Chapter 16 Cardiovascular Emergencies
The pain of an AMI differs from the pain of angina in three ways:
1. It may or may not be caused by exertion, but it can occur at any time, sometimes when a person is sitting quietly or even sleeping. 2. It does not resolve in a few minutes; rather, it can last between 30 minutes and several hours. 3. It may or may not be relieved by rest or nitroglycerin.
Treatment for Cardiogenic Shock
1. Position the patient comfortably 2. Administer high-flow oxygen 3. assist Ventilations as necessary 4.Cover the patient with sheets or blankets as necessary to preserve body heat. Be sure to cover the top of the patient's head in very cold weather, as this is where much heat is lost. 5. Provide prompt transport to the ED.
Which of the following symptoms would you see in a patient with a dissecting aneurysm?
1. Sharp or tearing pains 2. Pain does not abate once it has started
occlusion
A blockage, usually of a tubular structure such as a blood vessel.
thromboembolism
A blood clot that has formed within a blood vessel and is floating within the bloodstream.
dissecting aneurysm
A condition in which the inner layers of an artery, such as the aorta, become separated, allowing blood (at high pressures) to flow between the layers.
Atherosclerosis
A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, eventually leading to a partial or complete blockage of blood flow; an accumulation of fat and cholesterol in the arteries.
congestive heart failure (CHF)
A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs.
syncope
A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain.
acute coronary syndrome (ACS)
A group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction.
acute myocardial infarction (AMI)
A heart attack; death of heart muscle following obstruction of blood flow to it; in this context the attack is "new" or "happening right now."
ischemia
A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.
cardiac output
A measure of the volume of blood circulated by the heart in 1 minute, calculated by multiplying the stroke volume by the heart rate.
cardiogenic shock
A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions
parasympathetic nervous system
A subdivision of the autonomic nervous system, involved in control of involuntary functions such as digestion of food and relaxation, mediated largely by the vagus nerve through the chemical acetylcholine.
artifact
A tracing on an ECG that is the result of interference, such as patient movement, rather than the heart's electrical activity.
aortic aneurysm
A weakness in the wall of the aorta that makes it susceptible to rupture.
A patient with a left ventricular assist device (LVAD) tells you that the device's pump flow is continuous. Which of the following should you expect to encounter during your assessment?
Absence of a palpable pulse
A patient tells you that he has a left ventricular assist device (LVAD). Which of the following conditions should you suspect that he has experienced?
Acute myocardial infarction
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?
Administer the medication sublingually and allow it to dissolve or absorb.
Dysrhythmia:
An abnormality of heart rhythm
hypertensive emergency
An emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm
You are treating a 50-year-old woman who has just finished a 10k run. She is complaining of crushing pain in the chest radiating down her left arm and nausea, which came on suddenly. She is sweating profusely. What condition should you suspect?
Angina Pectoris
Which of the following is a major difference between angina pectoris and AMI?
Anginal pain typically subsides with rest.
Which of the following medications is commonly given to patients with chest pain to prevent blood clots from forming or getting bigger?
Aspirin
You and your partner have achieved return of spontaneous circulation (ROSC) in a patient who was in cardiac arrest. An ALS unit will arrive in less than 2 minutes. The patient remains unresponsive and has slow, irregular breathing. Further treatment for this patient should include:
BVM ventilation at 10-12 breaths/min and assessment of oxygen saturation.
What is cardiac output?
Cardiac output is the amount of blood pumped out of the left ventricle in 1 minute.
infarction
Death of a body tissue, usually caused by interruption of its blood supply.
The right side of the heart receives ________ from the_____
Deoxygenated blood; veins
Ventricular fibrillation (V fib):
Disorganized, ineffective quivering of the ventricles resulting in no blood flow and a state of cardiac arrest.
A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate?
