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Transcript of First Aid
- Modification of risk factors (smoking, BP, lipids)
- Antiplatelet drugs (aspirin and/or clopidogrel or ticagrelor)
- Nitroglycerin and Ca channel blockers for symptom control
- Revascularization if symptoms persist despite medical therapy
- ACE inhibitors and statins
Prognosis - Angina
Studies have shown that the following are significant prognosticators for poor outcome in patients with unstable angina:
- Ongoing CHF
- Presence or history of poor left ventricular ejection fraction (LVEF)
- Hemodynamic instability
- Recurrent angina despite intensive anti-ischemic therapy
- New or worsening mitral regurgitation
- Sustained ventricular tachycardia
Treatment & Prognosis - Angina
By Group 5
Angina & Myocardial Infarction
1- Definition & Epidemiology
2- Causes & Pathophysiology
3- Signs & Symptoms
5- Treatment & Prognosis
6- First aid steps
Definition - Angina
- Angina is a type of chest pain caused by reduced blood flow to the heart muscle.
- Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.
- It is relatively common but can be hard to distinguish from
other types of chest pain, such as the pain or discomfort of indigestion.
- If you have unexplained chest pain, seek medical attention right away.
Epidemiology - Angina
- 8% of men and 3% of women aged 55-64 years have, or have had, angina.
- 14% of men and 8% of women aged 65-74 years have, or have had, angina.
- People of South Asian origin in the UK have an increased risk of ischemic heart disease but black Caribbean people have a reduced risk compared with the overall UK population rate.
- In both men and women the rate is significantly higher in lower socio-economic groups
Definition - MI
- The term "myocardial infarction" focuses on the myocardium (the heart muscle) and the changes that occur in it due to the sudden deprivation of circulating blood.
- The main change is necrosis of myocardial tissue.
- The word "infarction" comes from the Latin "infarcire" meaning "to plug up or cram."
It refers to the clogging of the artery.
Epidemiology - MI
- Approximately 1.5 million cases of
MIs occur annually in the United States (600 cases
per 100,000 people).
- The proportion of patients diagnosed with NSTEMI
(non-ST segment elevation myocardial infarction) compared with STEMI has progressively increased.
- The total number of myocardial infarction-related
deaths in the United States has not declined.
- The most common cause of an MI is a
blood clot (thrombosis) that forms inside a coronary artery, or one of its branches.
- This blocks the blood flow to a part of the heart.
- A clot may form if there is an atheroma within the lining of the artery.
- Atheroma is fatty patches or plaques
that develop within the inside lining of arteries.
- Plaques of atheroma may gradually form over a number of years in one or more places in the coronary arteries.
- Each plaque has an outer firm shell with a soft inner fatty core.
- Gender (male)
- Lack of physical activity
- High fat diet
- Excess alcohol
- Family history of CV diseases…
- A crack develops in the outer shell of the atheroma plaque (plaque rupture)
- This exposes the softer inner core of the plaque to blood.
- This can trigger the clotting mechanism in the blood to form a blood clot.
- Therefore, a build-up of atheroma is the
root problem that leads to most cases of
ACS / MI.
If impaired blood flow to the heart lasts long enough, it triggers a process called
the ischemic cascade; the heart cells in the territory of the occluded
coronary artery die (chiefly through necrosis) and do not grow back.
A collagen scar forms in their place.
Signs & Symptoms
1- Typical or Stable Angina Pectoris
-The pain is classically described
as a crushing or squeezing substernal sensation
- Can radiate down the left arm or
to the left jaw
2- Prinzmetal Angina
- Occurs at rest due to coronary
artery spasm but the etiology is not very clear
3- Unstable Angina Pectoris
- Characterized by increasing
frequency of pain, precipitated by progressively less exertion.
- The episodes also tend to be more intense and longer lasting than stable angina
Signs & Symptoms
- Severe and crushing pain often described as being constricting, suffocating, or like “someone sitting on my chest”
- Usually substernal, radiating to the left arm, neck, or jaw
-More prolonged than that of an angina
- Complaints of fatigue and weakness,
especially of the arms and legs, are common
- Gastrointestinal complaints are common with STEMI: Epigastric distress, nausea & vomiting
(may be mistaken for indigestion)
- Pain and sympathetic stimulation combine to give rise to tachycardia, anxiety, restlessness, and feelings of impending doom
- The skin often is pale, cool & moist (cold sweat)
- Changes in mental status, particularly in the elderly
- Impairment of myocardial function may lead to Hypotension and/or Shock.
