Early Heart Attack CareHeart Attacks Have Beginnings
Heart Attack: A Community Problem
With A Community Solution
Course Outline
1. Anatomy and Physiology 101: Your Heart
2. A Heart Attack in Progress
3. Concepts of Early Heart Attack Care
4. Recognition and Intervention
5. Delay and Denial
6. You: The Early Heart Attack Care Giver
Part 1
Anatomy and Physiology 101: Your Heart
The Human Heart
• Location: Middle of the chest• Size: That of a fist• Purpose: Pumps blood throughout the
body• Weight: 7 - 12 ounces • Capacity: Pumps 1,800 gallons of blood &
beats over 100,000 times daily
The Human HeartThe Human Heartand Coronary Arteriesand Coronary ArteriesThe Human HeartThe Human Heartand Coronary Arteriesand Coronary Arteries
SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY)
ANTERIOR R. ATRIAL BRANCH OF R. CORONARY ARTERY
RIGHT CORONARY ARTERY
ANTERIOR CARDIAC VEINS
SMALL CARDIAC VEIN
ANTERIOR INTERVENTRICULAR (ANTERIOR DESCENDING) BRANCH OF L. CORONARY ARTERY
GREAT CARDIAC VEIN
CIRCUMFLEX BRANCH OF L. CORONARY ARTERY
L. CORONARY ARTERY
GREAT CARDIAC VEIN
CIRCUMFLEX BRANCH OF L. CORONARY ARTERY
CORONARY SINUS
OBLIQUE VEIN OF L. ATRIUM
POSTERIOR VEIN OF L. VENTRICLE
MIDDLE CARDIAC VEIN
SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY)
SINOATRIAL (S-A) NODE
SMALL CARDIAC VEIN
R. CORONARY ARTERY
POSTERIOR INTERVENTRICULAR (POSTERIOR DESCENDING) BRANCH OF R. CORONARY ARTERY
The Human HeartThe Human Heartand Coronary Arteriesand Coronary ArteriesThe Human HeartThe Human Heartand Coronary Arteriesand Coronary Arteries
The Human HeartElectric PumpThe Human HeartElectric Pump
Part 2
A Heart Attack in Progress
Heart Attack Facts
• #1 Killer of Adults
• 4,100 Heart Attacks every day
• 600,000 Heart Attack deaths each year
• Hundreds of thousands survive but are left with a damaged heart
Three Presentations of a Heart Attack
• Sudden, severe pain that stops you in your tracks.
• Gradual increasing pain with damage occurring over a period of hours.
• Very early presentation with mild symptoms over hours or days.
Ischemia & Angina PectorisIschemia & Angina Pectoris
Partial block producing chest pain
Area of decreased blood supply
Coronary Artery DiseaseCoronary Artery Disease
Area of Infarct
Complete Obstruction:AMIComplete Obstruction:AMI
Part 3
Concepts of Concepts of EHACEHAC
Are All Heart Attacks Created Equal?Are All Heart Attacks Created Equal?
Progress: Heart Attack Treatment
• Thrombolytic Therapy (clot busters)
• Angioplasty
• Prehospital Cardiac Care
• Decrease in hospital time to treatment saved heart muscle improvement in quality of life
Too Little Progress: Heart Attack Recognition
• Only 25% of heart attack victims receive thrombolytic therapy
• Only 10% receive therapy within the first critical hour
• Most heart attack patients do not benefit from optimal medical advances
WHY?
DELAY
in recognizing and responding to the early warning signs of a heart attack
Why EHAC?
• Early CareEarly Care: : Recognize & RespondRecognize & Respond– often mild symptoms, usually normal activity
• Late CareLate Care: : Obvious Emergency & RespondObvious Emergency & Respond– incapacitating pain, diminished activity
• Too Late CareToo Late Care: : Critical Emergency & RespondCritical Emergency & Respond– unconscious, CPR, defibrillation, probable death
• 85% of the heart damagedamage takes place within the first two hoursfirst two hours.
Part 4
Recognition and InterventionRecognition and Intervention
Early Symptoms of a Heart Attack
• Non-Specific Symptoms:Non-Specific Symptoms:
– weakness/fatigue
– clammy/sweating
– nausea/indigestion
– dizziness/nervousness
– shortness of breath
– neck/back/jaw pain
– feeling of doom
– elbow pain
• Non-Specific Symptoms:Non-Specific Symptoms:
– weakness/fatigue
– clammy/sweating
– nausea/indigestion
– dizziness/nervousness
– shortness of breath
– neck/back/jaw pain
– feeling of doom
– elbow pain
• Specific SymptomsSpecific Symptoms
– chest discomfort
– chest pressure
– chest ache
– chest burning
– chest fullness
• Present in up to half of heart attacks.
• Suddenly accelerate preceding the heart attack.
• Usually appear within 24 hours before the acute attack but can begin two to three weeks before.
• Duration varies from a few minutes to several hours.
• Usually intermittent with a pain free period before the onset of acute occlusion.
Early Signs of a Heart Attack
Part 5
Delay and DenialDelay and Denial
Why Do We Delay?Denial and Procrastination Denial and Procrastination
= Our Heart’s Enemy! = Our Heart’s Enemy!
1. It’s Nothing Really Serious
I’ll just rest a bit
2. I’m Too Busy Right Now
I don’t have time to be sick
3. I Don’t Want to be a Problem
If it turns out to be nothing I’ll be embarrassed by the fuss made.
4. Paramedics Beware!
First responders can easily be swayed by patient rationalizations and denials
5. It’s Probably Heartburn or Indigestion
I’ll take something for it
6. I’m Strong
Just walk it off, grin and bear it
7. I’m Healthy
I have no serious medical problems..I exercise
8. I’ll Just Wait It Out
Everything will be OK
Part 6
You: The Early Heart Attack Care Giver
The EHAC Caregiver
• Spouse• Children• Parent• Co-worker• Friend• Exercise Partner
Anyone who cares about you!
What to Ask and Look ForWhat to Ask and Look For
• Do you have any chest discomfort?
• Is it tightness, pressure, pain in the center of your chest?
• Is the discomfort also in your arms or jaw or neck or throat or back?
• Are you sick to your stomach?
• Is the person sweaty or clammy?
• What were you doing when the symptoms started?
• Do the symptoms go away with rest?
• Are you having any shortness of breath?
Overcoming ReluctanceOvercoming Reluctance
• Suggest he or she check out early symptoms, better safe than sorry. • Call 9-1-1. Paramedics have excellent evaluation tools.• Offer to call spouse or family members if he or she is anxious.• If he or she refuses to seek help, enlist friends or family members to
help you convince them.• Be personal and persistent. Sit, talk, try to relieve any tension and
don’t go away.• When he or she agrees, congratulate them on their good judgment.• If all else fails, take charge and be aggressive about getting the
patient to the hospital.
A C T W I S E L YA C T W I S E L Y
AACCTT
WWIISSEELLYY
Acknowledge the problemBe CalmBe Tenacious and do not give in.
Be Willing to spend the timeBe InfluentialKeep it SimpleBe EmpatheticLink patient w/ early symptoms to medical careSay Yes - I’ll pay attention
Listen to your and be a Winner!
Listen to your and be a Winner!
• Be aware of pressure, not necessarily pain, in your chest.• Be aware if it increases with activity and subsides with rest.• Don’t try to rationalize it away. Be honest with yourself and
others.• Call 9-1-1 or have someone drive you to the nearest emergency
room.• Don’t go to your doctors office or wait for an appointment.• EHACEHAC is knowing the subtle danger signs and acting on them
before damage occurs.