Cardiovascular Emergencies Chapter 5

Introduction Can be most Challenging Recognition and care can mean life or death Most athletes are not in profile of heart attack and stroke Other conditions such as congenital defects and trauma do occur These like all emergencies must be anticipated Health care providers must be proficient in resuscitative skills

Anatomy Review Heart Positioned centrally in thoracic cavity 1/3 is posterior to sternum Remainder is to the left 4 chambers enclosed in pericardium Atria- upper Ventricles- lower 4 valves Tricuspid Mitral Aortic Pulmonic

Blood flow

Chest Pain or discomfort Can be result of cardiac and non-cardiac events Considered cardinal sign of cardiac-related event Must be assessed thoroughly regardless of age and fitness level Other descriptors an individual may describe: Discomfort Ache Burning Fullness All situations with chest pain should be treated as a cardiac event until proven otherwise

Common Causes of chest pain Cardiac Noncardiac Myocardial Infarction Gastro reflux Angina Esophagitis Hypertrophic cardiomyopathy Esophageal spasm Aortic Stenosis Ulcers Cardiac Tamponade Asthma Cardiac Contusion Gastritis Coronary artery disorder Pneumothorax Valve disorders Pulmonary Embolism Aortic dissection Pleuritis Bronchitis Rib Fractures

Sudden Cardiac Arrest Or SCA is Sudden Cardiac Death Sudden loss of heart function #1 cause of death in young athletes Can be caused by traumatic or atraumatic events Traumatic Commotio Cordis Atraumatic Hypertrophic Cardomyopathy Can have no warning signs Signs with exertion can occur Chest discomfort Shortness of breath syncope

Management of SCA August 2006, a multidisciplinary group lead b the NATA made recommendations on steps to follow to manage SCA Training in CPR and AED use for all first responders Early activation of EMS, Early CPR, Early Defibrillation, and rapid advancement to advanced cardiac life support High suspicion of SCA on any unconscious or unresponsive athlete Training to recognize SCA with ability to accurately take and recognize pulse, respiration rate, and seizure activity Knowledge of Commotio Cordis More on pages 53 and 54

More common cardiovascular events Myocardial Infarction (Heart Attack) S&S: profuse sweating, difficulty breathing, nausea, dizziness, pain radiating to neck, jaw, arms, and back; some may complain of pressure or ache rather than pain Management: place in position of comfort, loosen restrictive clothing, oxygen administration if available and trained, EMS activation immediately, continue to monitor vital signs, CPR and AED if condition worsens Angina Pectoris S&S: Similar to Myocardial Infarction Management: Most have been diagnosed previously with this condition and will have nitroglycerin medication prescribed. If condition is unknown treat like myocardial infarction

More common cardiovascular events Stroke S&S: Sudden numbness; decrease or loss of function in face, arm, leg, usually only affecting one side of the body; severe headache; vision problems; unequal pupils; loss of balance; mental confusion; difficulty speaking or swallowing; loss of bowel or bladder control Management: protect airway; assess vital signs; detailed history with physical exam; administer oxygen if trained; alert EMS; transport to nearest hospital immediately; favorable prognosis if treated immediately Cardiac Tamponade S&S: shock; hypotension; jugular vein distension; muffled heart sounds; paradoxical pulse; DD in field may be tension pneumothorax, difference will be location of trachea location Management: protect airway; assess vital signs; detailed history with physical exam; administer oxygen if trained; alert EMS; transport to nearest hospital immediately

More common cardiovascular events Traumatic Aortic Rupture S&S: extremely difficult to diagnosis; consider MOI; often show no outward signs of chest trauma; may present with UE hypertension and LE diminished pulse Management: majority die immediately; if survival emergency surgery is needed immediately; activate EMS; monitor vitals; prepare for CPR and AED if situation deteriorates Myocardial Contusion S&S: same as an acute myocardial infarction; hard to differentiate in field; MOI may assist in diagnosis Management: : place in position of comfort, loosen restrictive clothing, oxygen administration if available and trained, EMS activation immediately, continue to monitor vital signs, CPR and AED if condition worsens

More common cardiovascular events Cardiac Arrhythmias S&S: most present in PPEs; some can present only after symptoms of a cardiac event; many types exist; when symptomatic may present with palpitations, syncope, near syncope, dizziness, fatigue, or sudden death Management: place in position of comfort, loosen restrictive clothing, oxygen administration if available and trained, EMS activation immediately, continue to monitor vital signs, CPR and AED if condition worsens Myocarditis S&S: cough, SOB , chest pain, intensify with exercise; may exhibit flu like symptoms including body ache, joint pain, headache, sore throat, fever, and diarrhea; can lead to further more dangerous and fatal arrhythmias

More common cardiovascular events Syncope S&S: loss of consciousness; can be benign or due to cardiac event Management: thorough assessment; never assume; if cardiac event suspected treat as such Valve and Blood Vessel Disorders S&S: may types that can turn into cardiac event upon exertion; difficult and near impossible to detect without thorough medical history Management: if cardiac event suspected treat as such