Chapter 16-cardiovascular Emergencies

Question 1

How does the heart pump?

Answer 1

Vena cava -> right atrium -> fills right ventricle -> contracts, sending blood into the pulmonary artery and pulmonary circulation in the lungs, and airs oxygenated -> gas exchange happens in the alveoli -> blood returns to the heart through the pulmonary vein -> the left side of the heart receives oxygen rich blood through pulmonary vein -> blood enters left atrium and passes to left ventricle -> pumps blood into aorta and then into rest of the body

Question 2

Automaticity

Answer 2

Allows a cardiac muscle to contract spontaneously without a stimulus from a nerve source

Question 3

Autonomic nervous system

Answer 3

A part of the brain that controls the functions of the body that do not require a conscious thought, such as the heartbeat, respirations, dilation and constriction of what’s out, digestion of food

Question 4

Sympathetic nervous system

Answer 4

“Fight or flight” system
Speeds up the heart rate, increases respiratory rate and depth, dilates blood vessels in the muscles, constricts blood vessels in the digestive system

Question 5

Parasympathetic nervous system

Answer 5

Does the opposite of the sympathetic nervous system.
Slows the heart and respiratory rates, constrict blood vessels in the muscles, dilates blood vessels in the digestive system

Question 6

Myocardium

Answer 6

Heart muscle

Question 7

Stroke volume

Answer 7

Volume of blood ejected with each ventricular contraction

Question 8

Dilation

Answer 8

Widening

Question 9

Coronary arteries

Answer 9

Blood vessels that supply blood to the heart muscle

Question 10

Cardiac output

Answer 10

The amount of blood pumped out of the left ventricle in one minute

Heart rate x stroke volume

Question 11

Perfusion

Answer 11

The constant flow of oxygenated blood to the tissues

Question 12

Ischemia

Answer 12

Decreased blood flow

Question 13

Atherosclerosis

Answer 13

A disorder in which calcium and cholesterol buildup and form a plaque inside the walls of the blood vessels, obstructing flow and interfering with their ability to dilate or contract

Question 14

Occlusion

Answer 14

Blockage

Question 15

Lumen

Answer 15

The inside diameter of the artery

Question 16

Thromboembolism

Answer 16

A blood clot floating through blood vessels until it reaches an area too narrow to pass

Question 17

Acute myocardial infection (AMI)

Answer 17

A classic heart attack
When blockage occurs in the coronary artery

Question 18

Infarction

Answer 18

Death of a tissue

Question 19

Cardiac arrest

Answer 19

When the heart fails to generate effective and detectable blood flow

Question 20

Acute coronary syndrome (ACS)

Answer 20

A group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction

Question 21

Angina pectoris

Answer 21

Short-lived chest discomfort caused by partial or temporary blockage of blood flow to the heart muscle

Question 22

What is angial pain like?

Answer 22

Crushing or squeezing. Like someone’s standing on your chest

Question 23

Signs and symptoms of acute myocardial infarction

Answer 23

*sudden onset of weakness, nausea, and sweating without obvious cause
* chest pain, discomfort, or pressure that is often crushing or squeezing and that does not chase with each breath
* pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck
* irregular heartbeat and Syncope (fainting)
*dyspnea
*nausea/vomiting
*pink, frothy sputum
*sudden death

Question 24

The pain of an AMI differs from the pain of angina in what three ways?

Answer 24

• It may or may not be caused by exertion but can occur at any time, sometimes when a person is sitting quietly or even sleeping
• it does not resolve in a few minutes: rather, it can last between 30 minutes and several hours
  *it may or may not be relieved by rest or nitroglycerin

Question 25

Physical findings of AMI and cardiac compromise

Answer 25

General appearance -appears frightened. Skin may be pale or ashen gray because of poor cardiac output and the loss of blood flow Pulse -pulse rate increases due to pain, stress fear, or physical injury of the myocardium BP -BP may fall as a result of diminished cardiac output and diminished capability of the left ventricle to pump Respiration -rate is usually normal unless patient has CHF. Respiratory rate may become rapid and labored with possibly cyanosis and sputum Mental status -patients with AMI's often experience confusion and agitation

Question 26

Dysrythmia

Answer 26

An irregular or abnormal heart rhythm

Question 27

What three serious consequences can AMI have?

