CARDIOVASCULAR
EMERGENCIES
Temple College
ECA
Cardiovascular Disease
 63,400,000
Americans have one or
more forms of heart or blood vessel
disease
 50% of all deaths are cardiovascular
disease
Cardiovascular Disease
Acute Myocardial Infarction (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!
Cardiovascular Disease

Acute Coronary Syndromes
 Acute
Myocardial Infarction
 Non
ST Segment Elevation (NSTEMI)
 ST Segment Elevation (STEMI)
 Unstable
Angina Pectoris
 Stable Angina Pectoris
Cardiovascular Disease
Risk Factors
 Major
Uncontrollable
Age
Sex
Race
Heredity
Cardiovascular Disease
Risk Factors
 Major
Controllable
Smoking
High
BP
High blood cholesterol
Diabetes
Cardiovascular Disease
Risk Factors
 Minor
Controllable
Obesity
Lack
of exercise
Stress
Personality
Cardiovascular Disease
Control of risk factors = decrease in
Coronary Artery Disease and
Acute Myocardial Infarction
Coronary Artery Disease
 Myocardium
(heart muscle) requires
continuous oxygen and nutrient supply
 Myocardial blood supply passes
through coronary arteries
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)
Atherosclerotic Plaque Formation
Angina Pectoris
“A choking in the chest”
 Angere
- to choke
 Myocardial oxygen
demand exceeds supply
during periods of
increased activity,
exercise, or stressful
event
Angina Pectoris
 During
stress the myocardium
demands more O2
 Coronary arteries would normally
dilate to supply more blood and O2
 In Angina Pectoris, the coronary
arteries are unable to dilate sufficiently
to increase perfusion
Classic Presentation
Chest Pain
 SOB
 Diaphoresis
 N/V

NOT ALL PATIENTS READ
THE TEXTBOOK!
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
Symptoms -Angina Pectoris
 Pain
usually associated with 3E’s
Exercise
Eating
Emotion
Symptoms -Angina Pectoris
 Pain
seldom lasts > 30 minutes
 Pain relieved by
Rest
Nitroglycerin
Symptoms -Angina Pectoris
 Great
anxiety/Fear
 Fixation of the body
 Pale, ashen, or livid face
 Dyspnea (SOB) may be associated
Symptoms -Angina Pectoris
 Nausea
 Diaphoresis
 BP
usually up during attack
 Dysrhythmia may be present
Angina Pectoris
 Following
an angina attack there is
no residual damage to the
myocardium
Forms of Angina Pectoris
 Stable
Angina
Occurs
with exercise
Predictable
Relieved by rest or Nitroglycerin
Forms of Angina Pectoris
 Unstable
More
Angina
frequent/severe
Can occur during rest
May indicate impending MI
Requires immediate treatment and
transport to appropriate facility
Acute Myocardial Infarction
“Heart Attack”
 Inadequate
perfusion
of myocardium
Death
of myocardium
Infarct
Damage
to myocardium
Ischemia
Symptoms - AMI
 Chest
Pain - cardinal sign of
myocardial infarction
Occurs
in 85% of MI’s
Substernal
“Crushing,” “squeezing,” “tight,”
“heavy”
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

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
Symptoms - AMI
 Shortness
of breath
 Weakness, dizziness, fainting
 Nausea, vomiting
 Pallor and diaphoresis (heavy
sweating)
Symptoms - AMI
 Sense
of impending doom
 Denial
50%
of deaths occur in first two hours
Average patient waits 3 hours before
seeking help
Symptoms - AMI
 Changes
in pulse, BP,
respiration are not diagnostic
of AMI
Acute Myocardial Infarction
Early
recognition of MI is
critical
Management of Cardiac
Chest Pain
When in doubt, manage
all chest pain as MI
Management of Cardiac
Chest Pain
 Begin
management immediately if
angina or MI are suspected.
 Complete the history and physical
exam as you treat.
Management of Cardiac
Chest Pain
 Position
of Comfort
 Patent Airway
 High concentration O2
non-rebreather
mask 10-15 lpm
Management of Cardiac
Chest Pain
 Reassure
the patient
 Obtain a brief history and physical
exam
 Aspirin 325mg p.o.
Management of Cardiac
Chest Pain
 Nitroglycerin
Patient
0.4mg tablet sublingual
should be sitting or lying down
Has Pt. Taken nitroglycerin in last 10
minutes? Is pain relieved? Headache?
Is BP > 100 systolic?
q 5 minutes until pain relieved or three
tablets administered
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
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
Management of Cardiac
Chest Pain
 Request
Deaths
early ALS back-up
in MI result from arrhythmia's
Arrhythmia's can be prevented with early
drug therapy
Hypertension

Condition
 Chronic
 Acute

Pathophysiology
 Increased
pressure to organs
 Reduced blood flow
 Increased Afterload
Congestive Heart Failure
 CHF
= Inability of heart to pump
blood out as fast as it enters.
 Type
 left-sided
 right-sided
 both.
Causes of CHF
 Coronary
Artery Disease
 Chronic hypertension (high blood
pressure)
 AMI
 Valvular heart disease
Congestive Heart Failure
 Usually
begins with left-sided failure.
Increased
workload on left ventricle
Left ventricle fails
Blood “stacks up” in lungs
High pressure in capillary beds
Fluid forced out of capillaries into alveoli
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
Symptoms of CHF
Weakness
 Dyspnea

 Dyspnea
on exertion
 Paroxysmal nocturnal dyspnea
Attacks
of SOB that usually occur at
night that awakens the patient
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
Symptoms of CHF
 Tachycardia
 Pulmonary
Noisy,
Edema
labored breathing
Coughing
Rales, wheezing
Pink, frothy sputum
Heart Failure
Management of CHF
 Sit
patient up, let feet dangle
 Administer high concentration O2
 Assist ventilation as needed
 Monitor vital signs q 5-10 minutes
 Request early ALS back-up
Pacemaker Failure
 Position
of comfort
 Patent airway
 High Concentration O2
 Assist ventilations as needed
 ALS Intercept
 CPR as needed
DO
NOT worry about damage to
pacemaker
Coronary Artery Bypass
 Position
of comfort
 Patent airway
 High Concentration O2
 Assist ventilations as needed
 ALS Intercept
 CPR as needed
DO
NOT worry about damage to
sutures/staples or by-passed arteries
Implanted Defibrillator
 If
performing CPR on a patient:
Implanted
defibrillator may “fire”
May feel slight “tingle”