Faculty Michelle Crumbley, RN, BSN Cardiac Rehabilitation Staff Nurse and Your Patient’s Health Tracy Edwards, RT(R) Diagnostic Educator Satellite Conference and Live Webcast Maria Huck, RN, BSN Wednesday, March 10, 2010 Cardiac Rehabilitation Charge Nurse 2:00 - 4:00 p.m. Central Time Baptist Medical Center South Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Montgomery, Alabama

Objectives Objectives • Recognize heart attack symptoms • Name treatment options for heart and name actions to take conditions

• List two different heart conditions • State which symptoms need to be

• Describe of reported to the nurse heart conditions • Describe heart disease progression

• Describe tests used to diagnose and disability heart conditions

Heart Attack Heart Attack () (Myocardial Infarction)

• According to the AHA Myocardial • When the coronary that Infarction is defined as death or supply blood to the heart muscle become blocked a heart attack (MI) damage to part of the heart muscle occurs due to an insufficient blood supply – This blockage will permanent damage to the heart

1 Signs and Symptoms of a Signs and Symptoms of a Heart Attack Heart Attack

• or discomfort in the jaw, neck, – Discomfort in the center of the back, or stomach chest that lasts more than a few minutes, or that goes away and • Feeling weak, light-headed or faint comes back • or discomfort – Also can be described as uncomfortable pressure, squeezing, fullness or pain

Signs and Symptoms of a Signs and Symptoms of a Heart Attack Heart Attack • Pain or discomfort in arms or • NOTE: Some people may have a shoulders heart attack with out having ANY • with or without symptoms chest discomfort • Other signs to look for include – Breaking out in a cold sweat –

Action to Take If Take Action an MI Is Suspected • Nitroglycerin is classified as a • If you recognize any or vasodilator symptom of an MI you should respond quickly and properly • Indication • DON’T HESITATE – Treatment & prevention of , control in • If you suspect an MI or think you may be having one you MUST preoperative , immediately call 911 or your treatment of CHF & MI emergency number

2 Take Action Take Action • Action • Aspirin (ASA) is classified as an antiplatelent agent, analgesic, & – Increases coronary blood flow by antipyretic dilating coronary arteries • Indication • If the person’s suspected of having an MI has been prescribed – Prophylaxis of MI, CVA, TIA, & Nitroglycerin, give as instructed while awaiting EMS

Take Action CPR • Action • If necessary be ready to perform – Inhibits prostaglandin production, CPR until EMS arrives producing analgesia – Prevention of platelet aggregation • Give ASA if recommend by a DOCTOR or EMS during possible MI • Remember if MI is suspected and ASA is given it must be chewed

Heart Conditions Coronary Disease • (CAD) • Coronary Artery Disease (CAD) is the

• Congestive (CHF) result of on the walls of the coronary arteries • Irregular Rhythms • CAD is the most common type of – / Dysrhythmias heart disease – • CAD occurs when a fatty material – called plaque (plak) builds up on the inner walls

3 Coronary Artery Disease Coronary Artery Disease • Angina – Plaque causes the coronary arteries to become narrow and stiff – Area of pain or discomfort that occurs when an area of the heart • This leads to a decrease in the muscle doesn’t get enough amount of oxygen rich blood getting oxygen-rich blood to the heart muscle causing a • 3 types symptom of CAD called Angina – Stable – Unstable – Variant

Coronary Artery Disease Coronary Artery Disease • Stable Angina

– Most Common

– Occurs when heart is working harder than usual

– Normal rhythm pattern

– Usually subsides once heart has rested

Coronary Artery Disease Coronary Artery Disease • Unstable Angina • Variant (Prinzmetal’s) Angina – Does not follow a pattern – Rare and occurs at rest – Occurs with or without exertion – Severe pain usually occurs – Not relieved by rest or between midnight and early AM – Very dangerous and needs – Usually relieved by medicine emergency treatment

4 CAD Risk Factors CAD Risk Factors • Risk factors include • Uncontrollable risk factors

– Uncontrolled hypertension – Male – Smoking – Age – Stress – Family history – High fat diet – Sedentary lifestyle – Uncontrolled – Mellitus

Congestive Heart Failure Congestive Heart Failure • CHF is defined as the heart isn’t • When the heart muscle is not pumping blood as it should pumping enough blood then the blood will back up into the • CHF doesn’t mean that the heart has stopped beating • Fluid builds up causing swelling in the feet, ankles and legs called • CHF Symptoms usually develop over weeks and months as the heart becomes weaker it pumps less blood • Fluid may also build up in the lungs than the body needs –

