Transcript Inside the Operating Room: Exploring Top Causes of Death in the

Presentation by:
Stephanie Scully, RN BSN
CHR Cardiac Operating Room
NCP Health Ministry Chair
To discuss three of the most common
causes of death in the elderly population
 To describe heart attacks, strokes, and
falls and how they occur
 To demonstrate what surgical
interventions are available to treat heart
attacks, strokes, and falls

Heart Disease
 Cancer
 Stroke
 COPD
 Flu/ Influenza
 Diabetes
 Injuries


Heart Attacks

Strokes

Falls

Heart disease and cancer
› Leading causes of death for >65 for 2
decades

35% of all deaths are due to heart
disease, including heart attacks and
chronic ischemic heart disease
Damage and death
of heart muscle from
the sudden blockage
of a coronary artery
by a blood clot
 Sudden blockage=
blood and oxygen
deprivation-> injury to
the heart muscle=
chest pain and chest
pressure




Coronary arteries provide heart with blood
Blood= oxygen and nutrients
CAD= Coronary Artery Disease
› Fatty matter, calcium, proteins, inflammatory
cells= plaque
› Plaque is hard on the outside, mushy on the
inside
 When the plaque is hard, outer shell cracks=
plaque rupture -> platelets form around rupture =
blood clot
**Total or near-total occlusion by blood clot =
heart attack
Discomfort, pressure, heaviness, or pain in the
chest, arm, or below the breastbone
 Discomfort radiating to the back, jaw, throat, or
arm
 Fullness, indigestion, or
choking feeling
 Sweating, nausea/
vomiting, or dizziness
 Weakness, anxiety,
or shortness of breath
 Rapid or irregular
heartbeat
*No symptoms= silent heart attack


Why is time important
in treatment of heart
attacks?
› 20-40 minute window
 Lack of blood flow
restoration= irreversible
death of the heart
muscle begins
› Muscle continues to die
for 6-8 hours, or until the
heart attack usually is
"complete.“
Amount of damage depends on size of
area supplied by the blocked artery and
time between injury and treatment
 Healing of the heart muscle begins soon
after a heart attack and takes about
eight weeks.

› Scar tissue will form in the damaged area
› Scar tissue does not contract= the heart's
pumping ability is lessened after a heart
attack

Medications
› Aspirin
 Prevent additional clotting

Heart Codes
› Cardiac Catheterizations
 Angioplasty and stenting
› Surgical intervention
 Coronary Artery Bypass Grafting (CABG)
 Depending upon blockage location and severity

CABG is one treatment for CAD
› A healthy artery or vein from the body is
connected, or grafted, to the blocked coronary
artery.
› The grafted artery or vein bypasses (that is, goes
around) the blocked portion of the coronary
artery.
› This creates a new path for oxygen-rich blood to
flow to the heart muscle.

Surgeons can bypass multiple coronary
arteries during one surgery.
CABG Surgery



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Results are usually excellent
Improves or completely relieves angina
symptoms
Most people remain symptom-free for as
long as 10 - 15 years
May lower your risk of having a heart attack
and help you live longer
You may need repeat surgery if blockages
form in the grafted arteries or veins or in
arteries that weren't blocked before.
Treatments do not cure
CAD
 It CAN happen again

› Take medicines
 Reduce blood pressure
 Relieve work of heart
 Prevent blood clots
 Lower cholesterol
› Make lifestyle changes
 Dietary changes
 Exercise
 Quit smoking
The third leading cause of death in
America is stroke
 Strokes are debilitating and lethal
 Stroke kills almost 130,000 Americans
each year—that’s 1 out of every 19
deaths.
 On average, one American dies from
stroke every 4 minutes.
 Every year, more than 795,000 people in
the United States have a stroke.

A stroke occurs when the blood supply
to part of your brain is interrupted or
severely reduced, depriving brain tissue
of oxygen and food.
 Within minutes, brain cells begin to die.
 Strokes are treatable and preventable

Sudden severe headache
 Weakness
 Numbness
 Vision problems
 Confusion
 Trouble walking
 Difficulty talking
 Dizziness
 Slurred speech

When blood supply to
the brain is interrupted
or reduced-> oxygen
and nutrient
deprivation= brain cell
death
 Two types

› Ischemic stroke ->
blocked artery
› Hemorrhagic stroke ->
leaking or burst blood
vessel

85% of strokes are ischemic
› Occur when one or both carotid
arteries (supplying the brain with
blood) become narrowed or blocked= severely
reduced blood flow (ischemia)

Thrombotic stroke
› A blood clot (thrombus) forms and blocks vessel
› Blood clot= fatty deposits (plaque)

