Terms to know • Ischemia • Infarction • Atherosclerosis • Thromboembolism • Angina Pectoris • Acute Myocardial Infarction (AMI) • Pacemaker/Defibrillator
Ischemia • “Decreased blood flow” In this case, to the heart muscle. • Causes can be partial or complete blockage of blood flow through coronary arteries. • The tissues soon begin to starve and eventually die if blood flow is not restored. • Ischemic Heart Disease – disease causing decrease in blood flow to heart muscle.
Infarction • “Death of tissue” • If ischemia is not corrected and blood flow restored to the muscle than the tissues begin to die. • Death of the heart muscle causes diminished ability to pump and if significant portion of the muscle is affected
Atherosclerosis • Disorder in which calcium and fatty material called cholesterol build up and form a plaque inside the walls of blood vessels. • Can cause partial or complete blockage of coronary arteries.
Pacemaker/Defibrillator • Can be just pacemaker, or just defibrillator, or both. • Single or dual chamber • Atrial vs. ventricular • Can be demand or constant.
What is Acute Coronary Syndrome? • “A group of symptoms caused by myocardial ischemia” • Chest pain usually caused by either angina pectoris or Acute Myocardial Infarction • Treat as if it is “worst case scenario” • Symptoms vary!
Angina pectoris • “Angina” • Can be caused by a spasm of the coronary artery • Usually it is a symptom atherosclerotic coronary artery disease but is brief and resolves. • It is a symptom of the heart muscle needing more oxygen and usually occurs during periods of physical or emotional stress. • Usually goes away if the stressor is stopped.
Acute Myocardial Infarction • HEART ATTACK • Blockage in a coronary artery • Infarction – “Death” Myocardial – Heart muscle • Serious consequences • Sudden death • Cardiogenic shock • Congestive heart failure
Acute Myocardial Infarction
AMI continued • Signs/Symptoms • Anxiety/confusion/agitation • Weakness • Nausea/vomiting • Sweating/pale or ashen • Slow or fast heart rate (depends on area of the heart affected) • Pain –”Crushing” • chest, back, neck, jaw, OR arms • Shortness of breath
Symptoms of AMI • Sudden onset of weakness, nausea and sweating without obvious cause • Chest pain, discomfort or pressure. “Crushing” “squeezing” • Other pain – jaw, back, neck, abdomen. • Irregular heart beat • Syncope • Shortness of breath • Nausea/vomiting • Sudden death
Assessment • Initial impression • Airway, breathing, circulation • Immediate life threats • VS • HR, BP, RR, SpO2, • History • SAMPLE/OPQRST • Medication List/allergies • Remember that symptoms can be very atypical and don’t always include chest pain.
History taking SAMPLE OPQRST • Signs/symptoms • Onset • Allergies • Provocation • Medications • Quality • Past medical History • Radiation • Last oral intake • Severity • Events leading up to event • Time
Treatment • Stabilize life threats (Airway, Breathing, Circulation) • Oxygen • Transport early if possible! • They need ALS care including EKG as soon as possible • Possibly assist with patient’s medications • Nitroglycerin
Other Causes of Chest Pain or Cardiac- like symptoms • Thoracic Aortic Aneurysm – weakened area of the aorta which may expand due to the pressure of the aorta and can even rupture. • Pulmonary Embolism – if that thromboembolism does go to the heart it might go to the lungs! • Anxiety/hyperventilation – causes muscle tightness and feeling of shortness of breath/chest pain. • Gastric issues (reflux, “heartburn”) – Can be felt in the chest, although it is a gastric problem.
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