Transcript Copyright © Texas Education Agency, 2014.

Cardiovascular Emergencies
Copyright © Texas Education Agency, 2014. All rights reserved.
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Copyright © Texas Education Agency,
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2014. All rights reserved.
Cardiovascular Anatomy and
Physiology
• Review the flow of blood through the heart and
through the major vessels. Discuss the
cardiovascular system.
• Review the function of the four chambers of the
heart. Deoxygenated blood enters the heart via
the vena cava, travels through the right and left
chambers, and moves to the lungs, where it
receives oxygen. Oxygenated blood returns from
the lungs via the pulmonary vein. It travels
through the left chambers of the heart and enters
the aorta to be pumped out to the body.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Cardiovascular Anatomy and
Physiology
• Review the cardiac conduction system (the electrical
impulses and specialized muscles that cause the heart to
contract). The cardiac conduction system allows for a
coordinated, rapid depolarization of cardiac cells and is
designed to facilitate mechanical contraction.
• Review the composition of blood (red and white blood
cells, platelets, and plasma) and the flow of blood
through the arteries, veins, arterioles, venules, and
capillaries. Review the names and positions of major
blood vessels and discuss the circulation of blood
between the heart and the lungs and between the heart
and the rest of the body.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Acute Coronary Syndrome
• Acute coronary syndrome (ACS) is a blanket term that refers to any
time that the heart may not be getting enough oxygen.
• An EMT should treat all patients with ACS-like signs and symptoms
as though they are having a heart problem.
• Always have a patient describe in his own words how he is feeling.
Patients complain of radiation to the left arm more than the right,
but either (or both) is possible.
• Always ask about shortness of breath when evaluating a potential
ACS patient. Dyspnea as a singular complaint is common in older
patients and in diabetic patients.
• Chest discomfort, dyspnea, nausea, and anxiety are common
symptoms of ACS, but not all ACS patients present with common
symptoms.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Acute Coronary Syndrome
• There is no such thing as a common finding in ACS.
Between one-quarter and one-third do not have the typical
presentation of chest discomfort. This is especially true in
older patients and women. You may see a patient who
complains of difficulty breathing, sudden onset of sweating
or a sudden, unusual feeling of fatigue, without chest
discomfort. Because of these many possibilities and
because of the potentially severe complications of heart
problems, it is important to have a high index of suspicion
and treat patients with any of these signs and symptoms
for cardiac compromise.
• You should always inquire about onset, provocation,
quality, radiation, severity, and time.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Acute Coronary Syndrome
• Occasionally, you will see a patient who has both difficulty
breathing and hypotension. It may be very difficult to find a
good position in this case. The best way to determine the
proper position is to ask the patient what position will
relieve breathing difficulty without making him weak or
lightheaded. Oxygen is especially important if the patient is
hypoxic, as reflected in signs and symptoms, including
oxygen saturation level. Keep the patient’s oxygen
saturation at least at 94%.
• Note that asthma and other anti-clotting medications are
relative contraindications. Some systems may allow the
administration of aspirin in these circumstances. Follow
local protocol.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Causes of Cardiac Conditions
• The majority of cardiovascular emergencies are caused,
directly or indirectly, by changes in the inner walls of
arteries. Conditions that narrow or block the arteries of
the heart are commonly called coronary artery disease
(CAD).
• An aneurysm occurs when weakened sections in the
arterial walls dilate and occasionally burst.
• The two most common sites of aneurysms are the
aorta and the brain. Tissues beyond the rupture can be
damaged because the oxygenated blood they need is
escaping and not reaching them. If a major artery
ruptures, death from shock can occur very quickly.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Causes of Cardiac Conditions
– Both electrical and mechanical problems can
cause the heart to fail.
– Angina pectoris and acute myocardial infarction
result from an interruption of the necessary blood
flow to heart muscle. Infarction occurs when this
blood supply is fully occluded.
– Occasionally angina pain can be seen at rest,
especially in progressive disease states.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Causes of Cardiac Conditions
• Congestive heart failure occurs when the heart cannot pump
properly due to damage or a disorder. Pulmonary edema is a
common symptom of CHF.
• When the left ventricle fails and fluid accumulates in the
lungs, it is called pulmonary edema. This edema causes a poor
exchange of oxygen between the lungs and the bloodstream,
and the patient experiences shortness of breath, or dyspnea.
When the right side fails, fluids may accumulate in the
dependent (lower) extremities, the liver, and the abdomen.
Accumulation of fluid in the feet or ankles is known as pedal
edema. The abdomen may become noticeably distended. In a
bedridden patient, fluid collects in the sacral area of the
spine.
Copyright © Texas Education Agency,
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2014. All rights reserved.