Congestive Heart Failure Congestive Heart Failure • Signs and Symptoms • CHF can be a result of – Shortness of breath – CAD (blockage not allowing • Especially when lying down enough blood to flow to the heart) – Tired, run-down feeling – Post MI (damaged heart muscle) – Swelling in the feet, ankles and – Increased blood pressure legs – Heart valve disease – Increased weight – Disease of the heart muscle • Because of fluid buildup – or can’t think clearly –

5 Congestive Heart Failure Irregular Heart Rhythms • NORMAL = 60 – 100 Bpm

• An (or dysrhythmia) is an abnormal rhythm of the heart

• Arrhythmias are problems that affect the electrical system of the heart muscle, producing abnormal heart rhythms

Irregular Heart Rhythms Irregular Heart Rhythms

– They can also cause the heart to • Causes of Arrhythmias pump less effectively – Many arrhythmias have no known • It may feel like a temporary pause cause and be so brief that it doesn’t change • Risk Factors your overall heart rate – CAD

– Increased BP

– Diabetes

Irregular Heart Rhythms Irregular Heart Rhythms

– Smoking • Bradycardia = HR <60 Bpm

– Excessive alcohol / caffeine • Treatment is not usually required unless symptoms of – Drug abuse – – Stress – – – Fainting or near-fainting spells

6 Irregular Heart Rhythms Irregular Heart Rhythms

• Bradycardia • Tachycardia = >100 Bpm – Can reduce the heart’s ability to pump, causing shortness of breath, chest pain, lightheadedness or loss of consciousness

– If severe, it can also cause heart attack or death

Irregular Heart Rhythms Irregular Heart Rhythms • Tachycardia • Treatments – Lifestyle changes

– Medicine to control HBP, CAD, and CHF

– Anticoagulants to reduce the risk of blood clots and

– Pacemaker insertion

Irregular Heart Rhythms Tests

– Implanted Cardiac Defibrillator • (ICD) –

– Cardiac Ablation – Heart Rate ()

– Surgery – Blood Pressure

–

7 Tests Tests • Echocardiogram – A test in which ultrasound is used to examine the heart – 2-D Echo is capable of displaying a cross-sectional "slice" of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right ventricle

Tests Tests • Chest x-ray • Heart catheterization

• Lab tests • Stress test

– Cardiac enzymes – Exercise stress test

– Cholesterol – Nuclear stress test

– BNP (B-type Natriuretic Peptide)

Treatment Options Treatment Options • Angioplasty and Stent – Angioplasty opens blocked arteries and restores normal blood flow in areas of an artery where atherosclerosis had formed – The Stent acts as scaffolding to keep the artery open once the balloon has been deflated and removed

8 Treatment Options Treatment Options • Coronary Artery Bypass Graft – The surgery reroutes, or Surgery "bypasses," blood around clogged arteries to improve blood flow and – This is a type of heart surgery oxygen to the heart – Sometimes called CABG – Surgeons take a segment of a ("cabbage") healthy blood vessel from another part of the body and make a detour around the blocked part of the coronary artery

Treatment Options Treatment Options • Valve Replacement or Repair – Heart valve problems make the heart work too hard and can lead to heart failure – In some cases, valves • Don’t open enough • Don’t let enough blood flow through

Treatment Options Treatment Options • Don’t close properly and let blood leak where it shouldn’t

• Mitral Valve Prolapse

9 Treatment Options Treatment Options • Pacemaker – A pacemaker is a small device that's placed in the chest or to help control abnormal heart rhythms – This device uses electrical to prompt the heart to beat at a normal rate

Treatment Options Treatment Options • AICD – If the heartbeat gets too fast (), the AICD – An implantable cardioverter will stimulate the heart to restore a defibrillator (AICD) is a device that normal rhythm (anti-tachycardia is implanted in the chest to pacing) monitor for and, if necessary, – In cases where the heartbeat is so correct episodes of rapid heartbeat rapid that the person may die (ventricular ), the AICD will also give an electric (defibrillation) to “reset” heartbeat

Treatment Options Treatment Options • Cardiac rehabilitation – Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning – The goal is to stabilize, slow or even reverse the progression of , thereby reducing the risk of heart disease, another cardiac event or death

10 Symptoms to Watch For Heart Disease

• Shortness of breath • Progression

• Swelling in feet or ankles • Disability • Extreme tiredness (unusual for patient) • Daily weight gain of greater than 2 pounds • Weekly weight gain of greater than 5 pounds

11