Inside the Operating Room: Heart Attacks, Strokes, and Falls
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Transcript of Inside the Operating Room: Heart Attacks, Strokes, and Falls
Inside the Operating Room: Heart Attacks,
Strokes, and Falls
Presentation by: Stephanie Scully, RN BSN
CHR Cardiac Operating RoomNCP Health Ministry Chair
Objectives
To discuss three of the most common causes of death in the elderly population
To describe heart attacks, strokes, and falls and how they occur
To demonstrate what surgical interventions are available to treat heart attacks, strokes, and falls
What are the Top Causes of Death Amongst the Elderly Population?
Heart Disease Cancer Stroke COPD Flu/ Influenza Diabetes Injuries
Heart Attack Prevalence Heart disease and cancer
› Leading causes of death for >65 for 2 decades
35% of all deaths are due to heart disease, including heart attacks and chronic ischemic heart disease
What is a Heart Attack? Damage and death of
heart muscle from the sudden blockage of a coronary artery by a blood clot
Sudden blockage= blood and oxygen deprivation-> injury to the heart muscle= chest pain and chest pressure
How do these blockages occur?
Coronary arteries provide heart with blood Blood= oxygen and nutrients CAD= Coronary Artery Disease
› Fatty matter, calcium, proteins, inflammatory cells= plaque
› Plaque is hard on the outside, mushy on the inside When the plaque is hard, outer shell cracks=
plaque rupture -> platelets form around rupture = blood clot
**Total or near-total occlusion by blood clot = heart attack
What are the symptoms of a Heart Attack?
Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
Discomfort radiating to the back, jaw, throat, or arm
Fullness, indigestion, or choking feeling Sweating, nausea/ vomiting, or dizziness Weakness, anxiety, or shortness of breath Rapid or irregular heartbeat*No symptoms= silent heart attack
Time is of the Essence Why is time important
in treatment of heart attacks?› 20-40 minute window
Lack of blood flow restoration= irreversible death of the heart muscle begins
› Muscle continues to die for 6-8 hours, or until the heart attack usually is "complete.“
What is the damage?
Amount of damage depends on size of area supplied by the blocked artery and time between injury and treatment
Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. › Scar tissue will form in the damaged area› Scar tissue does not contract= the heart's
pumping ability is lessened after a heart attack
How do we minimize damage during Heart Attacks?
Medications› Aspirin
Prevent additional clotting Heart Codes
› Cardiac Catheterizations Angioplasty and stenting
› Surgical intervention Coronary Artery Bypass Grafting (CABG)
Depending upon blockage location and severity
Coronary Artery Bypass Grafting
CABG is one treatment for CAD› A healthy artery or vein from the body is
connected, or grafted, to the blocked coronary artery.
› The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery.
› This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple coronary arteries during one surgery.
Benefits of CABG Surgery
Results are usually excellent Improves or completely relieves angina
symptoms Most people remain symptom-free for as
long as 10 - 15 years May lower your risk of having a heart
attack and help you live longer You may need repeat surgery if blockages
form in the grafted arteries or veins or in arteries that weren't blocked before.
After CABG Surgery Treatments do not cure
CAD It CAN happen again
› Take medicines Reduce blood pressure Relieve work of heart Prevent blood clots Lower cholesterol
› Make lifestyle changes Dietary changes Exercise Quit smoking
Stroke Prevalence The third leading cause of death in
America is stroke Strokes are debilitating and lethal Stroke kills almost 130,000 Americans
each year—that’s 1 out of every 19 deaths.
On average, one American dies from stroke every 4 minutes.
Every year, more than 795,000 people in the United States have a stroke.
What is a Stroke? A stroke occurs when the blood supply
to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food.
Within minutes, brain cells begin to die. Strokes are treatable and preventable
What are the Signs of Stroke?
Sudden severe headache Weakness Numbness Vision problems Confusion Trouble walking Difficulty talking Dizziness Slurred speech
Different Types of Strokes When blood supply to
the brain is interrupted or reduced-> oxygen and nutrient deprivation= brain cell death
Two types› Ischemic stroke ->
blocked artery› Hemorrhagic stroke ->
leaking or burst blood vessel
Ischemic Stroke
85% of strokes are ischemic› Occur when one or both carotid arteries (supplying the brain with blood) become narrowed or blocked= severely
reduced blood flow (ischemia) Thrombotic stroke
› A blood clot (thrombus) forms and blocks vessel› Blood clot= fatty deposits (plaque)
Embolic stroke › A blood clot or other debris is swept through your
bloodstream to lodge in narrower brain arteries This type of blood clot is called an embolus.
