Atherosclerosis is most common cause
•
Thrombus from atheroma may obstruct artery
•
Vasospasm is cause in a small percentage
•
Size and location of the infarct determine the damage
Warning Signs of Heart Attack
•
Feeling pressure, heaviness, or burning in chest especially with increased
activity
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Sudden shortness of breath, weakness, fatigue
•
Nausea, indigestion, anxiety and fear
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Pain may occur and if present is usually substernal, crushing, and radiating
Diagnostic Test
•
ECG changes, serum enzymes and Isoenzymes
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Serum levels of myosin, cardiac troponin are elevated
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Leukocytosis, elevated CRP, and ESR common
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Arterial blood gas and pulmonary artery pressure
Complications
•
Sudden death
Treatment
•
Reduce the cardiac demand
•
Oxygen therapy
•
Analgesics
•
Anticoagulants
•
Thrombolytic agents may be used
•
Tissue plasminogen activator
•
Medication to treat: Dysrhythmias, hypertension, congestive heart failure
•
Cardiac rehabilitation begins immediately
Cardiac Dysrhythmias
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What’s the problem? **
Cardiac Output is the problem- that is all she said to
know for dysrhythmias
Sinus node abnormalities
- pacemaker of the heart, which alters rate
•
Bradycardia- regular but slow heart rate
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Tachycardia- regular rapid heart rate
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Sick sinus syndrome- marked by alternating bradycardia and tachycardia
often requiring mechanical pacemaker
Atrial Contraction Abnormalities
•
Premature atrial contractions (PAC)- extra contraction or ectopic beats
irritable atrial muscle cells outside the conduction pathway
•
Atrial fibrillation- rate over 350 beats/min causing pooling of blood in the
atria and a risk for thrombus formation
Atrial Node Abnormalities
•
Heart block- conduction is excessively delayed or stopped at AV
node/bundle of HIS
•
First degree- conduction delay between atrial and ventricular contractions
•
Second degree- every second to third atrial beat is dropped at AV node
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Third degree- no transmission from atria to ventricles
•
Ventricular Conduction Abnormalities
•
Bundle branch block- interference with conduction in one of the bundle
branches
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Ventricular tachycardia- likely to reduce cardiac output as reduced
diastole occurs
•
Ventricular fibrillation- muscles fibers contract independently and rapidly
and cardiac standstill occurs if not treated immediately
•
Premature ventricular contractions- additional beat from ventricular
muscle cell or ectopic pacemaker. May lead to ventricular fibrillation
Treatment of Cardiac Dysrhythmias
•
Cause needs to be determined and treated
•
Antidysrhythmic drugs are effective in many cases
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SA nodal problems or total heart bock require pacemakers
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Defibrillator may be implanted for conversion of ventricular fibrillation
Cardiac Arrest
•
Cessation of all heart activity – no conduction of impulses, flat ECG
Many reasons cause this:
•
Excessive vagal nerve stimulation
•
Potassium imbalance, cardiogenic shock
•
Drug toxicity, insufficient oxygen
•

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- Fall '11
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- Bone marrow, blood cell levels
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