EMERGENCY MEDICAL
TECHNICIAN - BASIC
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Cardiovascular Disease
 63,400,000 Americans have one or more forms of heart or blood vessel disease
 50% of all deaths are cardiovascular disease
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Cardiovascular Disease

cute
yocardial
nfarction (Heart
Attack) - leading cause of death in U.S.

1.5 million Americans will have AMI’s this year
 Of these .5 million will die!
 350,000 will die in first two hours!
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Cardiovascular Disease
Risk Factors

 Age
 Sex
 Race
 Heredity
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Cardiovascular Disease
Risk Factors

 Smoking
 High BP
 High blood cholesterol
 Diabetes
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Cardiovascular Disease
Risk Factors

 Obesity
 Lack of exercise
 Stress
 Personality
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Cardiovascular Disease
Control risk factors - decrease
Coronary Artery Disease and Acute
Myocardial Infarction
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Coronary Artery Disease
 Myocardium (heart muscle) requires continuous oxygen and nutrient supply
 Myocardial blood supply passes through coronary arteries
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Coronary Artery Disease
 Atherosclerosis
 Narrowing of lumen
 plaque formation - related to Risk Factors
 results in decreased myocardial perfusion
 Poor tissue perfusion causes:
 tissue damage (ischemia)
 tissue death (infarction)
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Atherosclerotic Plaque
Formation
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Angina Pectoris
 Angere - to choke
 Myocardial oxygen demand exceeds supply during periods of increased activity, exercise, or stressful event
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Angina Pectoris
 During stress the myocardium demands more O
2
 Coronary arteries would normally dilate to supply more blood and O
2
 In Angina Pectoris, the coronary arteries are unable to dilate sufficiently to increase perfusion
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Symptoms -Angina Pectoris
 Pain
 Substernal
 Squeezing/Crushing/Heaviness
 May radiate to arms, shoulders, jaw, upper back, upper abdomen back
 May be associated with shortness of breath, nausea, sweating
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Symptoms -Angina Pectoris

Pain usually associated with 3E’s
 Exercise
 Eating
 Emotion
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Symptoms -Angina Pectoris
 Pain seldom lasts > 30 minutes
 Pain relieved by
 Rest
 Nitroglycerin
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Symptoms -Angina Pectoris
 Great anxiety/Fear
 Fixation of the body
 Pale, ashen, or livid face
 Dyspnea (SOB) may be associated
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Symptoms -Angina Pectoris
 Nausea
 Diaphoresis
 BP usually up during attack
 Dysrhythmia may be present
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Angina Pectoris
 Following an angina attack there is no residual damage to the myocardium
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Forms of Angina Pectoris
 Stable Angina
 Occurs with exercise
 Predictable
 Relieved by rest or Nitroglycerin
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Forms of Angina Pectoris
 Unstable Angina
 More frequent/severe
 Can occur during rest
 May indicate impending MI
 Requires immediate treatment and transport to appropriate facility
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Acute Myocardial Infarction

 Death of myocardium

 Damage to myocardium

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Symptoms - AMI
 Chest Pain - cardinal sign of myocardial infarction

Occurs in 85% of MI’s
 Substernal

“Crushing,” “squeezing,” “tight,”
“heavy”
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Symptoms - AMI
 Chest Pain
 May radiate to arms, shoulders, jaw, upper back, upper abdomen back
 May vary in intensity
 Unaffected by:
 swallowing
 coughing
 deep breathing
 movement
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Symptoms - AMI
 Chest Pain
 Unrelieved by rest/nitroglycerin
 Pain lasts longer than angina pain (up to 12 hours)

“Silent’ MI
 15% of patients with MI,
 particularly common in elderly and diabetics
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Symptoms - AMI
 Shortness of breath
 Weakness, dizziness, fainting
 Nausea, vomiting
 Pallor and diaphoresis (heavy sweating)
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Symptoms - AMI
 Sense of impending doom
 Denial
 50% of deaths occur in first two hours
 Average patient waits 3 hours before seeking help
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Symptoms - AMI

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Acute Myocardial Infarction

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Management of Cardiac
Chest Pain

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Management of Cardiac
Chest Pain
 Begin management immediately if angina or MI are suspected.
 Complete the history and physical exam as you treat.
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Management of Cardiac
Chest Pain
 Position of Comfort
 Patent Airway
 High concentration O
2
 non-rebreather mask 10-15 lpm
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Management of Cardiac
Chest Pain
 Reassure the patient
 Obtain a brief history and physical exam
 Aspirin 325mg p.o.
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Management of Cardiac
Chest Pain
 Nitroglycerin 0.4mg tablet sublingual
 Patient should be sitting or lying down
 Has Pt. Taken nitroglycerin in last 10 minutes? Is pain relieved? Headache?
 Is BP > 90 systolic?
 q 5 minutes until pain relieved or three tablets administered
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Management of Cardiac
Chest Pain
 If pain is unrelieved by rest, oxygen, nitroglycerin or if a change has occurred in pattern of angina, transport immediately
 Transport in semi-sitting position if
BP normal or elevated; flat if BP low
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Management of Cardiac
Chest Pain
 Do not walk patient to the ambulance
 Do not use lights/siren if patient is awake, alert, breathing without distress
 Monitor vital signs every 5-10 minutes
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Management of Cardiac
Chest Pain
 Request early ALS back-up
 Deaths in MI result from arrhythmia's
 Arrhythmia's can be prevented with early drug therapy
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Congestive Heart Failure
 CHF = Inability of heart to pump blood out as fast as it enters.
 May be left-sided, right-sided, or both.
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Congestive Heart Failure
 Usually begins with left-sided failure.
 Left ventricle fails

Blood “stacks up” in lungs
 High pressure in capillary beds
 Fluid forced out of capillaries into alveoli
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Congestive Heart Failure
 Right-sided failure most commonly caused by Left-sided failure. Blood
“backs up” into systemic circulation
 Distended neck veins
 Fluid in abdominal cavity
 Pedal edema
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 Coronary Artery Disease
 Chronic hypertension (high blood pressure)
 AMI
 Valvular heart disease
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Symptoms of CHF
 Weakness
 Dyspnea
 Dyspnea on exertion
 Paroxysmal nocturnal dyspnea
 Attacks of SOB that usually occur at night that awakens the patient
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Symptoms of CHF
 Orthopnea
 Difficulty breathing in any position other than standing or sitting
 Abdominal discomfort
 Jugular Vein Distention (JVD)

Pedal “Pitting” edema in lower extremities
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Symptoms of CHF
 Tachycardia
 Pulmonary Edema
 Noisy, labored breathing
 Coughing
 Rales, wheezing
 Pink, frothy sputum
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Management of CHF
 Sit patient up, let feet dangle
 Administer high concentration O
2
 Assist ventilation as needed
 Monitor vital signs q 5-10 minutes
 Request early ALS back-up
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Pacemaker Failure
 Position of comfort
 Patent airway
 High Concentration O
2
 Assist ventilations as needed
 ALS Intercept
 CPR as needed
 DO NOT worry about damage to pacemaker
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Coronary Artery Bypass
 Position of comfort
 Patent airway
 High Concentration O
2
 Assist ventilations as needed
 ALS Intercept
 CPR as needed
 DO NOT worry about damage to sutures/staples or by-passed arteries
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Implanted Defibrillator
 If performing CPR on a patient:

Implanted defibrillator may “fire”

May feel slight “tingle”
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