Power Points for EMS Education

1. Barry Kidd 2010Barry Kidd 2010 11
TheThe
Cardiovascular SystemCardiovascular System
& Cardiovascular& Cardiovascular
EmergenciesEmergencies

2. Barry Kidd 2010 2
ComponentsComponents
Heart – pumps bloodHeart – pumps blood
Vessels – Arteries carry bloodVessels – Arteries carry blood
away from the heart and veinsaway from the heart and veins
carry blood back to the heartcarry blood back to the heart
Blood – fluid that carriesBlood – fluid that carries
nutrients essential to cellnutrients essential to cell
functionfunction

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TheThe
Cardiovascular SystemCardiovascular System
The cardiovascular suppliesThe cardiovascular supplies
oxygenated blood to all cells in theoxygenated blood to all cells in the
body!!body!!

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The HeartThe Heart
Located in the thoracic cavityLocated in the thoracic cavity
2nd intercostal space at right2nd intercostal space at right
sternal border 5th intercostalsternal border 5th intercostal
space at left midclavicular linespace at left midclavicular line
about size of your clenched fistabout size of your clenched fist
in mediastinumin mediastinum

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The HeartThe Heart
 has 4 chambershas 4 chambers
 it is “2 sided” divided by the septumit is “2 sided” divided by the septum
 2 upper chambers called the2 upper chambers called the atriaatria
 2 lower chambers called the2 lower chambers called the
ventriclesventricles surrounded by thesurrounded by the
pericardiumpericardium
 It has a system of one way valvesIt has a system of one way valves

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Path of blood flow (SystemicPath of blood flow (Systemic
circulation)circulation)
 Blood leaves the left ventricle via theBlood leaves the left ventricle via the
aorta. The aorta reduces in size toaorta. The aorta reduces in size to
form arteries, arterioles, andform arteries, arterioles, and
capillariescapillaries
 The capillaries exchange gases andThe capillaries exchange gases and
waste and blood enters the Venawaste and blood enters the Vena
cava (superior and inferior) andcava (superior and inferior) and
travels to the right atriumtravels to the right atrium

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Path of blood flow (PulmonaryPath of blood flow (Pulmonary
circulation)circulation)
 right ventricleright ventricle
 pulmonary arterypulmonary artery
 Lung ( pulmonary capillaries)Lung ( pulmonary capillaries)
 Pulmonary veinsPulmonary veins
 Left atriumLeft atrium

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The Circulatory SystemThe Circulatory System

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Blood Flow Through the HeartBlood Flow Through the Heart

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The HeartThe Heart
Electrical SystemElectrical System
–independentindependent
–stimulates contractions of heartstimulates contractions of heart
–normally initiated in rightnormally initiated in right
atriumatrium
– if initiated from otherif initiated from other areas =areas =
abnormalabnormal

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Electrical ConductionElectrical Conduction
 Sinoatrial (SA) nodeSinoatrial (SA) node
 Atrioventricular nodeAtrioventricular node
 Bundle of HisBundle of His
(AV bundle)(AV bundle)
 Bundle branchesBundle branches
 Purkinje fibersPurkinje fibers

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VesselsVessels
ArteriesArteries
ArteriolesArterioles
CapillariesCapillaries
VeiniolesVeinioles
VeinsVeins

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VesselsVessels
VasoconstrictionVasoconstriction
Effect on Blood Pressure?Effect on Blood Pressure?
VasodilationVasodilation
Effect on Blood Pressure?Effect on Blood Pressure?

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Major Arteries and VeinsMajor Arteries and Veins
• AortaAorta
• PulmonaryPulmonary
• CarotidCarotid
• FemoralFemoral
• BrachialBrachial
• RadialRadial
• Superior vena cava
• Inferior vena cava
• Pulmonary

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coronary arteries –coronary arteries – SupplySupply
blood to heart muscle itselfblood to heart muscle itself
The two mainThe two main
coronary arteries havecoronary arteries have
openings immediatelyopenings immediately
above the aortic valveabove the aortic valve
at the beginning of theat the beginning of the
aorta where theaorta where the
pressures are highestpressures are highest

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BloodBlood
Liquid Portion - PlasmaLiquid Portion - Plasma
Solid PortionSolid Portion
–Red blood cellsRed blood cells
–White blood cellsWhite blood cells
–PlateletsPlatelets

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BloodBlood
Plasma - transports solidsPlasma - transports solids
It is basically a salt solutionIt is basically a salt solution

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BloodBlood
Red Blood cells - carry oxygenRed Blood cells - carry oxygen
AKA -AKA - ErythrocytesErythrocytes
Hemoglobin is the substance thatHemoglobin is the substance that
combines with oxygen in a redcombines with oxygen in a red
blood cellblood cell

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BloodBlood
White Blood cells - fight infectionWhite Blood cells - fight infection
AKAAKA LeukocytesLeukocytes
almost all blood cells (red oralmost all blood cells (red or
white) are made in the bonewhite) are made in the bone
marrow.marrow.