Time is of the Essence
A stroke is a MEDICAL EMERGENCY
Prompt treatment is crucial to survival
Early action can minimize brain damage and potential complications
Interventions for Ischemic Stroke
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.
Medications › TPA- Clot buster
Within 4.5 hours› Aspirin
Reduce additional clotting Emergency procedures
› Catheter- administered TPA Directly into the area where the stroke is occurring
› Mechanical clot removal= = thrombectomy› Angioplasty and stenting the carotid artery› Carotid endarterectomy
Carotid Endarterectomy (CEA)
Surgical removal of plaque from arteries that run along each side of your neck to your brain (carotid arteries)
May be done for someone that had a stroke, or someone at high risk for stroke› Determined by vascular ultrasound
Steps include: › Incision along side of neck› Opens up carotid artery› Blood may be rerouted temporarily through a shunt› Scrape out plaque› Stitch or patch artery shut› Close incision
When Surgery is Most Beneficial
CEA can be done several months after a stroke or TIA
Most benefit from the surgery within 2 weeks of the stroke or TIA
> 2 week surgery delay increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.
Benefits of a CEA
Symptomatic patients with blockages of 70% or more benefit greatly
Less than 50% narrowing of the carotid do not seem to benefit from surgery
CEA works better than treatment with medicine alone in preventing stroke › (For people who have symptoms that can
be attributed to a 70% to 99% blockage of the carotid arteries)
After Carotid Surgery
Medications› Aspirin› Anti-platelet (prevent clots)› Cholesterol lowering
Exercise Diet
› Low fat, low cholesterol Quit Smoking
Prevalence of Falls
Falls are one of the top causes of death among people 65 years of age and older
One in three older adults falls every year› Less than half report it
Falls are the leading cause of both fatal and nonfatal injuries in older adults
In 2010, the direct medical costs of falls was $30 billion
The Truth about Falls
A fall can change your life Falls lead to:
› Disability› Loss of independence› Breaking bones and hips
Falls seldom “just happen’› Preventing falls is important
Regular eye exams Eliminating tripping hazards Wearing non-skid shoes Using assistive deices
Falls Lead to Fracture, Trauma
Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries.
Falls are the number one cause of fractures in older adults
Fall- related Fracture injuries:› Hip› Pelvis› Spine› Arm › Hand › Ankle
Hip Fractures
One of the most serious types of fall injuries Leading cause of injury and loss of independence among older adults Healthy, independent older adults may
be able to return home or live on their own after treatment and rehab
Long term care is always necessary
What is a Hip Fracture?
A hip fracture is a break in the upper quarter of the femur (thigh) bone
The extent of the break depends on the forces that are involved
Type of surgery required› Bones and soft tissues involved› Level of fracture
What causes a hip fracture?
Most commonly from a fall or from a direct blow to the side of the hip
Some medical conditions increase susceptibility › Osteoporosis› Cancer› Stress injuries
In severe cases, standing on a leg and twisting
Surgical Treatment for Hip Fractures
Type of surgery depends on location, severity, and age› Repair with hardware
Metal screws into bone to hold it together until healed Screws to metal plates along bone Rods down center of bone through marrow (aka nails)
› Replace femur Partial hip replacement
If ends aren’t properly aligned, head and neck of femur removed and replaced
› Replace hip joint Total hip replacement
Replace upper femur and socket in pelvis
**If blood supply to ball joint is damaged, bone healing compromised-> hip replacement necessary
After Hip Repair/ Replacement
Take medications› Pain› Clot prevention
Rehabilitation› Programs available
Lifestyle adjustment› Long-term care and
rehab› Assistive devices
Future fall prevention
Preventing Falls Preventing falls is key to older adults
› Exercise regularly Leg strength increases, balance improves
› Review medications Dizziness side effect
› Regular eye exams Maximizes vision during age-related changes
› Lower hip fracture risk Enhance calcium and vitamin D intake Weight bearing exercises Screening and treatment for osteoporosis
References
http://www.cdc.gov/nchs/data/ahcd/agingtrends/01death.pdf
www.webmd.com www.medicinenet.com https://www.nhlbi.nih.gov/health/health
-topics www.mayoclinic.com www.stoke.org http://www.nlm.nih.gov/medlineplus http://nihseniorhealth.gov