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 supply. There are many different causes! Often the term “Heart Attack” is used to describe a variety of cardiac emergencies. All have similar symptoms: Pain and/or discomfort, Shortness of Breath, Anxiety Slide 3 Some Causes Are…. Myocardial Infarction, MI Angina 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 works. • 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 vessel. 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 discomfort Sweating Heartburn and/or indigestion Arm pain (more commonly the left arm, but may be either arm) 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 factors. High Blood Pressure / Hypertension High Cholesterol / Healthy diet Diabetes Obesity / Overweight Smoking Low Physical Activity Gender Heredity Age Stress Self explanatory risk factors Slide 10 Myocardial Infarction or MI. Sudden blockage of blood supply to a portion of the heart. Caused by clot, embolus/thrombus. 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. cont’d Muscle begin to die (necrosis) 20 - 40 min. from onset of blockage. 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 flow 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 membranes. Fluid fills lungs, impairs oxygen uptake. Heart becomes ischemic (hypoxic) 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 progress. Slide 15 Senario 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 evening. 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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