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Chapter 10Cardiac Emergencies

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Heart Disease Affects over 4 million/year in U.S.

~ 500,000 deaths/year Atherosclerosis

Plaque (fatty deposits) Narrowing of arteries

Arteriosclerosis Stiffing or hardening of artery wall

Loss of arterial elasticity Calcium deposits Changes blood flow

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CHD Risk Factors

Non-Controllable Age Heredity

Controllable Smoking Lack of regular exercise Obesity Hypertension High cholesterol & triglycerides

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Electrical Malfunctions

Arrhythmias Bradycardia

Less than 60 beats / minute Tachycardia

More than 100 beats / minute Ventricular fibrillation Pulseless electrical activity Asystole

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Angina Pectoris Pain in Chest Oxygen demand transiently

exceeds supply Generally Two (2) Types

Stable angina Occurs during activity Usually precipitated by physical or

emotional stress• Relatively short duration 3-5 minutes

or prolonged lasting 15 minutes or more

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Angina Pectoris

Usually relieved by rest, nitroglycerin or oxygen

Unstable (Preinfarction angina) Occurs at rest Indicates severe atherosclerotic

disease May not respond as well to

nitroglycerin or oxygen

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Angina Pectoris Signs and Symptoms

Primarily caused by a build up of lactic acid and CO2 in the ischemic myocardium

Substernal chest pain or epigastric discomfort (pain, pressure, squeezing or tightness) 1/3 patients feel pain only in the

chest Radiation to shoulder, arm, neck,

jaw, through to back

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Angina Pectoris

Associated Signs and Symptoms Anxiety Dyspnea Diaphoresis Dysrhythmias

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Angina Pectoris Care

Stop activity & rest Position semi-recumbent Secure airway High-flow O2

Determine vitals Place on Cardiac monitor Questioned as to meds:

How much? Any relief?

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Acute Myocardial Infarction (AMI) ~1,000,000 MI per year (AHA) ~ 500,000 deaths

Contributing Factor - delay in seeking medical attention

Nearly 25% of individuals have no prior history of cardiac problems

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AMI

Causes CHD - Coronary Heart Disease Chronic respiratory problems Unusual exertion Severe emotional stress

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AMI

Signs and Symptoms Pain - substernal or epigastric

(usually lasting more than 10 minutes)

Pressure. Squeezing or Tightness Same radiation

Dyspnea Diaphoresis Anxiety or apprehension

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AMI

Signs and Symptoms con’t. Nausea or vomiting General weakness or malaise Pallor Pulse Rate

Bradycardia or tachycardia Regular or irregular Weak or bounding

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AMI

Respirations Generally normal or increased Possible dyspnea

Some patients present with no symptoms at all ECG changes or Increased cardiac enzyme levels Complaint of only general malaise

or history of syncope

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Care for Heart Attacks

Have person stop all activity & rest Semi-recumbent position Assess ABCs Determine vital signs (frequently) High-flow O2

Maintain body temperature

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AMI

Care Determine meds history Has the patient been given clot

busters Streptocinase TPA Retavaise or Antivaise

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Cardiogenic Shock

Shock that remains after correction of existing dysrhythmias, hypovolemia or altered vascular tone Occurs following extensive AMI Myocardial damage 40% or more High mortality (~80%)

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Cardiogenic Shock Signs and Symptoms

Initially same as AMI As shock develops

Hypotension• Systolic pressure 80mmHg or less

Altered mental status Sinus tachycardia

• (hearts attempting to compensate)

Diaphoresis Care

Same as AMI

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Congestive Heart Failure

Back pressure of blood into systemic venous circulation causing venous congestion Causes

LV failure (pulmonary edema) Pure RV failure Pulmonary hypertension

• Affects of COPD

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Congestive Heart Failure Signs and Symptoms

Depends on degree of failure and patient’s general condition Tachycardia JVD - engorging or pulsating Pedal edema Abdominal distention Dyspnea Chest pain (may or may not be

present

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Congestive Heart Failure

Signs and Symptoms con’t. Pulmonary edema Rales Rhonchi Blood pressure - normal to slightly

elevated Engorged liver & spleen Fluid accumulation in serous

cavities

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Congestive Heart Failure

Signs and Symptoms con’t. Patient often has history of taking

Digoxin (Lanoxin) Furosemide (Lasix)

Care Same as for AMI

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Pacemaker Problems

Problems are RARE Battery failure

Underlying rhythm will occur Bradycardia or asystole

Run away Rapid rate of discharge when

battery gets low

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Pacemaker Problems

Demand Pacemakers May shut down when patient’s heart

rate exceeds limits set by device Failure to capture

leads become displaced or battery fails

• results in bradycardia

Care Same as AMI