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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