Atherosclerosis is a condition caused by a build-up of plaque in the inner lining of an artery, it's generally this condition that gives rise to Angina and a Myocardial Infarct due to a partial or complete blockage of an artery.
Atherosclerosis is a slow, progressive disease that may start as early as childhood. However, the disease has the potential to progress rapidly.
So what causes atherosclerosis?
It is unknown exactly how atherosclerosis begins or what causes it. Some scientists think that certain risk factors could be associated with atherosclerosis, including:
- Elevated cholesterol
- High blood pressure
- Diabetes mellitus (type 1 diabetes)
- Physical inactivity
Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of the heart does not receive enough blood. Angina is a symptom of coronary heart disease (CHD), which occurs when arteries that carry blood to the heart become narrowed and blocked due to atherosclerosis (as above).
Signs and Symptoms
Angina pectoris occurs when the heart muscle (myocardium) does not receive an adequate amount of blood needed for a given level of work (insufficient blood supply is called ischemia). The following are the most common symptoms of angina. However, each individual may experience symptoms differently. Symptoms may include:
- A pressing, squeezing, or crushing pain, usually in the chest under the breast bone
- Pain radiating in the arms, shoulders, jaw, neck, and/or back
The chest pain associated with angina usually begins with physical exertion. Other triggers include emotional stress, heavy meals, hypertension and family history. Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medications e.g. Glyceryl Trinitrate (GTN). If this medication is not relieving the pain then the patient is advised to call for an ambulance and be taken in to hospital as it may be the start of a myocardial infarct
A heart attack, or myocardial infarction, occurs when one of more regions of the heart muscle experience a severe or prolonged decrease in oxygen supply caused by a blocked artery and subsequent loss of blood flow to the heart muscle.
If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer severe and devastating damage and die (infarct). In some cases of myocardial infarct the patient could then go on to develop Left Ventricular Failure due to poor muscle function.
Signs and Symptoms
The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:
- Severe pressure, fullness, squeezing, pain and/or discomfort in the centre of the chest that lasts for more than a few minutes
- Pain or discomfort that spreads to the shoulders, neck, arms, or jaw
- Chest pain that increases in intensity
- Chest pain that is not relieved by rest or by taking cardiac prescription medication
Chest pain that occurs with any/all of the following (additional) symptoms:
- Sweating, cool, clammy skin, and/or paleness
- Shortness of breath
- Nausea or vomiting
- Dizziness or fainting
- Unexplained weakness or fatigue
- Rapid or irregular pulse
Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.
Treatment in the pre-hospital environment include:
- Continuous monitoring of the heart and vital signs
- Oxygen therapy - to improve oxygenation to the damaged heart muscle
- Pain medication (Entonox) - by decreasing pain, the workload of the heart decreases, thus, the oxygen demand of the heart decreases
- Cardiac medication - (i.e., to promote blood flow to the heart, prevent blood clotting, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure) use of Asprin and GTN.
Congestive Heart Failure
Congestive heart failure (CHF), also called Congestive Cardiac Failure (CCF) or just Heart Failure, is a condition that impairs the ability of the heart to pump a sufficient amount of blood throughout the body. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem.
Other ways to categorise heart failure:
- Is only part of the heart affected
- Left sided heart failure
- Right sided heart failure
Left Ventricular Failure or LVF is a condition you will come across more often as it is more acute compared to Right Ventricular Failure which takes a lot longer to show itself. Although the signs and symptoms are very similar your treatments will not differ between the conditions.
What causes CHF?
- Coronary artery disease
- Incompetent mitral valve
- Incompetent aortic valve
- Myocardial infarction
Signs and Symptoms
- Sense of suffocation
- Frothy sputum
- Cheyne-Stokes respiration
- Distended Jugular Veins
Management of CHF
Treat CHF as for other cardiac conditions, e.g. O2 as per BTS oxygen guidelines, Consider use of salbutamol to increase saturated O2, Use of Buccal GTN will assist vasodilation and help to clear the build up of fluid caused by the pulmonary oedema, Position the patient in the most comfortable position for them.
An aortic aneurysm is an abnormal bulge in the wall of the aorta, the body's largest artery (the blood vessel that carries oxygen-rich blood). Although an aneurysm can develop anywhere along your aorta, most occur in the section running through your abdomen (abdominal aneurysms). The rest occur in the section that runs through your chest (thoracic aneurysms).
An aortic aneurysm is serious because - depending on its size - it may rupture, causing life-threatening internal bleeding. The risk of an aneurysm rupturing increases as the aneurysm gets larger.
Dissecting Aneurysms - occur when a tear begins within the wall of the aorta, causing the three layers to separate. This is similar to what happens to a sheet of plywood that is left out in the weather. The dissection (separation of the layers) causes the wall of the aorta to weaken, and the aorta enlarges. Dissections may occur any place along the aorta and treatment depends upon the location.
Signs and Symptoms
As ambulance staff we would only know about the aneurysm if indicted by the patient or in a case when the aneurysm dissects. Some or all of the following sign and symptoms would be present :
- Abdominal/Chest and or back pain
- Tearing sensation in the chest/abdomen
- Cold extremities
- Lowering blood pressure
- Rapid heart rate
- Shortness of breath (Dyspnoea)
- Profuse sweating
- Orthopnoea (difficulty breathing when lying flat)
- Syncope (fainting)
- Pulsating mass in abdomen (If abdominal aneurysm)
- Distended abdomen
General management techniques, O2 as per BTS oxygen guidelines, raise patients feet to aid venous return, carry out vital observations, reassurance, use of suction if vomiting takes place and patient has a reduce level of consciousness.
A cardiac arrest refers to a sudden disturbance in the heart’s rhythm and the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. The resulting lack of blood supply results in cell death from oxygen starvation. Cerebral hypoxia, or lack of oxygen supply to the brain, causes victims to immediately lose consciousness and stop breathing.
Although cardiac arrest often strikes without warning, the event rarely takes place in a normal heart unless other factors (e.g., recreational drug use, trauma or myocardial infarction) are present.
- Immediate cardiopulmonary resuscitation (CPR)
- Where necessary restore a normal heart rhythm by defibrillation