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how many patients suffering an mi will die before they reach hospital
30
what is coronary heart disease
a condition in which the heart muscle can become damaged or prevented from acheivung its full potential following a reduction in blood supply to the myocardium due to an obstructio
what are the 3 non modifiable risk factors associated with coronary heart disease
heredity- family history
age and gender- 1 in 9 women between the ages of 45-64yrs will develop heart disease in comparison to
1 in 6
what are the 4 modifiable risk factors for coronary heart disease
smoking- 70% increase in the risk of death. nicotine increases heart rate stroke volume and cardiac output and constricts bv in extremities
also CO
affect viscosity of blood

high bp- heart will have to work harder lead to enlarged ventricles and hardening of vessels

blood cholesterol levels the fatty component is the main deposit causing atherosclerosis

stress- increase release of adrenaline which constricts arteries increase workload of heart and increase bp
3 other contributing risk factors to coronary heart disease
obesity
lack of exercise
diabetes- high blood sugars leads to acceleration in the thickening of the coronary artery membrane. increase sugar also increases viscosity
what is coronary artery disease
any condition that causea narrowing or obstruction of coronary arteries resulting in reduced or obstructed blood flow through the heart
what are the 5 principle causes of coronary artery disease
atherosclerosis-
arteriosclerosis
atheroma
thrombus
embolus
what is atherosclerosis
a long term degenerative disease of the arteries characterised by progressive narrowing of the lumen of medium and large arteries
arteriosclerosis
a gradual loss of elasticity in the walls of arteies due to thickening and degenerative processes
what is an atheroma
development of thick, hard plaque or lesions of hardened lipid material
commonly found at the greatest area of turbulent blood flow such as bifurications
what is a thrombus
a clot formed in an unbroken vessel
embolus
any debris transported by the blood stream eg plastic air blood clot and fat
what 3 cardiac conditions are associated with acute coronary syndrome
unstable angina
non-st elevation
st elevation myocardial infarction
what is the most common symptom of coronary artery disease
angina pectoris
what causes angina pectoris
a temporary lack of oxygen in the myocardial tissue and the build up of carbon dioxide and lactic acid during a period of increased oxygen demand
what are the different types of angina
stable angina
unstable angina
prinzmetal
what causes stable angina
exertion exposure to cold condition or emotion
it is predictable recurrent pattern
signs and symptoms of stable angina
often started with strenuous exercise
retrosternal pain (heaviness in arms or chest)
may be crushing pressing or described as tightness
pain refered to throar jaw teeth also arm pits
anxiety
nausea and vomiting
pallor
history of ihd (ischeamic heart disease)

what is unstable angina
its more serious and indicates increasing obstruction noticeable changes in frequenct intensity and duration of pain
may occur at rest
often precedes an mi its known as pre infarction or crescendo angina
pain last longer and without predictable stress
signs and symptoms of unstable angina
pain as angina
pain coming on at rest
pain coming on during sleep
pain more intense
pain not relieved as quickly
management of angina
place patient at physical and emotional rest
take baseline observations
administer gtn oral cavity 400mcg
administer 100% oxygen
consider entonox for pain relief
paramedic intervation
transport patient to hospital continue monitoring
what is a myocardial infarction
an interruption on normal coronary blood flow resulting in protion of cardiac muscle being deprived of oxygenated blood fir sufficient time results in necrotic cardiac muscle and replaced by non contractile scar tissue
what are the signs and symptoms of an mi
severe central chest pain usually left sided which is refered to neck arms jaw and back
dysponea
anxiety- impending sense doom
pallor/ diasphoresis (white/grey
faintness
nausea vomiting
cyanosis at extremities
irregular pulse
hypotension/hypertension
pain unrelieved by gtn
sudden onset
history of recent chest pain ecg irregarities
how would you manage an mi
place patient at physical and emotional rest
administer 100% oxygen
entonox
baseline observation
monitor patient
consider para back up
consider asprin
transport to hospital
what does heart failure describe
the signs and symptomd that occur when the heart becomes less efficient at pumping blood around the body
heart failure can be the result of damage to the heart muscle as a result of
mi
excessive alcohol consumption
virus infection
heart failure can result from what problems
hypertension
anaemia
leaking heart valves
damaged heart valves
thyroid gland disease
excessively fast/ slow heart rate
what are the two types of heart failure
left and right
where will excessive fluid accumulate in lvf
pulmonary circulation
lvf will alter the pressure in the atrium and pulmonary veins but how
it will increase it
swhat happens to the pulmonary veins during lvf
they become engorged forcing serum out of the capillaries into ths alveolar apace which when mixed with air producing foam (pulmonary oedema)
reduces gaseous exchange
signs and symptoms of lvf
severe dysponea
pulmonary odema
cough (frothy pink sputum)
wheezing and rhonchi lung sounds
pallor
tachy cardia
agitation
altered level of consciousness
distended neck veins
history of nocturnal dysponea
management of lvf and rvf
smart
airways
sit patient up with feet dangling
administer oxygen 100%
consider gtn providing bp above 90 lvf only
salbutamol lvf only
baseline observations
paramedic intervention
transport to hospital
pre alart
where will excessive fluid accumulate during rvf
systemic circulation
what us rvf caused by
high bp, copd, pe
where does rvf force serum out of and into
out of veins into surrounding tissues
signs and symptoms of rvf
peripheral odema
fluid accommodation in serous cavities
juglar vein distension
weight gain
abdominal distension
weak and very fatigued
n and v
tachycardia
arrhytmjas raised bp
previous history if mi
if you have bith rvf and lvf what should you treat
lvf
what signs suggest a peri arrest
clinical evidencr of low cardiac output
excessice tachycardia
excessive bradycardia
what is a cardiac arrest
sudden unconsciousness with the diagnosis of absent pulse at 2 sites and absent breathing
what are the signs of cardiac arrest
sudden collapse witb deepening coma
absent arterial pulse
rapidly decreasing respirations
moribund appearance
ashen colour
causes of cardiac arrest
drowning
electrocution
ventricular fibrillation
what is ventricular fibrillation
where the contraction of the heart becomes choatic uncoordinated or ineffective
what is cardiogenic shock
inability of the heart to pump sufficient volumes of blood to maintain adequate tissue perfusion
characterised by marked decrease in stroke volume, cardiac output and blood pressure
signs and symptoms of csrdiogenic shock
clinical evidence of hypoperfusion- blue fingers
profound hypertension
pulmonary congestion
altered loc
tachcardia/ Arrhythmia
pallor/ diaphoresis
tachyponea
agitation
dilated pupils
define cardiac tamponade
accumulation of blood in the pericardial sac causing an increase in pericardial pressure
what causes a cardiac tamponade
follows blunt or lenetrating trauma causes damahe to heart wall but pericardium remain in tact
150-200mls leaked
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