Dissecting aortic aneurysm
You are treating a 63-year-old patient whose vital signs are as follows: pulse, 140 beats/min and irregular; respiratory rate, 28 breaths/min; and blood pressure, 90/50 mm Hg. He is complaining of chest pain. Given this information, why would nitroglycerin be contraindicated?
HIs blood pressure is too low
Most often, low blood flow to heart tissue is caused by what?
Most often, low blood flow to heart tissue is caused by atherosclerosis, where calcium and cholesterol build up and form a plaque inside the walls of blood vessels.
Ventricle
One of two (right and left) lower chambers of the heart. The left chamber receives blood from the left atrium (upper chamber) and delivers blood to the aorta. The right chamber receives blood from the right atrium and pumps it into the pulmonary artery.
Atrium
One of two (right and left) upper chambers of the heart. The right receives blood from the vena cava and delivers it to the right ventricle. The left receives blood from pulmonary veins and delivers it to the left ventricle.
Tachycardia:
Rapid beating of the heart, 100 beats/min or more
Ventricular tachycardia :
Rapid heart rhythm, usually at a rate of 150 to 200 beats/min
An AMI can have three serious consequences:
Sudden death Cardiogenic shock Congestive heart failure
Signs and Symptoms of Acute Myocardial Infarction
Sudden onset of weakness, nausea, and sweating without an obvious cause Chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck Irregular heartbeat and syncope (fainting) Shortness of breath, or dyspnea Nausea/vomiting Pink, frothy sputum (indicating possible pulmonary edema) Sudden death
dependent edema
Swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues; a possible sign of congestive heart failure
Cardiac arrest is indicated in the field by the absence of a carotid pulse.
TRUE
The link in the chain of survival that is the most common determinant for survival is the third link—rapid defibrillation.
TRUE
automaticity
The ability of cardiac muscle cells to contract without stimulation from the nervous system.
posterior
The back surface of the body; the side away from you in the standard anatomic position.
coronary arteries
The blood vessels that carry blood and nutrients to the heart muscle.
perfusion
The circulation of oxygenated blood through body tissues and vessels; the circulation of blood within an organ or tissue in adequate amounts to meet the current needs of the cells
asystole
The complete absence of all heart electrical activity.
anterior
The front surface of the body; the side facing you in the standard anatomic position.
myocardium
The heart muscle
You are dispatched to a 60-year-old man reporting chest pain and shortness of breath. The patient has angina and is taking nitroglycerin, furosemide, and atorvastatin. You hear crackles when listening to his breath sounds. The patient's difficulty breathing and crackles are due to blood backing up in which part of the body?
The lungs
Aorta
The main artery leaving the left side of the heart, which receives blood from the left ventricle and delivers it to all the other arteries that carry blood to the tissues of the body.
What is the most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique?
The most effective way to assist a person with CHF to breathe effectively and prevent an invasive airway management technique is CPAP.
aortic valve
The one-way valve that lies between the left ventricle and the aorta and keeps blood from flowing back into the left ventricle after the left ventricle ejects its blood into the aorta; one of four heart valves.
sympathetic nervous system
The part of the autonomic nervous system that controls active functions such as responding to fear (also known as the "fight-or-flight" system).
autonomic nervous system
The part of the nervous system that regulates involuntary activities of the body, such as heart rate, blood pressure, and digestion of food.
stroke volume
The volume of blood ejected with each ventricular contraction.
Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet?
To appropriately assist the patient with nitroglycerin, place the tablet under the patient's tongue and have the patient keep his or her mouth closed with the tablet under the tongue until it is dissolved and absorbed.
defibrillate
To shock a fibrillating (chaotically beating) heart with specialized electric current in an attempt to restore a normal, rhythmic beat.
angina pectoris
Transient (short-lived) chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle; also called angina.
Bradycardia:
Unusually slow beating of the heart, 60 beats/min or less
Which dysrhythmia is the most common cause of sudden death in a cardiovascular emergency?
