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46 Cards in this Set

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Coronary artery disease (CAD)
A pathologic process caused by atherosclerosis that leads to progressive narrowing and eventual obstruction of the coronary arteries.
What are the modifiable risk factors of CAD?
Cigarette smoking
Lack of exercise/obesity
What are the nonmodifiable risk factors of CAD?
Family hx and male gender
"Swishing" sound heard with the stethoscope over the carotid arteries which signifies presnece of atherosclerosis and contraindicates carotid massage.
Swelling and pain along the veins that can lead to formation of blood clots (thrombophlebitis).
Risk factors for peripheral vascular disorders like pulmonary embolism include:
Age, oral contraceptive use, smoking, recent surgery, recreational IV drug use, trauma, and extended immobilization.
Signs of peripheral vascualr occlusion includes:
Pain, redness, swelling, warmth, and tenderness in the ext.
However these signs are present in only about half of all cases.
Acute coronary syndrome
The term used to describe any group of clinical symptoms consistent with acute myocardial ischemia. Most common being chest pain.
What is the principal symptom of coronary artery disease?
Angina pectoris, literally means "chocking in the chest." Occurs when the supply of oxygen to the myocardium is insuffient to meet the demand.
Stable vs unstable angina
Stable angina is chest pain that is predictable, ie caused by excertion and goes away with Nitro.
Unstable is chest pain that is unpredictable, signals an impending MI.
Inferior wall infarts are usually a result of what coronary artery?
Classic "textbook" AMI chest pain
Felt just beneath the sternum describe as heavy, squeezing, crushing, and/or tight. Pt may unconsciously clench fist when decriging the pain. Levine sign, to convey squeezing nature. 25% of the time it radiates to an arm, often the left side, and into the neck, jaw, upper back, or epigasteium. The pain of an AMI is not influenced by coughing, deep breathing, or other body movements.
Who is more prone to "silent MI", AMI without chest pain?
Diabetics, older people, and heart transplant pts.
Usually have symptoms related to reduce cardiac output.
Women with an AMI may experience
N/V, lightheadedness, epigastrium burning, sudden onset of weakness or tiredness.
Ways to confirm Nitro still has theraputic effects?
Burning sensation under tongue pt feels flushed, and has a headache.
Managemtn of chest pain/AMI
1) Place pt at physical and emotional rest (semi fowler or shock position)
Increasing heart rate, increases work load.
2) MONA but not in that order. Should be Oxygen, ASA, Nitro, than Morphine.
Before administering Nitro chekc with pt that...
They are not taking any phosphodiesterase-5 (PDE-5) inhibitors for erectile dysfunction. The combine effects will drastically drop BP. These include but are not limited to Viagra (4 hrs), Levitra (4 hrs), and Cialis (36 hrs).
Dose of Nitro
0.4 mg
Contraindications for Nitro
Hypotension (below 100 systolic), bradycardia, epigastric symptoms "indigestion" or hiccups.
Contraindications for morphine
Hypotension (below 100 systolic), dehydration, or suspected inferior AMI.
Fibrinolytic therapy
Medications used to dissolve the occluding blood clot. Indicated during the early hours of an AMI. It actions are to active the body's fibrinolytic system to dissolve the clot in the coronary arteries. However the action is not limited to the coronary arteries, thus may lead to bleeding elsewhere. Weight risk!
Common fibrinolytic therapies
Altepase/Activase, streptokinase/Streptase, Reteplase/Retavase.
All work by converting the body's clotting enzyme from its inactive form, plasminogen, to its active form, plasmin.
Percutaneous interventions
Passing ballons, stents, or other devices through a 2-mm-diameter catheter via a peripheral artery to recanalize and keep the block coronary artery open.
Congestive heart failure
Also known as chronic heart failure occurs when the heart is unable, for any number of reasons, to pump powerfully enough to empty chambers causing backflow.
Left sided heart failure
Often cause from HTN due to increase afterload causing backflow in the pulmonary circulation. End result being pulmonary edema.
S/S of left sided heart failure
Extreme restless and agitation, confusion, sever dyspnea and tachypnea, tachycardial, increase BP, crackles and possible wheezes, and frothy pink sputum.