- Sudden Death can occur within 1 hour of symptom onset due to development of Fatal Arrhythmias
It shows an ST-segment depression but most of the time it can be normal even though the patient is having a severe angina.
is performed using the ECG to determine the severity of the angina.
- An echocardiogram identify angina-related problems, including whether there are areas of the heart not getting enough blood or heart muscle that's been damaged by poor blood flow. It is sometimes given during a stress test.
it is a test to identify whether
your coronary arteries are narrowed and determine how severe any blockages are.
How does it work?
1- A thin, flexible tube, aka a catheter, is passed into a vein or artery
2- X-rays are used to guide it into your coronary arteries.
3- A dye is injected into the catheter to highlight the arteries supplying blood to your heart.
4- A number of (angiograms) are taken that will highlight any blockages.
The picture shows an occlusion at the level of the coronary arteries.
Check the level of a protein called
C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk of heart attack.
are performed to identify the
location and intensity of the angina such as:
- Chest X-ray
- Cardiac catheterization
- Computed Tomography Angiography
- Myocardial Perfusion Scientigraphy (MPS)
Treatment - Angina
Treatment & Prognosis - MI
Treatment - MI
- Aspirin, clopidogrel, or both (prasugrel and ticagrelor are alternatives to clopidogrel if fibrinolytic therapy has not been given)
- GP IIb/IIIa inhibitor considered for certain patients undergoing PCI and for some others at high risk (eg, with markedly elevated cardiac markers, TIMI risk score ≥ 4, persistent symptoms)
- A heparin (unfractionated or low molecular weight heparin) or bivalirudin(particularly in STEMI patients at high risk of bleeding)
- IV nitroglycerin(unless low-risk,
- Fibrinolytics for select patients with STEMI when timely PCI unavailable
- ACE inhibitor (as early as possible) and a statin
Prognosis - MI
Better prognosis is associated with the following
- Successful early re-perfusion (STEMI goals: patient arrival to fibrinolysis infusion within 30 minutes OR patient arrival to percutaneous coronary intervention within 90 minutes)
- Preserved left ventricular function
- Short-term and long-term treatment with beta-blockers, aspirin, and ACE inhibitors
- Heart disease - risk factors. (2014, October 9). Retrieved October 25, 2014, from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000106.htm
- Myocardial Infarction . (n.d.). Retrieved October 25, 2014, from Patient.co.uk: http://www.patient.co.uk/health/myocardial-infarction-heart-attack
- Thygesen, K., Alpert, J. S., Jaffe, A. S., & al, e. (2012). Third Universal Definition of Myocardial Infarction. Journal of the American College of Cardiology , 60 (x), 5-10.
- Bates', Guide to Physical Examination And History Taking, 9th Edition, Lynn S. Bickley, Lippincott Williams & Wilkins, 2010
- Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, Marcassa C, Quinn T, van Weert H (2002). "Task force on the management of chest pain" (PDF).
- Thygesen K, Alpert JS, White HD (October 2007). "Universal definition of myocardial infarction". Eur. Heart J.
First Aid Steps
• Skin Condition
• C A B C
C: Conciousness (AVPU PPTE)
Patient unable to talk and is tired
Chief Complaint: Chest Pain, Paleness, Sweat
A: Airways CHECK THEM
B: Breathing DEEP OR SHALLOW
C: Circulation pulse; rhythm DEEP OR SHALLOW
First Aid Steps
- Capillary refill usually more than 2 seconds
- If patient has ANGINA and normally takes NITROGLYCERIN (NG)-> give NG if high BP
(CI: in low BP)
Give the usual dose of NG that is prescribed by his/her physician
Do not exceed the maximum dose even if the BP remains high
Usually 45 Degrees (If High BP)
If normal BP then the patient can be supine or 45 degrees, depending on the patient's preference
If low BP -> raise his/her legs
Mohamad Hadi Dalati
Marguerita el Hachache
Special thanks to Sally (secouriste) from Red Cross - Jbeil
Red Cross - Jbeil