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CHAPTER
13
Caring for Cardiac Emergencies
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
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Daniel J. Limmer
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Objectives
1. Review cardiovascular anatomy and
physiology.
2. Define the following terms:
a.
b.
c.
d.
e.
Angina
Cardiac compromise
Conduction pathway
Heart failure
Myocardial infarction
(continued)
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Objectives
3. Describe the normal flow of blood
through the heart.
4. Explain common causes of cardiac
compromise.
5. Describe the signs and symptoms of a
patient experiencing cardiac
compromise.
6. Differentiate and explain the
pathophysiology of angina, myocardial
infarction, and heart failure.
(continued)
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Objectives
7. Explain the appropriate assessment
and care for a patient experiencing
cardiac compromise.
8. Demonstrate the ability to
appropriately assess and care for a
patient experiencing cardiac
compromise.
9. Value the importance of caring for all
patients with chest pain as though it
were cardiac compromise.
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
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• Wesley
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Media
Slide 16
Cardiac Compromise Video
Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
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Topics
• Normal Heart Function
• Cardiac Compromise
• Emergency Care for Cardiac
Compromise
Emergency
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NORMAL HEART FUNCTION
Emergency
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Normal Heart Function
• The heart beats 100,000 times per day.
• It circulates 6,000 to 7,500 liters of
blood each day.
• Blood flows through the right atrium
into the right ventricle and then into
the lungs.
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Normal Heart Function
• From the lungs, blood enters the left
atrium and flows into the left ventricle.
• The heart muscle receives its blood
supply from tiny vessels called coronary
arteries.
• Many problems of the heart are the
result of the coronary arteries
becoming narrowed or blocked.
Emergency
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Cross-section of the heart.
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Normal Heart Function
• The heart has an electrical system that
keeps it beating and, at the core, is the
conduction pathway.
• Damage to the conduction pathway can
lead to an abnormal heart rhythm and
is a common cause of poor circulation
and perfusion.
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The cardiac conduction pathway, highlighted in green.
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Think About It
• The heart is a muscle with a big job to
do.
• Problems can arise that affect the heart
tissue and/or the electrical system.
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CARDIAC COMPROMISE
Emergency
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Cardiac Compromise
• Cardiac Compromise Symptoms
–
–
–
–
–
–
–
–
Chest discomfort
Diaphoresis
Dyspnea
Nausea/vomiting
Anxiety/irritability
Feeling of impending doom
Abnormal pulse
Abnormal blood pressure
Emergency
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Click here to view a video on the topic of cardiac compromise.
BACK TO DIRECTORY
Emergency
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Myocardial Infarction
• Myocardial infarction (MI) is known as a
heart attack.
• The heart receives its blood supply
through coronary arteries.
• When these arteries become narrow or
blocked and can no longer supply the
heart with enough oxygenated blood,
the tissue of the heart begins to die.
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Both myocardial infarction and angina can present with symptoms of
chest pain. Treat all cases of chest pain as true cardiac emergencies.
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Myocardial Infarction
• Heart attack (MI)/cardiac arrest
differences.
• Patients in cardiac arrest are not
breathing; are unresponsive; have no
pulse.
• Signs and symptoms of a heart attack:
– Chest/upper abdominal sensations of pain,
pressure, tightness, or heaviness.
– Pain or discomfort behind the sternum.
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Myocardial Infarction
• Other Signs and Symptoms
– “Flu-like” signs and symptoms (nausea
and vomiting)
– Indigestion
– Feeling of general weakness
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Angina Pectoris
• Angina pectoris (angina) is pain in the
chest.
• It occurs when one or more of the
coronary arteries are unable to provide
an adequate supply of oxygenated
blood to the heart muscle.
• With angina, there is no actual damage
to the heart muscle.
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Angina Pectoris
• Chest pain caused by a heart attack
and angina is often triggered by
exertion.
• Signs and symptoms of angina are
nearly identical to a heart attack.