Ventricular Fibrillation
cardiac arrest
When the heart fails to generate effective and detectable blood flow; pulses are not palpable in cardiac arrest, even if muscular and electrical activity continues in the heart.
dilation
Widening of a tubular structure such as a coronary artery.
You are transporting a patient with angina and he loses consciousness on the way to the hospital. When you check, you cannot feel a pulse. What should you do?
You should have your partner pull over the ambulance and come back to help you with CPR and the AED.
Common signs and symptoms of a hypertensive emergency include:
a bounding pulse, a severe headache, and dizziness.
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should:
administer oxygen, give her 324 mg of aspirin, and assess her further.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
assess the adequacy of his respirations.
Narrowing of the coronary arteries caused by a buildup of fatty deposits is called:
atherosclerosis
The ability of cardiac muscle cells to contract spontaneously without a stimulus from a nerve source is called:
automaticity.
The inferior vena cava
carries blood from the abdomen, kidneys, and legs back to the right atrium.
The superior vena cava
carries blood from the head and arms back to the right atrium.
Red blood cells
carry oxygen to the body's tissues and remove carbon dioxide.
In contrast to an automatic implantable cardiac defibrillator (AICD), an external defibrillator vest:
delivers high-energy shocks, similar to an AED.
Prior to attaching the AED to a cardiac arrest patient, the EMT should:
dry the chest if it is wet
Prior to defibrillating a patient with an AED, it is MOST important that you:
ensure that no one is touching the patient.
The main legal risk in using the AED is:
failing to deliver a shock when one is needed.
Larger white blood cells
help to fight infection.
Which of the following signs or symptoms would you NOT expect to encounter in a patient with congestive heart failure?
hypotension and flat jugular veins
After the AED has delivered a shock, the EMT should:
immediately resume CPR
When obtaining a 12-lead ECG, the patient should be:
in a supine position with legs uncrossed.
Which of the following would cause the greatest increase in cardiac output?
increased heart rate and increased stroke volume
Cardiac arrest
is the complete cessation of cardiac activity—electrical, mechanical, or both
The AED is MOST advantageous to the EMT because:
it delivers prompt defibrillation to patients with ventricular fibrillation.
The left ventricle is more muscular than the right ventricle because______________
it must pump blood into the aorta to supply all other arteries of the body
Plasma
mixture of water, salts, nutrients, and proteins, is the fluid that the cells float in.
Angina pectoris occurs when:
myocardial oxygen demand exceeds supply.
An acute myocardial infarction (AMI) occurs when:
myocardial tissue dies secondary to an absence of oxygen
Your EMS team is performing CPR on a 60-year-old male in cardiac arrest. You connect the AED, push the analyze button, and receive a "no shock advised" message. You should:
perform CPR for 2 minutes and reassess.
Diastolic blood pressure
pressure exerted against the walls of the arteries while the left ventricle is at rest.
Which of the following blood vessels transports oxygenated blood?
pulmonary veins
A patient in cardiac arrest is wearing an external defibrillator vest, which is interfering with effective chest compressions. The EMT should:
remove the battery from the monitor and then remove the vest
Most AEDs are set up to adjust the voltage based on the impedance, which is the:
resistance of the body to the flow of electricity.
Deoxygenated blood from the body returns to the:
right atrium.
Normal electrical impulses begin in the ___________in the upper part of the______(also known as the sinoatrial (SA)node)
sinus node; right atrium
A dissecting aortic aneurysm occurs when:
the inner layers of the aorta become separated.
A patient with atherosclerotic heart disease experiences chest pain during exertion because:
the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.
Systolic blood pressure
the maximum pressure generated in the arms and legs during the contraction of the left ventricle, during systole.
Platelets
which help the blood to clot, are much smaller than either red or white blood cells
Nitroglycerin is contraindicated in patients:
who have experienced a head injury.
Defibrillator pads are placed on the patient's chest:
with one pad to the right of the upper sternum and the other pad to the left lower chest below the armpit.
