Temple College EMS Program1 Cardiovascular Disease n 63,400,000 Americans have one or more forms of heart or blood vessel disease n 50% of all deaths are cardiovascular disease

Temple College EMS Program2 Cardiovascular Disease n A cute M yocardial I nfarction (Heart Attack) - leading cause of death in U.S. n 1.5 million Americans will have AMI’s this year u Of these.5 million will die! u 350,000 will die in first two hours!

Temple College EMS Program3 Cardiovascular Disease Risk Factors n Major Uncontrollable u Age u Sex u Race u Heredity

Temple College EMS Program4 Cardiovascular Disease Risk Factors n Major Controllable u Smoking u High BP u High blood cholesterol u Diabetes

Temple College EMS Program5 Cardiovascular Disease Risk Factors n Minor Controllable u Obesity u Lack of exercise u Stress u Personality

Temple College EMS Program6 Cardiovascular Disease Control risk factors - decrease Coronary Artery Disease and Acute Myocardial Infarction

Temple College EMS Program7 Coronary Artery Disease n Myocardium (heart muscle) requires continuous oxygen and nutrient supply n Myocardial blood supply passes through coronary arteries

Temple College EMS Program8 Coronary Artery Disease n Atherosclerosis u Narrowing of lumen F plaque formation - related to Risk Factors F results in decreased myocardial perfusion u Poor tissue perfusion causes: u tissue damage (ischemia) u tissue death (infarction)

Temple College EMS Program9 Atherosclerotic Plaque Formation

Temple College EMS Program10 Angina Pectoris “A choking in the chest” n Angere - to choke n Myocardial oxygen demand exceeds supply during periods of increased activity, exercise, or stressful event

Temple College EMS Program11 Angina Pectoris n During stress the myocardium demands more O 2 n Coronary arteries would normally dilate to supply more blood and O 2 n In Angina Pectoris, the coronary arteries are unable to dilate sufficiently to increase perfusion

Temple College EMS Program12 Symptoms -Angina Pectoris n Pain u Substernal u Squeezing/Crushing/Heaviness u May radiate to arms, shoulders, jaw, upper back, upper abdomen back u May be associated with shortness of breath, nausea, sweating

Temple College EMS Program13 Symptoms -Angina Pectoris n Pain usually associated with 3E’s u Exercise u Eating u Emotion

Temple College EMS Program14 Symptoms -Angina Pectoris n Pain seldom lasts > 30 minutes n Pain relieved by u Rest u Nitroglycerin

Temple College EMS Program15 Symptoms -Angina Pectoris n Great anxiety/Fear n Fixation of the body n Pale, ashen, or livid face n Dyspnea (SOB) may be associated

Temple College EMS Program16 Symptoms -Angina Pectoris n Nausea n Diaphoresis n BP usually up during attack n Dysrhythmia may be present

Temple College EMS Program17 Angina Pectoris n Following an angina attack there is no residual damage to the myocardium

Temple College EMS Program18 Acute Myocardial Infarction “Heart Attack” n Inadequate perfusion of myocardium u Death of myocardium F Infarct u Damage to myocardium F Ischemia

Temple College EMS Program19 Symptoms - AMI n Chest Pain - cardinal sign of myocardial infarction u Occurs in 85% of MI’s u Substernal u “Crushing,” “squeezing,” “tight,” “heavy”

Temple College EMS Program20 Symptoms - AMI n Chest Pain u May radiate to arms, shoulders, jaw, upper back, upper abdomen back u May vary in intensity u Unaffected by: F swallowing F coughing F deep breathing F movement

Temple College EMS Program21 Symptoms - AMI n Chest Pain u Unrelieved by rest/nitroglycerin u Pain lasts longer than angina pain (up to 12 hours) u “Silent’ MI F 15% of patients with MI, F particularly common in elderly and diabetics

Temple College EMS Program22 Symptoms - AMI n Shortness of breath n Weakness, dizziness, fainting n Nausea, vomiting n Pallor and diaphoresis (heavy sweating)

Temple College EMS Program23 Symptoms - AMI n Sense of impending doom n Denial u 50% of deaths occur in first two hours u Average patient waits 3 hours before seeking help

Temple College EMS Program24 Symptoms - AMI n Changes in pulse, BP, respiration are not diagnostic of AMI

Temple College EMS Program25 Management of Cardiac Chest Pain n Position of Comfort n Patent Airway n High concentration O 2 u non-rebreather mask lpm

Temple College EMS Program26 Management of Cardiac Chest Pain n Reassure the patient n Obtain a brief history and physical exam n Aspirin 325mg p.o.

Temple College EMS Program27 Congestive Heart Failure n CHF = Inability of heart to pump blood out as fast as it enters. n May be left-sided, right-sided, or both.

Temple College EMS Program28 Congestive Heart Failure n Usually begins with left-sided failure. u Left ventricle fails u Blood “stacks up” in lungs u High pressure in capillary beds u Fluid forced out of capillaries into alveoli

Temple College EMS Program29 Congestive Heart Failure n Right-sided failure most commonly caused by Left-sided failure. Blood “backs up” into systemic circulation u Distended neck veins u Fluid in abdominal cavity u Pedal edema

Temple College EMS Program30 Causes of CHF n Coronary Artery Disease n Chronic hypertension (high blood pressure) n AMI n Valvular heart disease

Temple College EMS Program31 Symptoms of CHF n Weakness n Dyspnea n Dyspnea on exertion n Paroxysmal nocturnal dyspnea u Attacks of SOB that usually occur at night that awakens the patient

Temple College EMS Program32 Symptoms of CHF n Orthopnea u Difficulty breathing in any position other than standing or sitting n Abdominal discomfort n Jugular Vein Distention (JVD) n Pedal “Pitting” edema in lower extremities

Temple College EMS Program33 Symptoms of CHF n Tachycardia n Pulmonary Edema u Noisy, labored breathing u Coughing u Rales, wheezing u Pink, frothy sputum

Temple College EMS Program34 Management of CHF n Sit patient up, let feet dangle n Administer high concentration O 2 n Assist ventilation as needed n Monitor vital signs q 5-10 minutes n Request early ALS back-up