Early Heart Attack CareHeart Attacks Have Beginnings

Heart Attack: A Community Problem

With A Community Solution

Course Outline

1. Anatomy and Physiology 101: Your Heart

2. A Heart Attack in Progress

3. Concepts of Early Heart Attack Care

4. Recognition and Intervention

5. Delay and Denial

6. You: The Early Heart Attack Care Giver

Part 1

Anatomy and Physiology 101: Your Heart

The Human Heart

• Location: Middle of the chest• Size: That of a fist• Purpose: Pumps blood throughout the

body• Weight: 7 - 12 ounces • Capacity: Pumps 1,800 gallons of blood &

beats over 100,000 times daily

The Human HeartThe Human Heartand Coronary Arteriesand Coronary ArteriesThe Human HeartThe Human Heartand Coronary Arteriesand Coronary Arteries

SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY)

ANTERIOR R. ATRIAL BRANCH OF R. CORONARY ARTERY

RIGHT CORONARY ARTERY

ANTERIOR CARDIAC VEINS

SMALL CARDIAC VEIN

ANTERIOR INTERVENTRICULAR (ANTERIOR DESCENDING) BRANCH OF L. CORONARY ARTERY

GREAT CARDIAC VEIN

CIRCUMFLEX BRANCH OF L. CORONARY ARTERY

L. CORONARY ARTERY

GREAT CARDIAC VEIN

CIRCUMFLEX BRANCH OF L. CORONARY ARTERY

CORONARY SINUS

OBLIQUE VEIN OF L. ATRIUM

POSTERIOR VEIN OF L. VENTRICLE

MIDDLE CARDIAC VEIN

SUPERIOR VENA CAVAL BRANCH (NODAL ARTERY)

SINOATRIAL (S-A) NODE

SMALL CARDIAC VEIN

R. CORONARY ARTERY

POSTERIOR INTERVENTRICULAR (POSTERIOR DESCENDING) BRANCH OF R. CORONARY ARTERY

The Human HeartThe Human Heartand Coronary Arteriesand Coronary ArteriesThe Human HeartThe Human Heartand Coronary Arteriesand Coronary Arteries

The Human HeartElectric PumpThe Human HeartElectric Pump

Part 2

A Heart Attack in Progress

Heart Attack Facts

• #1 Killer of Adults

• 4,100 Heart Attacks every day

• 600,000 Heart Attack deaths each year

• Hundreds of thousands survive but are left with a damaged heart

Three Presentations of a Heart Attack

• Sudden, severe pain that stops you in your tracks.

• Gradual increasing pain with damage occurring over a period of hours.

• Very early presentation with mild symptoms over hours or days.

Ischemia & Angina PectorisIschemia & Angina Pectoris

Partial block producing chest pain

Area of decreased blood supply

Coronary Artery DiseaseCoronary Artery Disease

Area of Infarct

Complete Obstruction:AMIComplete Obstruction:AMI

Part 3

Concepts of Concepts of EHACEHAC

Are All Heart Attacks Created Equal?Are All Heart Attacks Created Equal?

Progress: Heart Attack Treatment

• Thrombolytic Therapy (clot busters)

• Angioplasty

• Prehospital Cardiac Care

• Decrease in hospital time to treatment saved heart muscle improvement in quality of life

Too Little Progress: Heart Attack Recognition

• Only 25% of heart attack victims receive thrombolytic therapy

• Only 10% receive therapy within the first critical hour

• Most heart attack patients do not benefit from optimal medical advances

WHY?

DELAY

in recognizing and responding to the early warning signs of a heart attack

Why EHAC?

• Early CareEarly Care: : Recognize & RespondRecognize & Respond– often mild symptoms, usually normal activity

• Late CareLate Care: : Obvious Emergency & RespondObvious Emergency & Respond– incapacitating pain, diminished activity

• Too Late CareToo Late Care: : Critical Emergency & RespondCritical Emergency & Respond– unconscious, CPR, defibrillation, probable death

• 85% of the heart damagedamage takes place within the first two hoursfirst two hours.