What is the goal of prehospital treatment of left sided heart failure?
Improve oxygenation and decrease the workload of the heart, chiefly by reducing the volume of venous blood returned to the heart (the preload), so that the left ventricle is less overburdened.
Medicaitons for left sided heart failure (besides oxygen)
Nitro in order to creast vasodilation for venous pooling, decrease workload on the heart.
Lasix/furosemide with two positive effects. Initally within 5 to 10 minutes venodilating, increase peripheral pooling of blood. Later removes excess fluid from the body by promoting excretion by the kidneys.
Morphine causing vasodilation, increase peripheral pooling. Along with a calming effect on the pt. Recommended dose being 3mg at a time, than reassessing.
Consider bronchodilators to counteract bronchoconstriction from the excess fluid.
Dose for Furosemide
20 to 40 mg or 0.5 to 1mg/kg IV bolus. Administer slow!
What is the most commonly cause of right sided heart failure?
Left sided heart failure because work increases on the right side since the left side has failed. May also occur as a result of pulmonary embolism, long standing COPD, especially chronic bronchitis.
S/S of right sided heart failure
Edema, hepatomegaly-painful liver which is engorged, JVD
Cardiac tamponade
When excessive fluid accumulates within the pericardium, limiting the heart's ability to expand fully after each contraction and resulting in reduced cardiac output.
Causes of cardiac tamponade
Tumor, pericarditis, and the big one for us is trauma.
S/S of cardiac tamponade
Initial complaint may just be dyspnea and weakness, epecially with gradually onset from pericarditis. Traumatic cases chest pain. As stroke volume decreases systolic will decrease and diastolic will slowly increase causing narrow pulse pressure follow by tachcardia, muffled heart tones, JVD which is know as Beck's triad.
Beck's triad
Three signs of cardiac tamponade including narrow pulse pressure, muffled heart tones, and JVD.
S/s of tension pneumothorax vs cardiac tamponade
With cardiac tamponade trachea will be midline and lung sounds will be equal because the lungs are not effected.
Tx of cardiac tamponade
Rarely performed in the filed due to its risk, pericardiocentesis involves inserting a needle into the pericardium and withdrawing fluid.
In prehospintal we need to focus on rapid transport. Consider 500 mL fluid bolus.
S/s of cardiogenic shock
Basically the same as other shocks. Confusion, restless, anxious, mass vasocontriction causing pale and cold skin. Rapid shallow respirations, racing thready pulse, droping BP.
Management of cadiogenic shock
Avoid increasing heart's workload, focus on improving oxygenation and peripheral perfusion. Prehospital wise we can do very little, thus early transport is imparient. May consider vasopressor drugs.
From the Greek word meaing widening refering to the dilation or out pouching of a blooding vessel.
AMI vs Acute Dissecting Aneurysm
AMI often preceded by other symptoms like nausea, "indigestion," weakness, and sweating. Tends to be gradually and is usually describe as "pressure" rather than "stabbing."
Aneurysm is often abrupt without prodromal symptoms, max from onset without relief, BP discrepancy in arms.
Management of aneurysm
Calm pt, along with ABC's. Controlling pain can decrease anxiety and workload from heart, consider morphine at 2mg up to 10mg over 10 to 15minutes.
Who is more prone to Abdominal Aortic
Middle-aged or older men preseing with sudden onset of back pain. Assess for pulsating abdominal mass.
Most hypertensive is a result of...
advanced atherosclerosis or arteriosclerosis, which decrease the lumen of the arteries and reduces elasticity. The result of higher afterload leads to increase filling stimulating Frank-Starling reflex, which rises pressure behind the blood leaving the heart.
Rate for hypertensinve
BP is greater than 140/90 consistently at rest. Cannot be dx during an emergency or even really during a single BP check. Inform the patient to have their BP check a couple times over the next few months under less stressful circumstances.
Tx of hypertensive emergencies
Supportive treatment especially if you are within 20 to 30 minutes of hospital. Be preparted to treat seizures. Labetolol (alpha and betal blocker) and Nitro may be considered from longer transports.