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Questions and Answers
Which of these symptoms is associated with a myocardial infarction (MI)?
Which of these symptoms is associated with a myocardial infarction (MI)?
What is the primary tool for diagnosing a MI in the prehospital setting?
What is the primary tool for diagnosing a MI in the prehospital setting?
Why is it important to obtain a 12-lead ECG before administering aspirin?
Why is it important to obtain a 12-lead ECG before administering aspirin?
What is the primary goal of prehospital management for a possible MI patient?
What is the primary goal of prehospital management for a possible MI patient?
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What position should the patient be placed in if there is concern for pulmonary edema?
What position should the patient be placed in if there is concern for pulmonary edema?
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What is the importance of obtaining a detailed history during secondary assessment?
What is the importance of obtaining a detailed history during secondary assessment?
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What is the recommended approach for administering aspirin to a patient with possible MI?
What is the recommended approach for administering aspirin to a patient with possible MI?
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Which of the following is NOT a specific physical exam finding that helps detect complications related to AMI?
Which of the following is NOT a specific physical exam finding that helps detect complications related to AMI?
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What is the most likely cause of the patient's jaw pain?
What is the most likely cause of the patient's jaw pain?
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What is the main prehospital management objective for this patient?
What is the main prehospital management objective for this patient?
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What are the most common complications of hypertension?
What are the most common complications of hypertension?
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Which of the following is NOT a symptom of hypertension?
Which of the following is NOT a symptom of hypertension?
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What is the best way to measure blood pressure in this situation?
What is the best way to measure blood pressure in this situation?
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How often should the patient's blood pressure be measured?
How often should the patient's blood pressure be measured?
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What is a common characteristic of unstable Angina?
What is a common characteristic of unstable Angina?
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Which of the following is NOT a typical symptom of Angina?
Which of the following is NOT a typical symptom of Angina?
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What does diaphoretic mean?
What does diaphoretic mean?
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What is the most important action to take when managing a patient with a suspected acute dissection of the aorta?
What is the most important action to take when managing a patient with a suspected acute dissection of the aorta?
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What is a key distinction between STEMI and Non-STEMI?
What is a key distinction between STEMI and Non-STEMI?
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What is the primary cause of most Acute Myocardial Infarctions (AMI)?
What is the primary cause of most Acute Myocardial Infarctions (AMI)?
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Which of the following is a possible differential diagnosis considered during the full assessment of a patient presenting with chest pain?
Which of the following is a possible differential diagnosis considered during the full assessment of a patient presenting with chest pain?
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What is the most likely immediate action to be taken for a patient presenting with Angina?
What is the most likely immediate action to be taken for a patient presenting with Angina?
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What is the most effective treatment to prevent infarction in a patient with unstable Angina?
What is the most effective treatment to prevent infarction in a patient with unstable Angina?
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What is the main reason for monitoring vital signs every 5 minutes in a patient presenting with chest pain?
What is the main reason for monitoring vital signs every 5 minutes in a patient presenting with chest pain?
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What should be done immediately if a serious arrhythmia or cardiac arrest occurs during transport?
What should be done immediately if a serious arrhythmia or cardiac arrest occurs during transport?
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Why is a 12 Lead ECG necessary before administering nitroglycerin?
Why is a 12 Lead ECG necessary before administering nitroglycerin?
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What is the primary function of aspirin (ASA) in prehospital management for myocardial infarction?
What is the primary function of aspirin (ASA) in prehospital management for myocardial infarction?
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Which of the following medications should be avoided in patients with right ventricular infarction (RVI)?
Which of the following medications should be avoided in patients with right ventricular infarction (RVI)?
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What role does nitroglycerin play in the treatment of cardiac ischemia?
What role does nitroglycerin play in the treatment of cardiac ischemia?
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Which of the following is NOT a predisposing factor for atherosclerosis that cannot be changed?
Which of the following is NOT a predisposing factor for atherosclerosis that cannot be changed?
