31 hours ago Chapter 14 Cardiovascular Emergencies. Home. Get App. Create. Acute coronary syndrome (ACS) is a term used to describe: A. the warning signs that occur shortly before a heart attack. B. a group of symptoms that are caused by myocardial ischemia. >> Go To The Portal
The goal for caring for cardiovascular emergencies is to improve oxygenation at the cellular level, decrease pain, and treat rhythm disturbances. John receives an IV for medications, but his cardiac rhythm changed and he became unconscious. Immediately the nurse noted there was no pulse.
Some medical directors have written protocols requiring patients with suspected cardiac emergencies to be transported to cardiac specialty centers with certain capabilities, such as cardiac catheterization or tar- geted temperature management after resuscitation from cardiac arrest.
Cardiovascular emergencies are life-threatening events of the heart requiring rapid identification and intervention for survival. They have similar symptoms including chest pain, shortness of breath, diaphoresis (sweating), nausea, vomiting, dizziness, and anxiety.
Oxford Handbook of Emergency Medicine, 4th edn, p. 65. Oxford University Press, Oxford.) The function of the cardiovascular system is to transport O 2 and nutrients to the cells and remove CO 2 and metabolic waste products from the body.
A percutaneous transluminal coronary angioplasty (PTCA) restores blood flow to the ischemic myocardium by:
B. tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.
A 67-year-old woman presents with difficulty breathing and chest discomfort that awakened her from her sleep. She states that she has congestive heart failure, has had two previous heart attacks, and has prescribed nitroglycerin. She is conscious and alert with adequate breathing.
Signs and symptoms of concern are: Chest pain or pressure, upper abdominal pain. Arm, jaw, back, or throat pain. Shortness of breath. Sweating (diaphoresis) Nausea, vomiting. Dizziness. Anxiety or restlessness.
The code team was called for a cardiac arrest, which is when there is no heart beat and no respiration. This is often caused by a fatal heart rhythm such as ventricular fibrillation or ventricular tachycardia, both of which reduce the flow of blood through the heart to the body.
The presence of a cardiac rhythm without an actual heartbeat is known as pulseless electrical activity or PEA . This cardiac emergency has the look of a regular rhythm on the monitor, but no actual heartbeat is detected.
The goal for caring for cardiovascular emergencies is to improve oxygenation at the cellular level, decrease pain, and treat rhythm disturbances.
The gold standard of care in this case is to place an IV, monitor vital signs, and give medications to slowly reduce the patient's blood pressure.
Signs and symptoms of hypertensive emergencies may reflect the organ system involved, and usually the patient's blood pressure will be higher than 180 systolic (top number) and 120 diastolic (bottom number). Other signs and symptoms include:
John has an electrocardiogram (ECG), a tracing of the electrical activity of the heart corresponding to the heartbeat. Nurses place an IV and monitor his oxygen and vital signs. Since he is not allergic, he is given an aspirin, and chest x-rays are taken.
Cardiac Output = Heart Rate × Stroke Volume Cardiac output is the amount of blood pumped out of the left ventricle in 1 minute. Heart rate is the number of times the heart contracts in 1 minute. Stroke volume is the volume of blood pumped out by the left ventricle in one contraction. Stroke volume is affected by preload, afterload, and contractility. Preload is related to the venous return to the right atrium. Afterload is associated with systemic vascular resistance, which is a func- tion of the constriction of the systemic blood ves- sels. As the blood vessels constrict, it is harder for the ventricle to push the blood into them. Contrac- tility refers to how forcefully the heart contracts. 636Section 6 Medical
The heart must pump effectively to ensure that the body’s tissues and cells receive an uninterrupted supply of oxygen and that metabolic waste (eg, car- bon dioxide) is removed from the tissues and cells and returned, through the heart, for elimination from the body by the respiratory system. 2.
The American Heart Association reports that car- diovascular disease claimed 786,641 lives in the United States in 2011. This is 31.3% of all deaths, or approximately 1 of every 3 deaths. Although this is a decline from previous years, heart disease has been the leading killer of Americans since 1900.
