide 16 Cardiac Compromise Video

6. Topics • Normal Heart Function • Cardiac Compromise • Emergency Care for Cardiac Compromise

7. NORMAL HEART FUNCTION

8. Normal Heart Function • The heart beats 100,000 times per day. • It circulates 6,000 to 7,500 liters of blood each day. • Blood flows through the right atrium into the right ventricle and then into the lungs.

9. Normal Heart Function • From the lungs, blood enters the left atrium and flows into the left ventricle. • The heart muscle receives its blood supply from tiny vessels called coronary arteries. • Many problems of the heart are the result of the coronary arteries becoming narrowed or blocked.

10. Cross-section of the heart.

11. Normal Heart Function The heart has an electrical system that keeps it beating and, at the core, is the conduction pathway. Damage to the conduction pathway can lead to an abnormal heart rhythm and is a common cause of poor circulation and perfusion.

12. The cardiac conduction pathway, highlighted in green.

13. Think About It The heart is a muscle with a big job to do. Problems can arise that affect the heart tissue and/or the electrical system.

14. CARDIAC COMPROMISE

15. Cardiac Compromise Cardiac Compromise Symptoms Chest discomfort Diaphoresis Dyspnea Nausea/vomiting Anxiety/irritability Feeling of impending doom Abnormal pulse Abnormal blood pressure

16. Click here to view a video on the topic of cardiac compromise. BACK TO DIRECTORY

17. Myocardial Infarction Myocardial infarction (MI) is known as a heart attack. The heart receives its blood supply through coronary arteries. When these arteries become narrow or blocked and can no longer supply the heart with enough oxygenated blood, the tissue of the heart begins to die.

18. Both myocardial infarction and angina can present with symptoms of chest pain. Treat all cases of chest pain as true cardiac emergencies.

19. Myocardial Infarction Heart attack (MI)/cardiac arrest differences. Patients in cardiac arrest are not breathing; are unresponsive; have no pulse. Signs and symptoms of a heart attack: Chest/upper abdominal sensations of pain, pressure, tightness, or heaviness. Pain or discomfort behind the sternum.

20. Myocardial Infarction Other Signs and Symptoms “Flu-like” signs and symptoms (nausea and vomiting) Indigestion Feeling of general weakness

21. Angina Pectoris Angina pectoris (angina) is pain in the chest. It occurs when one or more of the coronary arteries are unable to provide an adequate supply of oxygenated blood to the heart muscle. With angina, there is no actual damage to the heart muscle.

22. Angina Pectoris Chest pain caused by a heart attack and angina is often triggered by exertion. Signs and symptoms of angina are nearly identical to a heart attack. It is important to care for cardiac-related pain as though the patient is having a heart attack.

23. Heart Failure Congestive heart failure (CHF) is a condition that develops when the heart is unable to pump blood efficiently. The heart muscle is weakened; it is unable to manage the normal blood volume; fluid backs up within the circulatory system. Patients can have chest pain, difficulty breathing, or both.

24. Heart Failure • Signs and Symptoms of Heart Failure • Shortness of breath • Chest pain/discomfort • Rapid pulse rate • Pedal edema (swollen ankles) • Jugular Vein Distention (JVD) • Pale, moist skin • Altered mental status

25. Signs of congestive heart failure include bulging neck veins.

26. Signs of congestive heart failure include swollen ankles.

27. Think About It Cardiac Compromise is a life-threatening condition. Why is it important to rapidly identify cardiac compromise? Describe the difference between angina and MI.

28. EMERGENCY CARE FORCARDIAC COMPROMISE

29. Emergency Care for Cardiac Compromise Assessment—OPQRST Onset Provocation Quality Region and radiate Severity Time

30. Algorithm for assessment of patients with chest pain.

31. Emergency Care for Cardiac Compromise Emergency Care Take appropriate Standard Precautions. Perform a primary assessment and support the ABCs as necessary. Obtain a medical history. If allowed, provide oxygen per local protocols. (continued)

32. Emergency Care for Cardiac Compromise • Emergency Care • Keep the patient at rest. Provide emotional support and reassure the patient. • Allow the patient to maintain a position of comfort (usually sitting up). • Obtain vital signs. (continued)

33. Emergency Care for Cardiac Compromise Emergency Care Assist the patient with the prescribed dose of nitroglycerin, if your protocols permit. Consult medical direction. Continue to monitor vital signs. 

34. Emergency Care for Cardiac Compromise Medications Patients with angina usually have been prescribed nitroglycerin tablets/spray. Aspirin is used for the treatment of suspected heart attack.

35. Think About It What does “Time is Muscle” mean? Performing a thorough assessment and appropriate treatment can contribute to how well the patient recovers from cardiac compromise. Emergency Medical Responders make a difference!

36. SUMMARY

37. Summary • A healthy heart is the core of the cardiovascular system. • Blood flows through the heart in a precise way. • Electrical impulses flow along the conduction pathway. • There are key signs and symptoms of cardiac compromise.

38. Summary • Angina results from a diminished supply of oxygenated blood to the heart. • Myocardial infarction occurs when a portion of the heart dies due to inadequate blood supply. • Congestive Heart failure (CHF) is caused by a weakened heart that can no longer pump blood efficiently.

39. Summary • Care for cardiac compromise includes: • The ABCs • Supplemental oxygen • Obtaining a thorough medical history • Keeping the patient at rest • Monitoring vital signs • Initiate ALS transport if available.

40. REVIEW QUESTIONS

41. Review Questions • Describe the normal flow of blood through the heart. • What are some vague symptoms of MI that may be seen in women or the elderly? • What is the appropriate assessment and care for a patient experiencing cardiac compromise?

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