Part 4

Recognition and InterventionRecognition and Intervention

Early Symptoms of a Heart Attack

• Non-Specific Symptoms:Non-Specific Symptoms:

– weakness/fatigue

– clammy/sweating

– nausea/indigestion

– dizziness/nervousness

– shortness of breath

– neck/back/jaw pain

– feeling of doom

– elbow pain

• Non-Specific Symptoms:Non-Specific Symptoms:

– weakness/fatigue

– clammy/sweating

– nausea/indigestion

– dizziness/nervousness

– shortness of breath

– neck/back/jaw pain

– feeling of doom

– elbow pain

• Specific SymptomsSpecific Symptoms

– chest discomfort

– chest pressure

– chest ache

– chest burning

– chest fullness

• Present in up to half of heart attacks.

• Suddenly accelerate preceding the heart attack.

• Usually appear within 24 hours before the acute attack but can begin two to three weeks before.

• Duration varies from a few minutes to several hours.

• Usually intermittent with a pain free period before the onset of acute occlusion.

Early Signs of a Heart Attack

Part 5

Delay and DenialDelay and Denial

Why Do We Delay?Denial and Procrastination Denial and Procrastination

= Our Heart’s Enemy! = Our Heart’s Enemy!

1. It’s Nothing Really Serious

I’ll just rest a bit

2. I’m Too Busy Right Now

I don’t have time to be sick

3. I Don’t Want to be a Problem

If it turns out to be nothing I’ll be embarrassed by the fuss made.

4. Paramedics Beware!

First responders can easily be swayed by patient rationalizations and denials

5. It’s Probably Heartburn or Indigestion

I’ll take something for it

6. I’m Strong

Just walk it off, grin and bear it

7. I’m Healthy

I have no serious medical problems..I exercise

8. I’ll Just Wait It Out

Everything will be OK

Part 6

You: The Early Heart Attack Care Giver

The EHAC Caregiver

• Spouse• Children• Parent• Co-worker• Friend• Exercise Partner

Anyone who cares about you!

What to Ask and Look ForWhat to Ask and Look For

• Do you have any chest discomfort?

• Is it tightness, pressure, pain in the center of your chest?

• Is the discomfort also in your arms or jaw or neck or throat or back?

• Are you sick to your stomach?

• Is the person sweaty or clammy?

• What were you doing when the symptoms started?

• Do the symptoms go away with rest?

• Are you having any shortness of breath?

Overcoming ReluctanceOvercoming Reluctance

• Suggest he or she check out early symptoms, better safe than sorry. • Call 9-1-1. Paramedics have excellent evaluation tools.• Offer to call spouse or family members if he or she is anxious.• If he or she refuses to seek help, enlist friends or family members to

help you convince them.• Be personal and persistent. Sit, talk, try to relieve any tension and

don’t go away.• When he or she agrees, congratulate them on their good judgment.• If all else fails, take charge and be aggressive about getting the

patient to the hospital.

A C T W I S E L YA C T W I S E L Y

AACCTT

WWIISSEELLYY

Acknowledge the problemBe CalmBe Tenacious and do not give in.

Be Willing to spend the timeBe InfluentialKeep it SimpleBe EmpatheticLink patient w/ early symptoms to medical careSay Yes - I’ll pay attention

Listen to your and be a Winner!

Listen to your and be a Winner!

• Be aware of pressure, not necessarily pain, in your chest.• Be aware if it increases with activity and subsides with rest.• Don’t try to rationalize it away. Be honest with yourself and

others.• Call 9-1-1 or have someone drive you to the nearest emergency

room.• Don’t go to your doctors office or wait for an appointment.• EHACEHAC is knowing the subtle danger signs and acting on them

before damage occurs.