Cardiac Emergencies Flashcards
Angina
“pain in the chest”
heart’s demand for oxygen exceeds the blood’s oxygen supply
Common caused by atherosclerosis and coronary artery disease (CAD) and spasm of the coronary arteries
Stable Angina
- Typically sudden onset
- Onset generally with exertion
- Lasts 3 - 5 minutes
- Subsides with rest and/or nitroglycerin
Unstable Angina
- Typically sudden onset
- May initiate during rest
- Lasts > 20 minutes
- May not resolve with nitroglycerin
Variant Angina
- Also called “Prinz Metal” or “Spasmotic Angina”
- Caused by coronary vessel vasospasm
- Can occur at rest, similar to unstable angina
- May go away spontaneously or with medication
Angina Management
- Relieve anxiety/pain
- Place patient in a position of comfort
- Administer oxygen
- Establish IV access
- Obtain a 12 lead EKG
MONA
- Oxygen
- Aspirin
- Nitroglycerin
- Morphine (or Fentanyl)
Right Heart Failure causes
- Left Heart Failure # 1 cause
- Cor Pulmonale (right ventricular hypertrophy)
- Right ventricular infarct
- Tricuspid Valve damage
- Pulmonic valve damage
- Pulmonary embolism
Left Heart failure causes
- Pulmonary edema
- Hypertension
- Left Ventricle infarct
- Mitral Valve Damage
- Aortic valve damage
- Cardiomyopathy
- Myocardial infarction # 1 cause
Right Heart Failure signs & symptoms
- JVD
- Peripheral Edema
- Ascites (abdominal swelling)
- Sacral/Scrotal Edema
- Orthopnea
- Hepato-Jugular Reflex
Left Heart Failure signs & symptoms
- Anxiety
- Tachycardia
- Hypertension
- Pale, sweaty Skin
- Paroxysmal Nocturnal Dyspnea
- Orthopnea
- Rales/Crackles
- Pink Frothy Sputum (late sign)
- Pulsus Paradoxus
- Pulsus Alternans
Right Heart Failure Treatment
- Position of Comfort
- Oxygen
- 12 lead EKG
- Fluid administration (Starling’s Law) - monitor lung sound
Left Heart Failure treatment
- Position of comfort
- Oxygen
- 12 lead EKG
- Nitroglycerin
- CPAP
- Furosemide
Cardiac Tamponade
Occurs due to blunt trauma (steeling wheel to chest)
Heart surrounded by sac called Pericardial sac.
3 layers Pericardial Sac
- Innermost layer = Visceral
- Parietal pericardium
- Fibrous pericardium
- betwen visceral and parietal 25mL pericardial fluid
Tamponade = excess accumulation of fluid in the pericardial sac. Sac Does not expand, puts pressure on the heart which prevents it from filing and pumping like it needs. Leads to cardiogenic or obstructive shock.
Cardiac Tamponade
Tamponade caused by trauma, MI, pericarditis, or neoplasms
Cardiac Tamponade Management
ABC
Oxygen
IV access Fluid Bolus (20mL/kg)
Vasopressor
Cardiac Tamponade Other Signs and Symptoms
- Chest pain
- Dyspnea
- Orthopnea
- Narrowing Pulse pressure
- Electrical Alternans
- Pulsus Paradoxus
- A LOC
Dissecting Aortic Aneurysms Signs
3x more people affected by
- Syncope
- Absent or reduced pulses
- Unequal blood pressure readings (right side vs. left side)
- Unequal pulse strength (right side vs. left side)
- Heart failure
- “Tearing” sensation in chest or back
- Flank pain
- Scapular pain
- Pain radiating into legs