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What is the main mechanism by which atherosclerosis causes ischemia?
What is the main mechanism by which atherosclerosis causes ischemia?
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What is a direct cause of cardiac stress?
What is a direct cause of cardiac stress?
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What is the most common area affected by atherosclerosis?
What is the most common area affected by atherosclerosis?
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What is the primary cause of acute infarction in atherosclerosis?
What is the primary cause of acute infarction in atherosclerosis?
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How can an individual's genetics contribute to developing atherosclerosis?
How can an individual's genetics contribute to developing atherosclerosis?
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Which of the following is NOT a category of cardiac stress?
Which of the following is NOT a category of cardiac stress?
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What is the primary characteristic of indirect cardiac stress?
What is the primary characteristic of indirect cardiac stress?
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In what way does the presence of high-density lipoprotein (HDL) protect women from atherosclerosis before menopause?
In what way does the presence of high-density lipoprotein (HDL) protect women from atherosclerosis before menopause?
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What is the patient's pain level as reported during the assessment?
What is the patient's pain level as reported during the assessment?
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What does the term 'multifocal' refer to in the context of PVCs observed in the ECG?
What does the term 'multifocal' refer to in the context of PVCs observed in the ECG?
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During the assessment, which vital sign was reported as irregular?
During the assessment, which vital sign was reported as irregular?
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What is the most critical initial treatment that can be administered for this patient’s condition?
What is the most critical initial treatment that can be administered for this patient’s condition?
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Which of the following assessments is crucial for determining the cardiac rhythm?
Which of the following assessments is crucial for determining the cardiac rhythm?
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What could be a potential differential diagnosis if a patient reports dull jaw pain with an irregular pulse?
What could be a potential differential diagnosis if a patient reports dull jaw pain with an irregular pulse?
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What is likely the next step after observing the PVCs change from multifocal to unifocal during transport?
What is likely the next step after observing the PVCs change from multifocal to unifocal during transport?
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Which of the following is NOT a typical symptom to inquire about in a cardiac assessment?
Which of the following is NOT a typical symptom to inquire about in a cardiac assessment?
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Flashcards
Heart Disease
Heart Disease
Major cause of mortality and morbidity, includes various heart conditions.
Cardiac Stress
Cardiac Stress
Circumstances forcing the heart to work harder to maintain output; not necessarily pathological.
Direct Stress
Direct Stress
Structural or functional heart alterations reducing pump effectiveness (e.g. ischemia, infection).
Indirect Stress
Indirect Stress
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Atherosclerosis
Atherosclerosis
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Mechanisms of Atherosclerosis
Mechanisms of Atherosclerosis
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Predisposing Factors
Predisposing Factors
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Ischemia
Ischemia
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Secondary assessment in ACS
Secondary assessment in ACS
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ASA in Cardiac Ischemia
ASA in Cardiac Ischemia
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Nitro's role
Nitro's role
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Antiplatelet vs Anticoagulant
Antiplatelet vs Anticoagulant
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Management of MI transport
Management of MI transport
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Acute Aortic Dissection
Acute Aortic Dissection
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Cardiac Tamponade
Cardiac Tamponade
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Hypertensive Emergencies
Hypertensive Emergencies
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Symptoms of Hypertension
Symptoms of Hypertension
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Management of Aortic Dissection
Management of Aortic Dissection
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Hypertension Prevalence
Hypertension Prevalence
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Complications of Hypertension
Complications of Hypertension
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BP Measurement Management
BP Measurement Management
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OPQRST
OPQRST
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SAMPLE
SAMPLE
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PVCs
PVCs
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Sinus Rhythm
Sinus Rhythm
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Irregular Pulse
Irregular Pulse
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Differential Diagnosis
Differential Diagnosis
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IV Normal Saline
IV Normal Saline
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First-line Treatment for PVCs
First-line Treatment for PVCs
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Dizziness and Weakness
Dizziness and Weakness
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12-lead ECG
12-lead ECG
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Prehospital Management of ACS
Prehospital Management of ACS
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Administering Aspirin
Administering Aspirin
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Signs of Heart Failure
Signs of Heart Failure
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Semi-Fowler Position
Semi-Fowler Position
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Rapid Transport
Rapid Transport
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OPQRST Method
OPQRST Method
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Unstable Angina
Unstable Angina
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Symptoms of Angina
Symptoms of Angina
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Angina Treatment
Angina Treatment
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Acute Coronary Syndrome
Acute Coronary Syndrome
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Acute Myocardial Infarction (AMI)
Acute Myocardial Infarction (AMI)
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STEMI vs Non-STEMI
STEMI vs Non-STEMI
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Infarcted Tissue
Infarcted Tissue
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Coronary Artery Blockage
Coronary Artery Blockage
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Study Notes
Chest Pain
- Chest pain is a major cause of mortality and morbidity.
