Ch. 15:
Cardiovascular
Emergencies
The Heart
 Enclosed in pericardial sac
 Myocardium = heart muscle
 Four chambers: two atria, two ventricles
 Sides divided by septum
 Atrioventricular valves: tricuspid and mitral
 Semilunar valves: pulmonic and aortic
 Electrical pathways cause contractions
Blood Vessels
 Carry blood to and from the heart
 Arteries: transport blood away from the heart
 Aorta: largest artery in the body
 Veins: bring blood to the heart
 Super and inferior venae cavae
 Capillaries: connect arteries and veins
 Aorta – Arteries – Arterioles –
Cavae
Capillaries
– Venules – Veins – Venae
Major Arteries
Major Veins
Blood
 Transports materials from
one area of the body to
another
 Oxygen, CO2, protein
building blocks, sugars,
fats, hormones, waste
products, etc
 When engaging in physical
activity, body needs more
oxygen and nutrients than
when at rest – heart must
pump blood faster
© Catherine R. Gordon
Cardiovascular Emergencies
 Most causes of CV system failure traced back to
cardiovascular disease (CVD)
 CVD leading cause of death worldwide
 More than 1/3 of adult population in US has CVD.
 Most cases of CVD attributed to coronary artery
disease or atherosclerosis
Atherosclerosis
 “Hardening of the arteries”
 Plaques form and build up along the inner lining of the
arteries.
 Heart doesn’t receive the oxygen and nutrients it needs,
which causes the heart muscle to die
 End result of plaque build up is coronary artery disease.
 Angina pectoris
 Leads to hypertension, heart failure, AMI, and sudden
cardiac death.
Figure 15-8 The progression of artery occlusion in atherosclerosis: (a) the patient's risk factors and
other factors cause the inner wall to be damaged; (b) fatty deposits develop, which lead to (c) fibrous
plaque, which further occludes the vessel's internal diameter; (d) platelets aggregate in these areas,
forming blood clots that nearly or completely occlude the artery.
Hypertension
 Abnormally elevated blood pressure, over 140/90
 Internal diameters of small arterioles narrow due to
atherosclerosis or other cause that restricts blood flow
through arteries
 Vessel narrowing causes pressure to build
 Damages blood vessels over time
 Affects nearly 1B people worldwide; 1/3 in the US
 If untreated, it can lead to stroke and kidney failure, and
more
Pulmonary Edema
 Accumulation of fluid in the lungs
 Caused by severe left-sided congestive heart failure,
which in turn results from acute MI, direct trauma to the
lungs, certain medical conditions, and certain drugs
 As the condition worsens, the patient goes into
cardiogenic shock from profound hypoxia
Congestive Heart Failure
 Occurs when the heart can’t adequately pump blood to
the body
 Blood backs up into major blood vessels leading to heart,
and subsequently into organs
 Right-sided heart failure results in back-up into the
systemic circulation, and then the dependent tissues,
esp. the ankles and feet
 Left-sided heart failure causes back-up into the lungs,
resulting in pulmonary edema
S/S: Congestive Heart Failure
 S/S depend on the side affected.
 Right heart failure: swollen ankles that can progress up
the leg, often with “pitting edema.”
 Left heart failure: Shortness of breath is common. If
onset is rapid, it can be life-threatening.
 Patients can have right and left CHF simultaneously.
Angina Pectoris
 Chest pain/discomfort caused by ischemia of the
myocardium
 Occurs when the oxygen demands of the heart exceed
the available supply
 Common occurrence in people with CAD due to
narrowing of the arteries
 Can also be caused by vasoconstriction or spasm of
the coronary arterie
Acute Myocardial Infarction
(AMI)
 Mostly (90%) caused by blood clots that in turn cause
blockage of the coronary arteries.
 The result is ischemia and death of heart muscle
served by the affected coronary artery(ies).
 If enough tissue dies, life is threatened because the
heart can’t pump
S/S: AMI
 Chest pain can be crushing or
heavy, stationary or radiating.
 Women have painless MI more
often than men.
 S/S can include anxiety, dizziness,
nausea, diaphoresis, feeling of
impending doom
Aortic Aneurysm
 A ballooning outwards of the aorta
 Two types: abdominal and thoracic
 S/S:
 Abdominal pain radiating to the groin/back
 Dizziness
 Abdomen may be tender, with a pulsatile mass
• Ruptured? Profound shock with hypotension and
diaphoresis
Cardiogenic Shock
 Caused by damage to myocardium
 Heart’s output of blood reduced
 Blood pressure cannot be maintained
S/S: Cardiogenic Shock
 Patients appear deathly ill and in shock: pale skin,
diaphoresis, anxiety, respiratory distress.
 If caused by AMI, the patient will be tachycardic and
hypotensive
 If caused by abnormal heart rhythm, the patient might
be bradycardic, or tachycardic and hypotensive.
Pericardial Tamponade
 Occurs when excess fluid
builds up in the pericardial
space
 Compresses heart, can’t
pump adequately
 PT is life-threatening,
requires emergency fluid
removal
S/S: Pericardial Tamponade
 Shortness of breath, anxiety or restlessness, and pale,
cool, diaphoretic skin
 Chest pain is common
 Hypotension, distended neck veins, and muffled/distant
heart tones
 Patient might present with only fatigue and tachycardia.
Pulmonary Embolism
 One of the most lethal forms of thromboembolism
 Passage of a blood clot (thrombus) formed in a vein
through right side of heart and into pulmonary artery
where it lodges
 Deep venous thrombosis
 Decreases or blocks blood flow—no exchange of oxygen
or CO2
 Arterial carbon dioxide increases, oxygen decreases
 Inhibits circulation
S/S: Pulmonary Embolism
 Sudden onset of chest pain
 Shortness of breath
 Tachycardia
 Sharp pain that increases with deep breaths
 Cyanosis and hypoxia
 S/S DVT:
 Severe pain, tenderness to touch, swelling in one leg
Sudden Cardiac Arrest (SCA)
 Abrupt cessation of effective pumping of blood from
heart to coronary arteries, brain, and other vital organs
 Caused by AMI, ventricular fibrillation, pulseless
ventricular tachycardia, asystole.
Arrhythmias
 Irregular heart beat or heart rhythm, which can
compromise normal heart function
 Primary cause of life-threatening arrhythmia is ischemia of
myocardium
 Life-threatening arrhythmias (can lead to SCA):
 Ventricular fibrillation: chaotic and ineffective contraction of
that ventricles that leads to cardiac arrest
 Ventricular tachycardia: rapid contraction of the ventricles
that can lead to ineffective blood flow to body tissues,
cardiac arrest
 Asystole: complete absence of a heartbeat due to lack of
electrical activity within the heart
Assessment

