““Early Heart Attack Care”Early Heart Attack Care”

EHACEHAC

Heart Attacks Have Beginnings!Heart Attacks Have Beginnings!

Heart Attack: Heart Attack: A Community ProblemA Community Problem

With a With a

Community SolutionCommunity Solution

Course OutlineCourse Outline

1. Anatomy and Physiology 101: Your Heart

2. A Heart Attack in Progress

3. Concepts of Early Heart Attack Care

4. Recognition and Intervention

5. Delay and Denial

6. You: The Early Heart Attack Care Giver

Part 1Part 1

Anatomy and Physiology 101:Anatomy and Physiology 101:

Your HeartYour Heart

The Human HeartThe Human 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 HeartThe Human Heartand Coronary Arteriesand Coronary Arteries

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 HeartThe Human Heartand Coronary Arteriesand 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 HeartThe Human HeartElectric PumpElectric Pump

Part 2Part 2

A Heart Attack in ProgressA Heart Attack in Progress

Heart Attack FactsHeart Attack Facts

• #1 Killer of Adults

• 4,100 Heart Attacks every day

• 600,000 Heart Attack deaths each year

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

Three Presentations of aThree Presentations of aHeart AttackHeart Attack

• 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.

Ischemia & Angina PectorisIschemia & Angina Pectoris

Partial block producing chest pain

Area of decreased blood supply

Coronary Artery DiseaseCoronary Artery Disease

Stable and Vulnerable PlaqueStable and Vulnerable Plaque

Complete Obstruction: AMIComplete Obstruction: AMI

Area of Infarct

Part 3Part 3

Concepts of Concepts of EHACEHAC

Are All Heart Attacks Created Equal?Are All Heart Attacks Created Equal?

ProgressProgress: Heart Attack : Heart Attack TreatmentTreatment

• Thrombolytic Therapy (clot busters)

• Angioplasty

• Prehospital Cardiac Care

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

Too Little ProgressToo Little Progress: : Heart Attack RecognitionHeart Attack Recognition

• Only 25% of heart attack victims receive thrombolytic therapy

• Only 10% receive therapy within the first critical hour

• Most heart attack patients do not benefit from optimal medical advances because of ………………………………….

DELAY

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

Why Why E.H.A.C.E.H.A.C. ??

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

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

• Too Late CareToo Late Care: : Critical Emergency & RespondCritical Emergency & Respond

– unconscious, CPR, defibrillation, probable death

• 85% of the heart damagedamage takes place within the

first two hoursfirst two hours.

Part 4Part 4

Recognition and InterventionRecognition and Intervention

Early Symptoms of a Heart AttackEarly Symptoms of a Heart Attack(Prodromal Angina)(Prodromal Angina)

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

– weakness/fatigue

– clammy/sweating

– nausea/indigestion

– dizziness/nervousness

– shortness of breath

– neck/back/jaw pain

– feeling of doom

• Specific Heart Attack Specific Heart Attack Symptoms:Symptoms:

– chest discomfort

– chest pressure

– chest ache

– chest burning

– chest fullness

Early Signs of Heart AttackEarly Signs of Heart Attack(Prodromal Symptoms)(Prodromal Symptoms)

• Present in up to half of heart attacks.

• Suddenly accelerate preceding the heart attack.

• Usually appear within 24 hours before the acute

attack but can begin two to three weeks before.

• Duration varies from a few minutes to several

hours.

• Usually intermittent with a pain free period before

the onset of acute occlusion.

Part 5Part 5

Delay and DenialDelay and Denial

Why Do We Why Do We Delay Delay ??

Denial and Procrastination = Our Heart’s Enemy!Denial and Procrastination = Our Heart’s Enemy!

1. It’s Nothing Really Serious1. It’s Nothing Really Serious

I’ll just rest a bitI’ll just rest a bit

2. I’m Too Busy Right Now2. I’m Too Busy Right Now

I don’t have time to be sickI don’t have time to be sick

3. I Don’t Want to be a Problem3. I Don’t Want to be a Problem

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

4. Paramedics Beware!4. Paramedics Beware!

First responders can easily swayed by First responders can easily swayed by patient rationalizations and denialspatient rationalizations and denials

5. 5. It’s Probably Heartburn or It’s Probably Heartburn or IndigestionIndigestion

I’ll take something for itI’ll take something for it

6. I’m Strong6. I’m Strong

““Just walk it off, grin and bear it”Just walk it off, grin and bear it”

7. I’m Healthy7. I’m Healthy

I have no serious medical problemsI have no serious medical problems

I exerciseI exercise

8. 8. I’ll Just Wait It OutI’ll Just Wait It Out

Everything will be OKEverything will be OK

Part 6Part 6

You: The Early Heart Attack Care You: The Early Heart Attack Care GiverGiver

The The E.H.A.C.E.H.A.C. Caregiver Caregiver

• Spouse• Children• Parent• Co-worker• Friend• Exercise partner

Anyone who cares about you!Anyone who cares about you!

What To Ask and Look ForWhat To Ask and Look For

• 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?

Overcoming ReluctanceOvercoming Reluctance

• Suggest he or she check out early symptoms, better safe than sorry.

• Find out the most critical issue on the persons mind.

• Call 9-1-1. Paramedics have excellent evaluation tools.

• Offer to call spouse or family members if he or she is anxious.• If he or she refuses to seek help, enlist friends or family members to

help you convince them.

• Be personal and persistent. Sit, talk, try to relieve any tension and don’t go away.

• When he or she agrees, congratulate them on their good judgement.

• If all else fails, take charge and be aggressive about getting the patient to the hospital.

A C T W I S E L YA C T W I S E L Y• AA• CC• TT

• WW• II• SS• EE• LL• YY

Acknowledge the problem

Be Calm

Be Tenacious and do not give in.

Be Willing to spend the time

Be Influential

Keep it Simple

Be EmpatheticLink the patient with early symptoms to medical care

Say Yes - I’ll pay attention

Listen to your Heart Listen to your Heart and be a Winner! and be a Winner!

• 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.

• EHACEHAC is knowing the subtle danger signs

and acting on them before damage occurs.

With gratitude for their assistance:

Raymond D. Bahr, MD and Jane Strong, RNSt. Agnes Hospital, Baltimore, MD

Terence D. Valenzuela, MDUniversity of Arizona

Captain Richard Hardman, EMT-PClark County Fire Department, Las Vegas, NV

In Memory Of

Sally Ann Spackman1943 - 1998

Designed & developed by: Lani Clark Tucson, Arizona 1998