- Heart disease is a major cause of chest pain.
- Congenital heart defects, hypertensive heart disease, angina, heart attacks, and arrhythmias are types of heart disease.
- Atherosclerosis is the thickening of the artery wall from fatty material.
- Atherosclerosis affects coronary, renal, aortic, femoral, carotid, and cerebral arteries.
- Chronic gradual narrowing of arteries can cause ischemia.
- Acute plaque rupture and subsequent thrombus formation can cause acute infarction.
- Risk factors for coronary heart disease include hypertension, high blood cholesterol and triglyceride levels, unhealthy diet, smoking, diabetes, excessive alcohol use, obesity, physical inactivity, stress, hormonal replacement therapy, oral contraceptives, family history of CHD, advanced age, sex, and race or ethnicity.
- Cardiac stress is when conditions force the heart to work harder to maintain cardiac output.
- Cardiac stress is not necessarily pathological.
- Cardiac stress is categorized as direct or indirect.
- Direct stress involves structural or functional alterations in the heart that reduce pump effectiveness (ischemia, infection, arrhythmias, congenital defects).
- Indirect stress involves disorders external to the heart that increase its workload (anxiety, stress from an accident).
- 2 mechanisms of chronic gradual narrowing of the arteries causing ischemia from reduced blood flow and acute infarction caused by acute plaque rupture and subsequent thrombus formation and occlusion of coronary arteries (MI).
- Predisposing factors that can't be changed include age (more common after 40, especially in men), gender (women are protected by HDL until menopause), and genetics (affecting fat levels and metabolism).
- Predisposing factors that can be changed include obesity (high levels of LDL), cigarette smoking (decreases HDL, increases LDL, promotes platelet adhesion, increases vasoconstriction), sedentary lifestyle (sluggish blood flow), and uncontrolled HTN (causes vessel wall damage).
- Angina Pectoris (also known as chest pain) occurs when there is a deficiency of oxygen (O2) for the heart muscle.
- Angina can occur when the heart is working harder than usual and needs more O2 or if the blood supply to the myocardium is impaired.
- Stable Angina typically follows a predictable pattern (pain, location, severity, etc.).
- Stable Angina is characterized by Insufficient O2 supply, anaerobic metabolism and accumulation of lactic acid and CO2.
- Stable angina usually lasts for 1-5 minutes and is relieved by rest.
- Unstable Angina has a more severe pain, different feeling, and is not as easily relieved by rest or medication.
- Unstable Angina typically lasts longer than 15 minutes.
- Unstable angina is often indicative of a pre-MI.
- Unstable Angina differs from stable angina in their usual pattern.
- Unstable angina is a greater degree of obstruction of the coronary arteries.
- Unstable angina has a high risk of imminent MI
- Symptoms of Angina include recurrent, intermittent episodes of substernal chest pain, tightness or pressure in the chest that radiates to the neck or left arm, pallor, diaphoresis, nausea, lasting a few seconds to much longer.
- Angina treatment includes full assessment, detailed questioning (differential diagnosis), need for oxygen (ASA, 12 lead, nitro, IV therapy), and vitals every 5 minutes.