Scene safety

Primary assessment: ABCDs

Patients in SCA will be unresponsive, apneic, pulseless – immediately begin CPR

Secondary assessment: SAMPLE history, pay close attention to complaints of chest pain
and any medications (esp. nitroglycerin or aspirin)
 Patient may have difficulty communicating, talk to relative
 Assess chest pain using OPQRST (cardiac pain usually described as either “heavy,”
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Detailed secondary physical exam
 Check pulse, blood pressure, skin condition, capillary refill, level of responsiveness –
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“crushing,” or “tight.”
If pain radiates into jaw or down arm, may indicate AMI
evidence as to whether not tissue perfusion is effective
Assess skin for color, temperature, diaphoresis (with chest pain may indicate that heart is
ischemic.
Listen to breath sounds
Reassess patient and vital signs
 Every 3-5 mins if patient is unstable
 Every 10-15 mins if patient is stable
Management
 Evaluate ABCs and treat problems as they are found
 If patient is in cardiac arrest:
 Time is of the essence – Golden Hour
 Request ALS immediately, and call for oxygen and an AED.
 Begin CPR.
Management
 Chain of Survival
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Immediate recognition of cardiac arrest, activation of EMS
Early CPR emphasizing chest compressions
Rapid defibrillation if indicated
Early, effective ALS
Integrated post-cardiac arrest care
Management
 CVD Patient NOT in Cardiac Arrest
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Call for immediate assistance, oxygen, AED, and ALS.
Keep patient calm, put in position of comfort.
If hypotensive, keep supine and warm, and elevate legs
If CHF, sit patient up and put legs in dependent position
Other Considerations
 Medications:
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Plavix: anti-platelet to prevent formation of clots
Nitroglycerin: vasodilator
Coumadin: blood thinner
Lipitor: lowers harmful cholesterol levels
Cordarone: diuretic that removes excess fluid from the body
 Implantable devices may be in place
 High flow oxygen therapy is crucial
 Nitroglycerin -- assist patient if they have their prescription
with them and conditions/protocols allow
 Aspirin -- assist patient if they have aspirin and protocols
allow for it