Embolic stroke
› A blood clot or other debris is swept through your
bloodstream to lodge in narrower brain arteries
 This type of blood clot is called an embolus.
A stroke is a MEDICAL
EMERGENCY
 Prompt treatment is
crucial to survival
 Early action can
minimize brain
damage and
potential
complications



To treat an ischemic stroke, doctors must
quickly restore blood flow to your brain.
Medications
› TPA- Clot buster
 Within 4.5 hours
› Aspirin
 Reduce additional clotting

Emergency procedures
› Catheter- administered TPA
 Directly into the area where the stroke is occurring
› Mechanical clot removal= = thrombectomy
› Angioplasty and stenting the carotid artery
› Carotid endarterectomy


Surgical removal of plaque from arteries that
run along each side of your neck to your brain
(carotid arteries)
May be done for someone that had a stroke,
or someone at high risk for stroke
› Determined by vascular ultrasound

Steps include:
› Incision along side of neck
› Opens up carotid artery
› Blood may be rerouted
temporarily through a shunt
› Scrape out plaque
› Stitch or patch artery shut
› Close incision
CEA can be done several months after a
stroke or TIA
 Most benefit from the surgery within 2
weeks of the stroke or TIA
 > 2 week surgery delay increases the risk
for stroke, because people are more
likely to have a stroke in the first few days
and weeks after a first stroke or a TIA.

Symptomatic patients with blockages of
70% or more benefit greatly
 Less than 50% narrowing of the carotid
do not seem to benefit from surgery
 CEA works better than treatment with
medicine alone in preventing stroke

› (For people who have symptoms that can
be attributed to a 70% to 99% blockage of
the carotid arteries)

Medications
› Aspirin
› Anti-platelet (prevent clots)
› Cholesterol lowering
Exercise
 Diet

› Low fat, low cholesterol

Quit Smoking
Falls are one of the top causes of death
among people 65 years of age and
older
 One in three older adults falls every year

› Less than half report it
Falls are the leading cause of both fatal
and nonfatal injuries in older adults
 In 2010, the direct medical costs of falls
was $30 billion

A fall can change your life
 Falls lead to:

› Disability
› Loss of independence
› Breaking bones and hips

Falls seldom “just happen’
› Preventing falls is important
 Regular eye exams
 Eliminating tripping hazards
 Wearing non-skid shoes
 Using assistive deices



Each year, more than 1.6 million older U.S.
adults go to emergency departments for fallrelated injuries.
Falls are the number one cause of fractures in
older adults
Fall- related Fracture injuries:
›
›
›
›
›
›
Hip
Pelvis
Spine
Arm
Hand
Ankle
One of the most serious
types of fall injuries
 Leading cause of injury
and loss of independence
among older adults
 Healthy, independent older adults may
be able to return home or live on their
own after treatment and rehab
 Long term care is always necessary

A hip fracture is a break in the upper
quarter of the femur (thigh) bone
 The extent of the break depends on the
forces that are involved
 Type of surgery required

› Bones and soft tissues
involved
› Level of fracture
Most commonly from a fall or from a
direct blow to the side of the hip
 Some medical conditions increase
susceptibility

› Osteoporosis
› Cancer
› Stress injuries

In severe cases,
standing on a leg and twisting

Type of surgery depends on location, severity, and
age
› Repair with hardware
 Metal screws into bone to hold it together until healed
 Screws to metal plates along bone
 Rods down center of bone through marrow (aka nails)
› Replace femur
 Partial hip replacement
 If ends aren’t properly aligned, head and neck of femur removed
and replaced
› Replace hip joint
 Total hip replacement
 Replace upper femur and socket in pelvis
**If blood supply to ball joint is damaged, bone healing
compromised-> hip replacement necessary

Take medications
› Pain
› Clot prevention

Rehabilitation
› Programs available

Lifestyle adjustment
› Long-term care and
rehab
› Assistive devices

Future fall
prevention

Preventing falls is key to older adults
› Exercise regularly
 Leg strength increases, balance improves
› Review medications
 Dizziness side effect
› Regular eye exams
 Maximizes vision during
age-related changes
› Lower hip fracture risk
 Enhance calcium and vitamin D intake
 Weight bearing exercises
 Screening and treatment for osteoporosis
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http://www.cdc.gov/nchs/data/ahcd/agin
gtrends/01death.pdf
www.webmd.com
www.medicinenet.com
https://www.nhlbi.nih.gov/health/healthtopics
www.mayoclinic.com
www.stoke.org
http://www.nlm.nih.gov/medlineplus
http://nihseniorhealth.gov