Early Heart Attack Care

For Questions, call Amy Fraulini, MSN, RNDirector of Critical Care and Heart Services

(740)356-8305 fraulina@somc.org

Heart attacks have beginnings

Heart Attack:

A community problem…

with a community solution

County Mortality Rate per 100,000

Adams 283.2

Jackson 328.0

Lawrence 346.8

Pike 300.0

Scioto 401.2

Greenup, KY 332.5

Lewis, KY 327.8

Ohio 303.1

Kentucky 324.4

United States 279.2

Source: US CDC Mortality Database

BLUE indicates those counties which exceed the state of Ohio’s mortality rate

Cardiovascular Disease Mortality Rates

Course Outline

1. Anatomy and Physiology 101: Your Heart

2. Who’s at risk for heart disease?

3. A Heart Attack in Progress

4. Concepts of Early Heart Attack Care

5. Recognition and Intervention

6. Delay and Denial

7. You: The Early Heart Attack Caregiver

Part 1

Anatomy & Physiology 101:Your Heart

• Location– Middle of the chest

• Size– That of a fist

• Purpose– Pumps blood throughout the body

• Weight– 7 - 12 ounces

• Capacity– Pumps 1,800 gallons of blood & beats over

100,000 times daily

The Human Heart

SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY)

ANTERIOR R. ATRIAL BRANCH OF R. CORONARY ARTERY

RIGHT CORONARY ARTERY

ANTERIOR CARDIAC VEINS

SMALL CARDIAC VEIN

ANTERIOR INTERVENTRICULAR (ANTERIOR DESCENDING) BRANCH OF L. CORONARY ARTERY

GREAT CARDIAC VEIN

CIRCUMFLEX BRANCH OF L. CORONARY ARTERY

L. CORONARY ARTERY

The Human Heart & Coronary Arteries

GREAT CARDIAC VEIN

CIRCUMFLEX BRANCH OF L. CORONARY ARTERY

CORONARY SINUS

OBLIQUE VEIN OF L. ATRIUM

POSTERIOR VEIN OF L. VENTRICLE

MIDDLE CARDIAC VEIN

SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY)

SINOATRIAL (S-A) NODE

SMALL CARDIAC VEIN

R. CORONARY ARTERY

POSTERIOR INTERVENTRICULAR (POSTERIOR DESCENDING) BRANCH OF R. CORONARY ARTERY

The Human Heart & Coronary Arteries

The Human Heart: Electric Pump

• Some persons are more likely than others to have a heart attack because of their “risk factors”

• There are– Factors you can control– Factors you cannot control

Who’s at risk for Heart Disease?

• Smoking• High blood pressure• High blood cholesterol• Overweight and obesity• Physical inactivity• Diabetes

Risk factors we can control:

• Pre-existing coronary heart disease, including a heart attack, prior angioplasy, bypass surgery, or angina

• Age• Family history of heart disease

– A father or brother diagnosed before age 55– A mother or sister diagnosed before age 65

Risk factors we cannot control:

Part 3

A Heart Attack in Progress

• #1 Killer of Adults BOTH Men and Women

• 1.1 million Americans suffer a heart attack each year

• 460,000 of those heart attacks are fatal

• Hundreds of thousands survive but are left with a damaged heart

Heart Attack Facts

• Sudden, severe pain that stops you in your tracks.

• Gradual increasing pain with damage occurring over a period of hours.

• Very early presentation with mild symptoms over hours or days.

Some different presentations of heart attack

Partial block producing chest painArea of decreased blood supply

Ischemia & Angina Pectoris

Coronary Artery Disease

Area of Infarct

Complete Obstruction: AMI

Part 4

Concepts of Early Heart Attack Care

Are all heart attacks created equal?

• Prehospital Cardiac Care

• Thrombolytic Therapy (clot busters)

• Angioplasty (preferred treatment with optimal outcomes)

• Decrease in time to treatment saved heart muscle improvement in quality of life

Progress: Heart Attack Treatment

• Most heart attack patients do not benefit from optimal medical advances……………WHY?

Too Little Progress: Heart Attack Recognition

• in recognizing and responding to the early warning signs of a heart attack

Delay

• Early CareEarly Care:: Recognize & Respond Recognize & Respond– often mild symptoms, usually normal activity

• Late CareLate Care:: Obvious Emergency & Respond Obvious Emergency & Respond– incapacitating pain, diminished activity

• Too Late CareToo Late Care:: Critical Emergency & Respond Critical Emergency & Respond– unconscious, CPR, defibrillation, probable death

• 85% of the heart damagedamage takes place within the first first

two hourstwo hours.

Why Early Heart Attack Care?

Part 5

Recognition & Intervention

• Non-Specific Heart Attack Non-Specific Heart Attack Symptoms:Symptoms:

– weakness/fatigue

– clammy/sweating

– nausea/indigestion

– dizziness/nervousness

– shortness of breath

– neck/back/jaw pain

– feeling of doom

– elbow pain

• Specific Heart Attack Specific Heart Attack SymptomsSymptoms

– chest discomfort

– chest pressure

– chest ache

– chest burning

– chest fullness

Early Symptoms of a Heart Attack

Part 6

Delay & Denial

Denial and Procrastination Denial and Procrastination

= Our Heart’s Enemy!= Our Heart’s Enemy!

Why do we delay?

“I’ll just rest a bit”

It’s nothing really serious

“I don’t have time

to be sick”

I’m too busy right now

“If it turns out to be nothing, I’ll be embarrassed by the fuss made.”

I don’t want to be a problem

First responders can easily be swayed by patient rationalizations and denials

Paramedics BEWARE!

“I’ll take something for it”

It’s probably heartburn or indigestion

“Just walk it off, grin and bear it”

I’m strong!

“I have no serious medical problems…I exercise.”

I’m healthy

“Everything will be OK.”

I’ll just wait it out

Part 7

YOU:The Early Heart Attack Caregiver

• Spouse• Children• Parent• Co-worker• Friend• Exercise Partner• Anyone who cares about you!

Who is the Caregiver?

• Do you have any chest discomfort?

• Is it tightness, pressure, pain in the center of your chest?

• Is the discomfort also in your arms or jaw or neck or throat

or back?

• Are you sick to your stomach?

• Is the person sweaty or clammy?

• What were you doing when the symptoms started?

• Do the symptoms go away with rest?

• Are you having any shortness of breath?

What to ask and look for

• Be aware of pressure, not necessarily pain, in your chest.

• Be aware if it increases with activity and subsides with rest.

• Don’t try to rationalize it away. Be honest with yourself and

others.

• Call 9-1-1 or have someone drive you to the nearest

emergency room.

• Don’t go to your doctors office or wait for an appointment.

• RecognizeRecognize the subtle danger signs and act on them before

damage occurs.

Listen to your Heart and be a Winner

• EMS can begin treatment immediately-even before arrival at

the hospital

• The heart may stop beating during a heart attack. EMS have

the equipment needed to start the heart again

• Heart attack patients have emergency needs that can be met

by the EMS….such as oxygen, heart medications, and pain

relief treatments

• EMS are linked to the hospital and doctors to give them

needed resources during this critical time

Remember to Call 9-1-1 WHY?

Any

questions?questions?

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