Cardiac Pathophysiology Paper

Kines 403 February 28, 2012 Katelyn Cherry

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Disease Process Chest pain is a common condition that affects individuals of all ages. There are many different types of chest pain ranging from a dull ache to a sharp stabbing sensation. Also, the pain may be accompanied with a burning sensation or the feeling of large amounts of pressure on the chest. The pain may also radiate up into the neck, down one or both arms or down the back (Staff). Chest pain also has many different causes including, a tear in the aorta wall, swelling, panic attacks, blood clots, gallstones, heartburn, stomach ulcers and myocardial infarction (heart attack). (Chest Pain). Ischemia is the term used to define chest pain associated with the heart due to decreased blood flow. Atherosclerosis is a condition where major vessels leading to the heart are partially or fully blocked because of built-up cholesterol and calcium. The vessels are no longer able to adequately dilate or constrict and therefore, the heart may not receive an appropriate amount of oxygen and nutrients. The surrounding tissues may begin to starve and if the blood flow is not returned to normal, the tissue will eventually die. This tissue death may be the cause of chest pain or other more serious heart related conditions (Gulli, et al. 531). Affected Organ System The main organs that are affected due to chest pain consist primarily of the heart, major blood vessels and the brain. The heart and blood vessels are part of the circulatory system, which aid in supplying the body with an adequate amount of blood. Meanwhile, the brain is an important component of the nervous system and if its function is compromised due to decreased blood flow, then the rest of the bodys organ systems may be affected. During an episode of chest pain, blockage in a coronary vessel cuts of blood supply to the heart. This blockage causes a decrease in the amount of oxygen and nutrients that are circulating

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throughout the body. If the blockage is not rapidly corrected, parts of the heart tissue may begin to die, thus, blood will no longer be adequately delivered to other organ systems. These factors are what contribute to the signs and symptoms of chest pain as described below (Staff). However, if the signs and symptoms are not controlled and the heart is compromised, oxygen will no longer be delivered to the different tissues of the body. Therefore, decreasing perfusion and eventually organ failure. Signs and Symptoms There are many signs and symptoms related to a period of chest pain. Signs can be described as something that is physically seen, while symptoms are observed by the patient. According to the Mayo Clinic, the main symptoms of chest pain related to heart complications include pressure or fullness in the chest, shortness of breath, dizziness and crushing pain that may radiate into the jaw, arm or neck (Staff). Chest pain that radiates into the jaw, neck or arm and the feeling that someone is sitting on my chest are both characteristic signs of angina pectoris. Angina pectoris is a period of time when the heart tissue is not receiving enough oxygen. This type of pain typically subsides with rest, high-flow oxygen and nitroglycerin (Gulli, et al. 532). Treatment The main treatment that is available to alleviate the symptoms of chest pain associated with heart conditions is nitroglycerin. Nitroglycerin, commonly known as nitro, can be administered through a sublingual tablet or spray. Nitroglycerin is a type of medication called a vasodilator. This class of medication aids in dilating the blood vessels leading to the heart, thus, decreasing the workload and oxygen needed by the heart (Chest Pain). Because nitroglycerin causes vasodilatation, there are certain

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contraindications involved when administering this medication. If the patient has taken erectile dysfunction medications, such as, Viagra, Cialis or Levitra within the last 24-48 hours, then nitroglycerin should not be given. Also, if the patients systolic blood pressure is less than 100 mm Hg, then nitroglycerin is contraindicated (PA Protocol, 501). Nitroglycerin treatment by a trained EMT provider is crucial for someone suffering from chest pain related to heart conditions, such as a myocardial infarction. When arriving on scene, the EMT must follow all standard procedures and then check the patients airway, breathing and circulation to rule out any life threats. The EMT must call ALS (advance life services) at this time in case the patient begins to rapidly deteriorate. After checking airway, breathing and circulation, high-flow oxygen must be administered via a non-rebreathing mask at 15 L/min. If the patient does not tolerate the mask, a nasal cannula may be used with a flow rate of 4-6 L/min. While it is not mandatory, a pulse oximeter may be utilized to monitor oxygen saturation of the blood. If the patient is still experiencing chest pain, the EMT may assist in administering one sublingual tablet of nitroglycerin. However, the EMT must first ask about erectile dysfunction medications and confirm that the systolic blood pressure is above 100 mm Hg (PA Protocol, 501). After doing so, the EMT must check the six rights pertaining to the medication. These rights include, the right medication, patient, dose, route, time, documentation and finally that the medication has not expired. Then, the EMT must remove the re-breathing mask and hand the nitroglycerin tablet to the patient. Next, the EMT must instruct the patient to place the tablet under his or her tongue and allow it to dissolve and then reapply the oxygen (Gulli, et al, 235). The EMT may only help to administer one dose of the medication before they must call medical command for further instruction. After the medication is administered, the patient may be transported to the hospital. The EMT must assess vitals en route to the hospital every 15 minutes

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if the patient is stable or every 5 minutes if patient is unstable. Also, the EMT must check blood pressure if medical command orders another dose of nitroglycerin (PA Protocol, 501)

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Bibliography "Chest Pain: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine. Web. 28 Feb. 2012. <http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm>. Gulli, Benjamin, Joseph A. Ciatolla, and Leaugeay Barnes. Emergency Care and Transportation of the Sick and Injured. Sudbury, MA: Jones and Bartlett, 2011. Print. PA DOH BLS Protocol. Protocol #421. Print. 28 Feb. 2012. Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 01 Dec. 2011. Web. 28 Feb. 2012. <http://www.mayoclinic.com/health/chestpain/DS00016>.

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