- Acute Coronary Syndrome (ACS) arises from prolonged cardiac disorder causing myocardial ischemia or infarction.
- ACS includes STEMI, Non-STEMI, and unstable angina.
- ACS is typically caused by a rupture of the plaque in the arteries and subsequent thrombosis of the coronary artery.
- Acute Myocardial Infarction (AMI) deprives the coronary muscle of blood flow, causing it to die (infarct).
- AMI's most common cause is plaque rupture and thrombus formation.
- AMI can also occur from spasm of a coronary artery (with angina -- arteries are already narrowed) or thrombus size blocks the artery.
- AMI is classified as STEMI or Non-STEMI, with clinical presentation similar except for ECG findings.
- Blood work troponin is a distinguishing factor.
- Location and size of AMI depends on which coronary artery is blocked.
- Infarcted tissue is inevitably surrounded by ischemic tissue, relatively deprived of O2 but still viable.
- Ischemic tissue is often electrically unstable, causing cardiac arrhythmias.
- Of all deaths from MI, 90% are due to arrhythmias (usually V-fib).
- Prehospital 12-lead ECGs are crucial in recognizing STEMI.
- Location and size of an MI depend on which coronary artery is blocked, where along its course the blockage occurred, and which ventricle is involved.
- The majority of infarcts involve the left ventricle.
- 90% of all deaths from AMI are due to dysrhythmias.
- Most common symptom of AMI is chest pain (felt beneath the sternum or on the left side of the chest).
- Chest pain is described as heavy, squeezing, crushing, or tight.
- Patient may unconsciously clench a fist, which may be a Levine sign.
- Chest pain during angina or heart attack can be located in the upper chest, substernal (radiating to neck and jaw), down left arm (substernal radiating down left arm), and intrascapular.
- Not every patient with AMI has chest pain.
- Silent MI is common in patients with diabetes, older people, and heart transplant recipients.
- Different symptoms of ACS may occur depending on the sex (men and women present differently).
- Women may present with nausea, light-headedness, epigastric burning, sudden onset of weakness, and may not recognize symptoms as potentially cardiac.
- Other signs of an AMI include pain (sudden, substernal, radiating to jaw, neck, and left arm, severe, steady, crushing, no relief with vasodilators, indigestion, gastric discomfort), pallor, diaphoresis, dizziness, weakness, anxiety, fear, hypotension, rapid and weak pulse, and dyspnea.
- Many AMI patients have normal physical exam findings.
- Diagnosis depends on history and 12-lead ECG findings.
- Specific physical exam findings can help detect complications to AMI (General appearance, Level of responsiveness, Skin, vital signs, and signs of left/right heart failure).
- Prehospital management of ACS includes assessment and management for possible ACS on arrival (be calming, place patient at rest, determine ACS; how to rule in or out ACS)
- Confirm possible ACS, a 12-lead ECG, and assessment of aspirin and oxygen administration before secondary assessment and anti-ischemic therapy are preferred for ACS.
- Consider rapid transport if patient has evidence of a STEMI, early ECG prior to treatment, and document ischemic ECG changes.
- If aspirin hasn’t been taken, give the patient aspirin to chew and swallow. Only administer oxygen if needed (avoid hyperoxemia).
- Put the patient physically and emotionally at ease.
- Decrease the amount of work the heart has to do (semi-Fowler position or sitting up if there is pulmonary edema).
- Perform cardiac monitoring, document initial rhythm, record vital signs (12 leads, serial), and defib pads if STEMI.
- Secondary assessment for ACS includes detailed history (cardiac disease, medications, heart attack, heart surgery), more complete description of present symptoms (especially onset, OPQRST), and do not delay transport.
- If a serious arrhythmia or cardiac arrest happens during transport, pull over and start immediate treatment.
- Ongoing need for potential causes of symptoms and complications from ACS. Start an IV line.
