Inside the Operating Room: Heart Attacks, Strokes, and Falls

1. Inside the Operating Room:Heart Attacks, Strokes, and Falls Presentation by: Stephanie Scully, RN BSN CHR Cardiac Operating Room NCP Health Ministry Chair

2. Objectives • To discuss three of the most common causes of death in the elderly population • To describe heart attacks, strokes, and falls and how they occur • To demonstrate what surgical interventions are available to treat heart attacks, strokes, and falls

3. What are the Top Causes of Death Amongst the Elderly Population? • Heart Disease • Cancer • Stroke • COPD • Flu/ Influenza • Diabetes • Injuries

4. Topics We Will Focus On Today • Heart Attacks • Strokes • Falls

5. HEART ATTACKSaka Myocardial Infarction (MI)

6. Heart Attack Prevalence • Heart disease and cancer • Leading causes of death for >65 for 2 decades • 35% of all deaths are due to heart disease, including heart attacks and chronic ischemic heart disease

7. What is a Heart Attack? • Damage and death of heart muscle from the sudden blockage of a coronary artery by a blood clot • Sudden blockage= blood and oxygen deprivation-> injury to the heart muscle= chest pain and chest pressure

8. How do these blockages occur? • Coronary arteries provide heart with blood • Blood= oxygen and nutrients • CAD= Coronary Artery Disease • Fatty matter, calcium, proteins, inflammatory cells= plaque • Plaque is hard on the outside, mushy on the inside • When the plaque is hard, outer shell cracks= plaque rupture -> platelets form around rupture = blood clot **Total or near-total occlusion by blood clot = heart attack

9. How a heart attack forms

10. What are the symptoms of a Heart Attack? • Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone • Discomfort radiating to the back, jaw, throat, or arm • Fullness, indigestion, or choking feeling • Sweating, nausea/ vomiting, or dizziness • Weakness, anxiety, or shortness of breath • Rapid or irregular heartbeat *No symptoms= silent heart attack

11. Time is of the Essence • Why is time important in treatment of heart attacks? • 20-40 minute window • Lack of blood flow restoration= irreversible death of the heart muscle begins • Muscle continues to die for 6-8 hours, or until the heart attack usually is "complete.“

12. What is the damage? • Amount of damage depends on size of area supplied by the blocked artery and time between injury and treatment • Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. • Scar tissue will form in the damaged area • Scar tissue does not contract= the heart's pumping ability is lessened after a heart attack

13. How do we minimize damage during Heart Attacks? • Medications • Aspirin • Prevent additional clotting • Heart Codes • Cardiac Catheterizations • Angioplasty and stenting • Surgical intervention • Coronary Artery Bypass Grafting (CABG) • Depending upon blockage location and severity

14. Coronary Artery Bypass Grafting • CABG is one treatment for CAD • A healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. • The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. • This creates a new path for oxygen-rich blood to flow to the heart muscle. • Surgeons can bypass multiple coronary arteries during one surgery.

15. SURGICAL INTERVENTION FOR HEART ATTACKS- CABG CABG Surgery

16. Benefits of CABG Surgery • Results are usually excellent • Improves or completely relieves angina symptoms • Most people remain symptom-free for as long as 10 - 15 years • May lower your risk of having a heart attack and help you live longer • You may need repeat surgery if blockages form in the grafted arteries or veins or in arteries that weren't blocked before.

17. After CABG Surgery • Treatments do not cure CAD • It CAN happen again • Take medicines • Reduce blood pressure • Relieve work of heart • Prevent blood clots • Lower cholesterol • Make lifestyle changes • Dietary changes • Exercise • Quit smoking

18. STROKEaka Cerebrovascular Accident (CVA)

19. Stroke Prevalence • The third leading cause of death in America is stroke • Strokes are debilitating and lethal • Stroke kills almost 130,000 Americans each year—that’s 1 out of every 19 deaths. • On average, one American dies from stroke every 4 minutes. • Every year, more than 795,000 people in the United States have a stroke.

20. What is a Stroke? • A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. • Within minutes, brain cells begin to die. • Strokes are treatable and preventable

21. What are the Signs of Stroke? • Sudden severe headache • Weakness • Numbness • Vision problems • Confusion • Trouble walking • Difficulty talking • Dizziness • Slurred speech

22. Different Types of Strokes • When blood supply to the brain is interrupted or reduced-> oxygen and nutrient deprivation= brain cell death • Two types • Ischemic stroke -> blocked artery • Hemorrhagic stroke -> leaking or burst blood vessel

23. Ischemic Stroke • 85% of strokes are ischemic • Occur when one or both carotid arteries (supplying the brain with blood) become narrowed or blocked= severely reduced blood flow (ischemia) • Thrombotic stroke • A blood clot (thrombus) forms and blocks vessel • Blood clot= fatty deposits (plaque) • Embolic stroke • A blood clot or other debris is swept through your bloodstream to lodge in narrower brain arteries • This type of blood clot is called an embolus.

