Heart Attack by dfsdf224s


									Slide 1

          Heart Attack

             Chris Vickery

              Prepared by: Chris Vickery ACP
Slide 2

                     What is a Heart Attack?

                  An injury suffered by the cardiac muscle
                     from an interruption of oxygen and blood

                  There are many different causes!

Often the term “Heart Attack” is used to describe a variety of cardiac
All have similar symptoms: Pain and/or discomfort, Shortness of Breath, Anxiety
Slide 3

                       Some Causes Are….
                         Myocardial Infarction, MI
                         Congestive Heart Failure, CHF
                         Commotio Cordis, (Cardiac Concussion)
                         Pericardial Tamponade

These are generally the most common causes the EMR may see on the road.
The important part of the presentation is to realize not
All Heart Attacks are the same and come from different causes with different age
groups at risk
Slide 4

                         First lets review how a heart
                    • 4 pumping chambers. 2 left & 2 right
                    • Deoxygenated blood from body
                    travels into the right side then is
                    pumped out to lungs.
                    • Oxygenated blood from lungs travels
                    back into the left side of the heart then
                    is pumped out to the body.
                    • As the blood leaves the heart from
                    the left ventricle it immediately feed
                    itself via the carotid arteries.

General review circulation, highlighting the fact that the left and right side of the
heart operate as 2 separate pumps.
Will be important when trying to understand CHF
Slide 5

                        The Heart is held in place and surrounded by a sac
                                     called the Pericardial sac.

Review of Pericardium, important for understanding Pericardial Tamponade
This sac simply holds the heart in place, thin layer of fluid between sac and heart
acts a lubricant for movement.
Slide 6

                        Definitions to Remember.

                  Ischemia: deficient supply of blood to a body part (as the heart or brain) that
                     is due to obstruction of the inflow of arterial blood (as by the narrowing of
                     arteries by spasm or disease).. Tissue hypoxia.

                  Necrosis: death of living tissue; specifically : death of a portion of tissue
                    differentially affected by local injury. Tissue dies from prolonged hypoxia.

                  Thrombus: clot of coagulated blood or plaque attached to vessel wall.

                  Embolus: free floating particle in blood stream, eg. thrombus detaches from

Thrombus is a stationary clot, embolus is one that breaks off and travels
eventually getting lodged.
Turbulance in the right atrium from A-fib can cause small clots to form and be
eject into the circulation (embolus), you may find
These people on blood thinners (warfarin or coumadin) or ASA.
Slide 7

          Signs and Symptoms
Slide 8

                         Signs and Symptoms                       cont’d

                       Pain, fullness, and/or squeezing sensation of the chest
                       Jaw pain
                       Shortness of breath
                       Nausea, vomiting, and/or general upper middle abdomen
                       Heartburn and/or indigestion
                       Arm pain (more commonly the left arm, but may be either
                       Upper back pain
                       General malaise (vague feeling of illness)
                       No symptoms (Approximately 25% of all MI’s are silent,
                       without chest pain or symptoms. Silent heart attacks are
                       especially common among patients with diabetes.

Each sign & symptom appears individually, tap mouse/spacebar to have appear.
*Long term diabetics may not feel the mild signs of Heart attack because they no
longer feel pain the same due to the effect
of diabetes on nerves over long periods.
Slide 9

                      Risk Factors
                      On initial assessment your patient will likely have many of these risk

                         High Blood Pressure / Hypertension
                         High Cholesterol / Healthy diet
                         Obesity / Overweight
                         Low Physical Activity

Self explanatory risk factors
Slide 10

                        Myocardial Infarction or MI.
                       Sudden blockage of
                       blood supply to a
                       portion of the heart.
                       Caused by clot,
                       Oxygen starved
                       muscle, tires and
                       becomes weak.

A Myocardial Infarction describes tissue that has had blood supply cut off or
limited so severely that muscle is dying.
Dead cells cannot conduct the signals that are normally transmitted from cell to
cell causing the heart beat cycle to occur.
If enough of the heart muscle dies the heart simply will not beat effectively and
the person will die.
Slide 11

                      Myocardial Infarction or MI.

                      Muscle begin to
                      die (necrosis)
                      20 - 40 min.
                      from onset of

                      Damage &
                      death of muscle
                      continues for 6 -                Area of Infarct

                      8 hrs.

Times are given to help understand the urgency need when approaching
possible MI’s. Often patients with chest pain are in denial for several hours
before the pain becomes so intense they have no choice but to active 911
services. High flow oxygen helps prolong the window to minimize the damage
until admission to hospital is made.
Slide 12

                                 Angina. (ischemia)

                     : Spasmodic attacks of
                        intense suffocative pain
                     Caused by:
                        vascular spasm,
                        tightening of blood
                        vessels reducing blood
                        Exercise, inability to
                        pump enough blood to
                        meet need.

Similar to MI however often can be relieved with rest and oxygen. The coronary
arteries are so clogged that an increases in demand(exercise) of oxygen and
blood from the heart cannot be met. Vascular spasm often occurs in anginal
patients this is why you will often see these patients with Nitro spray at home (
small pink spray )
Slide 13

                       Congestive Heart Failure, CHF
                    Damaged or weakened heart
                    cannot pump enough blood
                    to maintain proper
                    circulation or clear the
                    volume of blood backing up
                    in the lungs.
                    High pressures cause fluid to
                    leak across lung
                    Fluid fills lungs, impairs
                    oxygen uptake.
                    Heart becomes ischemic

Because each side of the heart operates as a separate pump, right pumps to
lungs and left pumps to body, if damage occurred then that area that had been
injured would no longer pump as effectively as it did causing a back up behind it.
If it backs up behind the left side of the heart then the lungs become swollen and
fluid leaks into the air exchange spaces. If unchecked then the cycle continues
until failure/MI
Slide 14

                              *EMR Treatment*
                          Establish baseline vitals & information.
                          High flow oxygen via NRB.
                          Position of comfort.
                          Limit exertion ie: walking, moving
                          Attempt to reduce anxiety.
                          Reassess, reassess, reassess!

                          Have the AED available and ready.

Import to stress effective initial assessment and action. Reassess chest pain
vitals every 5 minutes.
Any event that cause the heart to become starved (hypoxic) of oxygen and blood
will produce symptoms of pain, pressure, sweaty, cyanosis, SOB etc. And any
event that causes these symptoms should be considered a heart attack in
Slide 15

                        A heavy set 47 yr. old male is at a
                        house party and begins to describe
                        what feels like tension in his neck. He
                        has not been exerting himself but he
                        has been drinking and smoking all

                      Q: Could this be a Heart Attack?

Yes this could be a heart attack, the intake of excessive alcohol 2 drinks/day
causes a 1.5 – 2 time increase in the prevalence of hypertension. Smoking
causes an immediate, temporary rise in the blood pressure of 5 to 10 mm Hg.
The patient meet many of the risk factors associated with heart attack. Often
people have symptoms other than chest arm pain.

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