Answer 27

*sudden death *cariogenic shock * congestive heart failure

Question 28

Ventricular tachycardia

Answer 28

Rapid heart rhythm, usually at rate of 150-200 beats/min. Not enough time is allowed for the left ventricle to fill with blood, therefore not making an adequate pump

Question 29

Ventricular fibrillation

Answer 29

Disorganized, ineffective quivering of the ventricles. No blood is pumped through the body, and the patient becomes unconscious within seconds. The only way to stop this is to difibrillate the heart

Question 30

Defibrillate

Answer 30

Means to shock the heart with a specialized electric current in an attempt to stop the chaotic, disorganized contractions of the heart.

Question 31

Asystole

Answer 31

The absence of all heart electrical activity.

Question 32

Cariogenic shock

Answer 32

Often caused by heart attack; the heart lacks the proper amount of power to force the proper volume of blood through the circulatory system

Question 33

CHF

Answer 33

A disorder in which the heart loses part of its ability to effectively pump blood, usually a result the damage of the heart muscle can usually resulting in a back up of fluid in the lungs

Question 34

Signs and symptoms of cardiogenic shock

Answer 34

* anxiety or restlessness as the brain becomes relatively starved for oxygen "air hunger" * as the shock continues, the body tries to send blood to the most important organs, such as the brain and heart and away from the less important organs like the skin. Therefore you may see pale, cool, clammy skin *as shock continues, the pulse rate will get higher for the body trying to compensate for pumped blood * can also present with rapid and shallow breathing, nausea and vomiting, and a decrease in body temperature * as the heart and other organs begin to malfunction, the blood pressure will fall below normal

Question 35

Signs and symptoms of CHF

Answer 35

* The patient finds it easier to breath with sitting up. When lying down, more blood is returned to the right ventricle and lungs causing further congestion *patient is often agitated *chest pain may or may not be prevalent * The patient may have swollen ankles from dependent edema (backup of fluids) * The patient generally will have a high blood pressure, rapid heart rate, and rapid respirations * skin is usually pale or cyanotic and sweaty * The fluid surrounding small airways may produce crackles *distended neck veins

Question 36

How to treat a patient with CHF

Answer 36

1. Take vital signs and give oxygen. 2. Allow patient to be sitting in upright position with legs down 3. Be reassuring 4. Patients who have had problems with CHF before will usually have specific medications for his treatment, gather these medications and take them to the hospital 5. Nitroglycerin may be of value reducing pulmonary Adema if the patient systolic blood pressure is more than 100

Question 37

Dependent Edema

Answer 37

Swelling of the part of the body closest to the ground

Question 38

Hypertensive emergency

Answer 38

Usually occurs with the systolic pressure greater than 180 mm HG or a rapid rise in the systolic pressure

Question 39

Signs and symptoms of a hypertensive emergency

Answer 39

A sudden severe headache, strong bounding pulses, ringing in the ears, nausea and vomiting, dizziness, warm skin, nosebleed, altered mental status

Question 40

Aortic aneurysm

Answer 40

A weakness in the wall of the aorta

Question 41

Dissecting aneurysm

Answer 41

Occurs when the inner layers of the aorta become separated, allowing blood to flow between the layers

Question 42

Artifact

Answer 42

Tracing on an ECG (electrocardiogram) that is the result of interference, such as patient movement, rather than the hearts electrical activity

Question 43

Automatic implantable cardiac defibrillator

Answer 43

Attached directly to the heart and continuously monitor his heart rhythm, delivering shocks as needed; shocks don't affect rescuers

Question 44

Pacemaker

Answer 44

Typically inserted under the skin in the left upper portion of the chest, delivers an electrical impulse to regulate the heartbeat

Question 45

External defibrillator vest

Answer 45

An alternative to the implantable cardiac defibrillator. This device is a vest with a built-in monitoring electrodes and defibrillation pads, which is one by the patient under his or her clothing

Question 46

Left ventricular assist devices (LVAD's)

Answer 46

Are used to enhance the pumping of the left ventricle in patients with severe heart failure or in patients who need a temporary boost due to an MI