• It is important to care for cardiacrelated pain as though the patient is
having a heart attack.
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Heart Failure
• Congestive heart failure (CHF) is a
condition that develops when the heart
is unable to pump blood efficiently.
• The heart muscle is weakened; it is
unable to manage the normal blood
volume; fluid backs up within the
circulatory system.
• Patients can have chest pain, difficulty
breathing, or both.
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Heart Failure
• Signs and Symptoms of Heart Failure
–
–
–
–
–
–
–
Shortness of breath
Chest pain/discomfort
Rapid pulse rate
Pedal edema (swollen ankles)
Jugular Vein Distention (JVD)
Pale, moist skin
Altered mental status
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Signs of congestive heart failure include bulging neck veins.
Emergency
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Signs of congestive heart failure include swollen ankles.
Emergency
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Think About It
• Cardiac Compromise is a lifethreatening condition.
• Why is it important to rapidly identify
cardiac compromise?
• Describe the difference between angina
and MI.
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EMERGENCY CARE FOR
CARDIAC COMPROMISE
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Emergency Care for Cardiac
Compromise
• Assessment—OPQRST
–
–
–
–
–
–
Onset
Provocation
Quality
Region and radiate
Severity
Time
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Algorithm for assessment of patients with chest pain.
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Emergency Care for Cardiac
Compromise
• Emergency Care
– Take appropriate Standard Precautions.
– Perform a primary assessment and support
the ABCs as necessary.
– Obtain a medical history.
– If allowed, provide oxygen per local
protocols.
(continued)
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Emergency Care for Cardiac
Compromise
• Emergency Care
– Keep the patient at rest. Provide emotional
support and reassure the patient.
– Allow the patient to maintain a position of
comfort (usually sitting up).
– Obtain vital signs.
(continued)
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Emergency Care for Cardiac
Compromise
• Emergency Care
– Assist the patient with the prescribed dose
of nitroglycerin, if your protocols permit.
Consult medical direction.
– Continue to monitor vital signs.
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Emergency Care for Cardiac
Compromise
• Medications
– Patients with angina usually have been
prescribed nitroglycerin tablets/spray.
– Aspirin is used for the treatment of
suspected heart attack.
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Think About It
• What does “Time is Muscle” mean?
• Performing a thorough assessment and
appropriate treatment can contribute to
how well the patient recovers from
cardiac compromise.
• Emergency Medical Responders make a
difference!
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SUMMARY
Emergency
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Summary
• A healthy heart is the core of the
cardiovascular system.
• Blood flows through the heart in a
precise way.
• Electrical impulses flow along the
conduction pathway.
• There are key signs and symptoms of
cardiac compromise.
Emergency
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Summary
• Angina results from a diminished
supply of oxygenated blood to the
heart.
• Myocardial infarction occurs when a
portion of the heart dies due to
inadequate blood supply.
• Congestive Heart failure (CHF) is
caused by a weakened heart that can
no longer pump blood efficiently.
Emergency
Medical Responder: First on Scene, Ninth Edition
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Summary
• Care for cardiac compromise includes:
–
–
–
–
–
The ABCs
Supplemental oxygen
Obtaining a thorough medical history
Keeping the patient at rest
Monitoring vital signs
• Initiate ALS transport if available.
Emergency
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REVIEW QUESTIONS
Emergency
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Review Questions
• Describe the normal flow of blood
through the heart.
• What are some vague symptoms of MI
that may be seen in women or the
elderly?
• What is the appropriate assessment
and care for a patient experiencing
cardiac compromise?
Emergency
Medical Responder: First on Scene, Ninth Edition
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Emergency
Medical Responder: First on Scene, Ninth Edition
Emergency Care,
Twelfth Edition
Le •Baudour
Bergeron
• Wesley
Daniel J. Limmer
O’Keefe ••Grant
• Murray
• Bergeron • Dickinson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.