24. Thrombotic vs. Embolic Strokes

25. Time is of the Essence • A stroke is a MEDICAL EMERGENCY • Prompt treatment is crucial to survival • Early action can minimize brain damage and potential complications

26. Interventions for Ischemic Stroke • To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. • Medications • TPA- Clot buster • Within 4.5 hours • Aspirin • Reduce additional clotting • Emergency procedures • Catheter- administered TPA • Directly into the area where the stroke is occurring • Mechanical clot removal= = thrombectomy • Angioplasty and stenting the carotid artery • Carotid endarterectomy

27. Carotid Endarterectomy (CEA) • Surgical removal of plaque from arteries that run along each side of your neck to your brain (carotid arteries) • May be done for someone that had a stroke, or someone at high risk for stroke • Determined by vascular ultrasound • Steps include: • Incision along side of neck • Opens up carotid artery • Blood may be rerouted temporarily through a shunt • Scrape out plaque • Stitch or patch artery shut • Close incision

28. Carotid Endarterectomy

29. When Surgery is Most Beneficial • CEA can be done several months after a stroke or TIA • Most benefit from the surgery within 2 weeks of the stroke or TIA • > 2 week surgery delay increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.

30. Benefits of a CEA • Symptomatic patients with blockages of 70% or more benefit greatly • Less than 50% narrowing of the carotid do not seem to benefit from surgery • CEA works better than treatment with medicine alone in preventing stroke • (For people who have symptoms that can be attributed to a 70% to 99% blockage of the carotid arteries)

31. After Carotid Surgery • Medications • Aspirin • Anti-platelet (prevent clots) • Cholesterol lowering • Exercise • Diet • Low fat, low cholesterol • Quit Smoking

32. Falls

33. Prevalence of Falls • Falls are one of the top causes of death among people 65 years of age and older • One in three older adults falls every year • Less than half report it • Falls are the leading cause of both fatal and nonfatal injuries in older adults • In 2010, the direct medical costs of falls was $30 billion

34. The Truth about Falls • A fall can change your life • Falls lead to: • Disability • Loss of independence • Breaking bones and hips • Falls seldom “just happen’ • Preventing falls is important • Regular eye exams • Eliminating tripping hazards • Wearing non-skid shoes • Using assistive deices

35. Falls Lead to Fracture, Trauma • Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries. • Falls are the number one cause of fractures in older adults • Fall- related Fracture injuries: • Hip • Pelvis • Spine • Arm • Hand • Ankle

36. Hip Fractures • One of the most serious types of fall injuries • Leading cause of injury and loss of independence among older adults • Healthy, independent older adults may be able to return home or live on their own after treatment and rehab • Long term care is always necessary

37. What is a Hip Fracture? • A hip fracture is a break in the upper quarter of the femur (thigh) bone • The extent of the break depends on the forces that are involved • Type of surgery required • Bones and soft tissues involved • Level of fracture

38. What causes a hip fracture? • Most commonly from a fall or from a direct blow to the side of the hip • Some medical conditions increase susceptibility • Osteoporosis • Cancer • Stress injuries • In severe cases, standing on a leg and twisting

39. Surgical Treatment for Hip Fractures • Type of surgery depends on location, severity, and age • Repair with hardware • Metal screws into bone to hold it together until healed • Screws to metal plates along bone • Rods down center of bone through marrow (aka nails) • Replace femur • Partial hip replacement • If ends aren’t properly aligned, head and neck of femur removed and replaced • Replace hip joint • Total hip replacement • Replace upper femur and socket in pelvis **If blood supply to ball joint is damaged, bone healing compromised-> hip replacement necessary

40. Hip Fracture Repair

41. Hip Fracture Repair

42. After Hip Repair/ Replacement • Take medications • Pain • Clot prevention • Rehabilitation • Programs available • Lifestyle adjustment • Long-term care and rehab • Assistive devices • Future fall prevention

43. Preventing Falls • Preventing falls is key to older adults • Exercise regularly • Leg strength increases, balance improves • Review medications • Dizziness side effect • Regular eye exams • Maximizes vision during age-related changes • Lower hip fracture risk • Enhance calcium and vitamin D intake • Weight bearing exercises • Screening and treatment for osteoporosis

44. References • http://www.cdc.gov/nchs/data/ahcd/agingtrends/01death.pdf • www.webmd.com • www.medicinenet.com • https://www.nhlbi.nih.gov/health/health-topics • www.mayoclinic.com • www.stoke.org • http://www.nlm.nih.gov/medlineplus • http://nihseniorhealth.gov