The heart must increase cardiac output to meet the increased metabolic requirements of the body. Cardiac output is increased by increasing the heart rate or stroke volume. The stroke volume is the volume of blood ejected with each ventricular contrac- tion.
A. The right side of the heart receives oxygen-poor blood from the venous circulation. B. The left side of the heart receives oxygen-rich blood from the lungs through the pulmonary veins.
Chest pain does not always mean that a person is hav- ing an AMI. When, for a brief time, heart tissues are not getting enough oxygen, the pain is called angina pectoris, or angina. Although angina can result from a spasm of an artery, it is most often a symptom of atherosclerotic coronary artery disease. Angina occurs when the heart’s need for oxygen exceeds its sup- ply, usually during periods of physical or emotional stress when the heart is working hard. A large meal or sudden fear may also trigger an attack. When the increased oxygen demand goes away (eg, the person stops exercising), the pain typically goes away. Anginal pain is commonly described as crushing, squeezing, or “like somebody standing on my chest.” It is usually felt in the mid portion of the chest, under the sternum. However, it can radiate to the jaw, the arms (frequently the left arm), the midportion of the back or the epigastrium (the upper-middle region of the abdo- men). The pain usually lasts from 3 to 8 minutes, rarely longer than 15 minutes. It may be associated with short- ness of breath, nausea, or sweating. It usually disappears promptly with rest, supplemental oxygen, or nitroglyc- erin (NTG), all of which decrease the need or increase the supply of oxygen to the heart. Although angina pec- toris is frightening, it does not mean that heart cells are dying, nor does it usually lead to death or permanent heart damage. It is, however, a warning that you and the patient should take seriously. Even with angina, because the oxygen supply to the heart is diminished, the elec- trical system can be compromised, and the person is at risk for significant cardiac rhythm problems. Angina can be further differentiated into “stable” and “unstable” angina. Unstable angina is character- ized by pain or discomfort in the chest of coronary ori- gin that occurs in response to progressively less exercise or fewer stimuli than ordinarily required to produce angina. If untreated, it can lead to AMI. Stable angina is characterized by pain in the chest of coronary origin that is relieved by the things that normally relieve it in a given patient, such as resting or taking nitroglycerin. EMS usually becomes involved when stable angina becomes unstable, such as when a patient whose pain is normally relieved by sitting down and taking one
is caused by an autoimmune response to damaged cardiac tissue and consists of pericarditis, fever, and pericardial effusion. It can occur 3–14 days post-AMI/cardiac surgery and requires admission—ideally to CCU/cardiology ward.
The function of the cardiovascular system is to transport O 2 and nutrients to the cells and remove CO 2 and metabolic waste products from the body. The right side of the heart pumps deoxygenated blood to the lungs where gas exchange takes place and then returns the oxygenated blood to the LA through the pulmonary veins (PVs). The left side of the heart pumps blood to the rest of the body through the aorta, arteries, arterioles, and systemic capillaries, and then returns blood to the RA through the venules and great veins.
Hypotension with streptokinase is common but is rarely 2° to anaphylaxis. Maintain meticulous monitoring of BP and pulse every 2–5min, initially for first 15min and then as the condition dictates. If the patient develops hypotension, do the following.
AF is a rapid and disorganized atrial activity associated with an inconsistent ventricular response. It is increasingly common due to the ageing population. By definition, it is a narrow-complex tachycardia, but it is often incorrectly referred to as supraventricular tachycardia (SVT). The incidence of AF ↑ with age, but that of SVT ↓ with age.
Heartbeats follow a sequential pattern. Contraction of the atria (atrial systole) is followed by contraction of the ventricles (ven tricular systole). All chambers then relax during diastole. Simultaneous pressure characteristics occur in the aorta, LA, and LV through one cardiac cycle.
Patients presenting with chest pain should be assessed in an area where resuscitation equipment is easily accessible.
The initial diagnosis, management, and admission are the same as for unstable angina. Formal diagnosis is made at 24h following ECG review and assessment of cardiac enzymes (e.g. TnT/TnI, CK, CK-MB). This type of infarct is becoming commoner, and care is required to ensure early identification and admission to CCU.