2 The Heart Enclosed in pericardial sac Myocardium = heart muscle Four chambers: two atria, two ventriclesSides divided by septumAtrioventricular valves: tricuspid and mitralSemilunar valves: pulmonic and aorticElectrical pathways cause contractions
4 Blood VesselsCarry blood to and from the heartArteries: transport blood away from the heartAorta: largest artery in the bodyVeins: bring blood to the heartSuper and inferior venae cavaeCapillaries: connect arteries and veinsAorta – Arteries – Arterioles – Capillaries – Venules – Veins – Venae Cavae
6 Blood Transports materials from one area of the body to another Oxygen, CO2, protein building blocks, sugars, fats, hormones, waste products, etcWhen engaging in physical activity, body needs more oxygen and nutrients than when at rest – heart must pump blood faster
9 Cardiovascular Emergencies Most causes of CV system failure traced back to cardiovascular disease (CVD)CVD leading cause of death worldwideMore than 1/3 of adult population in US has CVD.Most cases of CVD attributed to coronary artery disease or atherosclerosis
10 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 dieEnd result of plaque build up is coronary artery disease.Angina pectorisLeads to hypertension, heart failure, AMI, and sudden cardiac death.
11 Figure 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.
12 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 arteriesVessel narrowing causes pressure to buildDamages blood vessels over timeAffects nearly 1B people worldwide; 1/3 in the USIf untreated, it can lead to stroke and kidney failure, and more
13 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 drugsAs the condition worsens, the patient goes into cardiogenic shock from profound hypoxia
14 Congestive Heart Failure Occurs when the heart can’t adequately pump blood to the bodyBlood backs up into major blood vessels leading to heart, and subsequently into organsRight-sided heart failure results in back-up into the systemic circulation, and then the dependent tissues, esp. the ankles and feetLeft-sided heart failure causes back-up into the lungs, resulting in pulmonary edema
15 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.
16 Angina PectorisChest pain/discomfort caused by ischemia of the myocardiumOccurs when the oxygen demands of the heart exceed the available supplyCommon occurrence in people with CAD due to narrowing of the arteriesCan also be caused by vasoconstriction or spasm of the coronary arterie
17 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
21 Aortic Aneurysm A ballooning outwards of the aorta S/S: Two types: abdominal and thoracicS/S:Abdominal pain radiating to the groin/backDizzinessAbdomen may be tender, with a pulsatile massRuptured? Profound shock with hypotension and diaphoresis
22 Cardiogenic Shock Caused by damage to myocardium Heart’s output of blood reducedBlood pressure cannot be maintained
23 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 hypotensiveIf caused by abnormal heart rhythm, the patient might be bradycardic, or tachycardic and hypotensive.
24 Pericardial Tamponade Occurs when excess fluid builds up in the pericardial spaceCompresses heart, can’t pump adequatelyPT is life-threatening, requires emergency fluid removal
25 S/S: Pericardial Tamponade Shortness of breath, anxiety or restlessness, and pale, cool, diaphoretic skinChest pain is commonHypotension, distended neck veins, and muffled/distant heart tonesPatient might present with only fatigue and tachycardia.
26 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 lodgesDeep venous thrombosisDecreases or blocks blood flow—no exchange of oxygen or CO2Arterial carbon dioxide increases, oxygen decreasesInhibits circulation
27 S/S: Pulmonary Embolism Sudden onset of chest painShortness of breathTachycardiaSharp pain that increases with deep breathsCyanosis and hypoxiaS/S DVT:Severe pain, tenderness to touch, swelling in one leg
28 Sudden Cardiac Arrest (SCA) Abrupt cessation of effective pumping of blood from heart to coronary arteries, brain, and other vital organsCaused by AMI, ventricular fibrillation, pulseless ventricular tachycardia, asystole.
29 ArrhythmiasIrregular heart beat or heart rhythm, which can compromise normal heart functionPrimary cause of life-threatening arrhythmia is ischemia of myocardiumLife-threatening arrhythmias (can lead to SCA):Ventricular fibrillation: chaotic and ineffective contraction of that ventricles that leads to cardiac arrestVentricular tachycardia: rapid contraction of the ventricles that can lead to ineffective blood flow to body tissues, cardiac arrestAsystole: complete absence of a heartbeat due to lack of electrical activity within the heart
30 Assessment Scene safety Primary assessment: ABCDs Patients in SCA will be unresponsive, apneic, pulseless – immediately begin CPRSecondary 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 relativeAssess chest pain using OPQRST (cardiac pain usually described as either “heavy,” “crushing,” or “tight.”If pain radiates into jaw or down arm, may indicate AMIDetailed secondary physical examCheck pulse, blood pressure, skin condition, capillary refill, level of responsiveness – evidence as to whether not tissue perfusion is effectiveAssess skin for color, temperature, diaphoresis (with chest pain may indicate that heart is ischemic.Listen to breath soundsReassess patient and vital signsEvery 3-5 mins if patient is unstableEvery mins if patient is stable
31 Management Evaluate ABCs and treat problems as they are found If patient is in cardiac arrest:Time is of the essence – Golden HourRequest ALS immediately, and call for oxygen and an AED.Begin CPR.
32 Management Chain of Survival Immediate recognition of cardiac arrest, activation of EMSEarly CPR emphasizing chest compressionsRapid defibrillation if indicatedEarly, effective ALSIntegrated post-cardiac arrest care
33 Management CVD Patient NOT in Cardiac Arrest Call for immediate assistance, oxygen, AED, and ALS.Keep patient calm, put in position of comfort.If hypotensive, keep supine and warm, and elevate legsIf CHF, sit patient up and put legs in dependent position
34 Other Considerations Medications: Implantable devices may be in place Plavix: anti-platelet to prevent formation of clotsNitroglycerin: vasodilatorCoumadin: blood thinnerLipitor: lowers harmful cholesterol levelsCordarone: diuretic that removes excess fluid from the bodyImplantable devices may be in placeHigh flow oxygen therapy is crucialNitroglycerin -- assist patient if they have their prescription with them and conditions/protocols allowAspirin -- assist patient if they have aspirin and protocols allow for it