- Prehospital treatment for MI includes full assessment, vitals and detailed questioning and assessing for ASA (Cardiac Ischemia Medical Directive), assessing for O2 (BLS standard), assessing for 12-lead, and assessing for Nitro (Cardiac Ischemia Medical Directive).
- PCI if possible, if not to closest ER or hospital.
- Prehospital medications for cardiac ischemia include Nitro and ASA.
- A possible additional prehospital medication would be Narcotics PRN.
- Aspirin (ASA) is a platelet aggregating inhibitor (anticlotting); interferes with clotting factor.
- ASA has been shown to significantly decrease mortality in MI patients.
- ASA is orally administered (160-162 mg) and chewed or swallowed.
- Anticoagulants (blood thinners) impede the blood's ability to clot by targeting thrombin.
- Nitroglycerin (Nitro) is a vasodilator that dilates the coronary vasculature and can relieve vasospasm and improve blood flow.
- Nitro can also reduce peripheral vasculature and reduce cardiac workload but typically won't relieve pain, is not life-saving, and has side effects (hypotension, headache).
- Nitro should never be used in patients with RVI and is administered sublingually by EMS.
- Other cardiac medications include beta blockers (-lol), calcium channel blockers (-ine), diuretics (-ide), and antihypertensive agents (-pril).
- BLS PCS Chest Pain Standard.
- Chest pain (non-traumatic) standard guidelines for situations involving non-traumatic chest pain.
- Consider potential life/limb/function threats like acute coronary syndrome/acute myocardial infarction (STEMI), dissecting thoracic aorta, pneumothorax, tension pneumothorax/other respiratory disorders, pulmonary embolism, and pericarditis.
- Acquire a 12-lead ECG, and assess chest for subcutaneous emphysema, accessory muscle use, urticaria, indrawing; assess shape, symmetry, tenderness and auscultate to lungs for decreased air entry and adventitious sounds.
- Assess abdomen, neck and tracheal position for jugular vein distension, and extremities for leg/ankle edema.
- STEMI Hospital Bypass Protocol.
- Pre-hospital procedures for suspected STEMI cases
- Aortic emergencies include dissecting aortic aneurysm (Aorta subjected to hemodynamic forces, leading to degenerative changes in the middle layer), where these changes can lead to “ungluing” of the inner layer, tearing, pumping blood into abnormal layers, chronically stretching the vessel, often preventing valve closure, and blood entering back into the ventricle during systole.
- Symptoms of aortic dissection may include chronic hypertension, middle/older ages, sudden pain (described as “worst pain felt,” “ripping or tearing,” “like a knife”), located in anterior chest or back, between shoulder blades radiating to back or abdomen, difference in blood pressure between arms, disruption of blood flow through brachiocephalic or left subclavian artery).
- Signs & symptoms vary depending on the site and extent of the dissection.
- Acute dissection of the aorta disrupts blood flow, frequently resulting in a stroke, and nearly always death due to rupture of the pericardium and resultant cardiac tamponade.
- Management of aortic dissection focuses on managing pain and transporting the patient without delay (consider ALS, calm patient, provide O2, IV, cardiac monitor).
- Hypertensive emergencies involve blood pressure consistently above 130/80 mm Hg.
- Hypertensives are often asymptomatic, yet have major complications (MI, heart failure, stroke, renal damage, and heart failure).
- Most hypertensive emergencies result from atherosclerosis and arteriosclerosis.
- Hypertensive S&Ss vary per patient and severity (headache, dizziness, blurred vision, buzzing in ears, chest pain, altered LOC).
- Management of hypertension focuses on supportive care, keeping the patent supine, measuring blood pressure often (in both arms), completing a manual blood pressure check.
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Description
Test your knowledge on the prehospital management of myocardial infarction (MI) and related conditions. This quiz covers diagnosis, treatment protocols, and important assessments to ensure optimal patient care in emergency situations. Assess your understanding of critical interventions and symptoms associated with MI.