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BloodBlood
Platelets – are essential forPlatelets – are essential for
formation of blood clots. Theyformation of blood clots. They
perform coagulation.perform coagulation.
AKA - thrombocytesAKA - thrombocytes

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average amount of blood
in an adult is 4-6 liters.

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notenote
 Systemic (system-wide, affecting aSystemic (system-wide, affecting a
group or system such as a body)group or system such as a body)
Vs pulmonary circulationVs pulmonary circulation
 Pulmonary arteryPulmonary artery
 Pulmonary veinPulmonary vein
 Coronary arteriesCoronary arteries
 PericardiumPericardium
 MyocardiumMyocardium

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If the cardiovascular systemIf the cardiovascular system
is working as it should ...is working as it should ...

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You get…PerfusionYou get…Perfusion
DefinitionDefinition
Adequate flow of bloodAdequate flow of blood
through body tissue or organsthrough body tissue or organs
to meet the needs of the cell.to meet the needs of the cell.

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CardiovascularCardiovascular
EmergenciesEmergencies

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Abnormal Heart ConditionsAbnormal Heart Conditions
 Angina PectorisAngina Pectoris
 Myocardial InfarctionMyocardial Infarction
 Congestive Heart FailureCongestive Heart Failure

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Angina PectorisAngina Pectoris
 Decreased blood flow to heart muscleDecreased blood flow to heart muscle
results in ischemia- lack of oxygen.results in ischemia- lack of oxygen.
Causes mild to moderate pain, pain mayCauses mild to moderate pain, pain may
radiate.radiate.
 Usually lasts 3-8 minutes (rarely longerUsually lasts 3-8 minutes (rarely longer
than 15 mins)than 15 mins)
 IT GOES AWAY with no permanentIT GOES AWAY with no permanent
damage to heart muscledamage to heart muscle
 Can be difficult to differentiate from heartCan be difficult to differentiate from heart
attackattack

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Acute Myocardial InfarctionAcute Myocardial Infarction
 A decreased flow of blood to theA decreased flow of blood to the
myocardium leading to death of tissuemyocardium leading to death of tissue
 may not be provokedmay not be provoked
 moderate to severe painmoderate to severe pain
 Can last between 30 minutes and severalCan last between 30 minutes and several
hourshours
 May not go away with rest, O2 orMay not go away with rest, O2 or
nitroglycerinnitroglycerin
 Immediate transport is essentialImmediate transport is essential

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there are always exceptions ...there are always exceptions ...
Referred painReferred pain
Atypical painAtypical pain
No painNo pain

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Congestive Heart FailureCongestive Heart Failure
CausesCauses
–diseased heart valves anddiseased heart valves and
damaged ventriclesdamaged ventricles
–Chronic hypertensionChronic hypertension
–obstructive pulmonary diseaseobstructive pulmonary disease
(emphysema, chronic(emphysema, chronic
bronchitis)bronchitis)
–often a complication of an MIoften a complication of an MI

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CHFCHF
 Heart tries to compensate.Heart tries to compensate.
 Increased heart rateIncreased heart rate
 Enlarged left ventricleEnlarged left ventricle
 The heart can not efficiently pump theThe heart can not efficiently pump the
amount of fluid in the body and CHFamount of fluid in the body and CHF
developsdevelops
 Fluid backs up into lungs or body as heartFluid backs up into lungs or body as heart
fails to pumpfails to pump

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Signs & Symptoms of CHFSigns & Symptoms of CHF
Pedal edemaPedal edema
JVDJVD
Ascites (Ascites (excess fluid in the spaceexcess fluid in the space
between the tissues lining thebetween the tissues lining the
abdomen and abdominal organs inabdomen and abdominal organs in
the peritoneal cavity).the peritoneal cavity).

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Critical CHF & Pulmonary EdemaCritical CHF & Pulmonary Edema
dyspneadyspnea
rales & audible ralesrales & audible rales
pink frothy sputumpink frothy sputum
tachycardiatachycardia
cyanosiscyanosis
anxiety, restlessnessanxiety, restlessness

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Vascular emergenciesVascular emergencies
Atherosclerosis &Atherosclerosis &
arteriosclerosisarteriosclerosis
ThrombusThrombus
EmbolusEmbolus
AneurysmAneurysm

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Athero/arterio -sclerosisAthero/arterio -sclerosis
Are a build up of fatty deposits &Are a build up of fatty deposits &
calcium that causes narrowing ofcalcium that causes narrowing of
the lumen or the opening of thethe lumen or the opening of the
artery or vein that can createartery or vein that can create
rough inner surface that can leadrough inner surface that can lead
to clotto clot

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Athero/arterio -sclerosisAthero/arterio -sclerosis
Results in:Results in:
–restricted blood flowrestricted blood flow
–high blood pressurehigh blood pressure
–AMI (acute myocardial infarction)AMI (acute myocardial infarction)

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ThrombusThrombus
 Is a formation of a blood clot andIs a formation of a blood clot and
other debris in the vessels that canother debris in the vessels that can
become large enough to occlude abecome large enough to occlude a
vesselvessel
 partial blockage = distalpartial blockage = distal
reduction of O2reduction of O2
complete blockage = distalcomplete blockage = distal
tissue deathtissue death

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EmbolusEmbolus
 an embolus is a clot that breaks offan embolus is a clot that breaks off
from vessel wall, flows through bloodfrom vessel wall, flows through blood
vessels and may partially orvessels and may partially or
completely occlude smaller artery.completely occlude smaller artery.
 An occlusion will result in decreasedAn occlusion will result in decreased
oxygen to tissue or tissue deathoxygen to tissue or tissue death

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AneurysmAneurysm
 An aneurysm is a ballooning out of aAn aneurysm is a ballooning out of a
weakened section of an arteryweakened section of an artery
 It can also have the possibility ofIt can also have the possibility of
rupturingrupturing

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Ruptured aneurysmRuptured aneurysm
 Is a bursting of an aneurysm thatIs a bursting of an aneurysm that
can result in rapid, life threateningcan result in rapid, life threatening
internal bleedinginternal bleeding

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Abdominal Aortic AneurysmAbdominal Aortic Aneurysm
(AAA)(AAA)
 Signs & SymptomsSigns & Symptoms
– ““Tearing” abdominal or back painTearing” abdominal or back pain
– Pulsating mass in midline of abdomenPulsating mass in midline of abdomen
– Unequal femoral pulsesUnequal femoral pulses
– SyncopeSyncope

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AAA TreatmentAAA Treatment
Rapid transportRapid transport
High flow O2High flow O2
Treat for shockTreat for shock

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Other ConsiderationsOther Considerations
other causes of chest painother causes of chest pain
pacemakerspacemakers
defibrillator implantsdefibrillator implants
CABG – coronary artery bypassCABG – coronary artery bypass
graftgraft

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RX for allRX for all
High flow oxygenHigh flow oxygen
(ventilate patient if needed!)(ventilate patient if needed!)
Position of comfortPosition of comfort
Rapid transportRapid transport

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Cerebral VascularCerebral Vascular
AccidentsAccidents
AKAAKA
““Stroke”Stroke”
““Brain Attack”Brain Attack”

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CVA - Cerebral Vascular AccidentsCVA - Cerebral Vascular Accidents
 Is a sudden change in neurologicalIs a sudden change in neurological
status caused by interference withstatus caused by interference with
blood supply to brain can be:blood supply to brain can be:
 obstructiveobstructive
 hemorragichemorragic

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CVA signs & symptomsCVA signs & symptoms
 hypertensionhypertension
 altered mental statusaltered mental status
 hemiparesis & hemiparalysishemiparesis & hemiparalysis
 headache, blurred visionheadache, blurred vision
 one sided facial droopone sided facial droop
 Aphasia (inability to talk)Aphasia (inability to talk)
 incontinenceincontinence

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Transient Iscemic AttackTransient Iscemic Attack
 TIA’s are also called a “mini-stroke”TIA’s are also called a “mini-stroke”
and can have symptoms of CVA.and can have symptoms of CVA.
These attacks are usually for a shortThese attacks are usually for a short
time with the patient fullytime with the patient fully
recovering.recovering.

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The endThe end
Questions?Questions?