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A narrowing of the small blood vessels that supply blood and oxygen to the heart
Coronary artery disease
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Risk factors of Coronary artery disease
- High blood cholesterol
- High blood pressure
- Diabetes
- Overweight
- Smoking
- Lack of physical activity
- Diet
- Stress
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Risk factors affecting the venous return
- Heart contractions
- Breathing
- Gravity
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Significance of Starling's Law
- Heart wall determines force of contraction
- Further stretched greater the recoil
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Risk factors for heart disease
- Hypertension
- High cholesterol
- Smoking
- Diet
- Obesity
- Sedentary lifestyle
- Oral contraceptives
- Hormone replacement
- Stress
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The difference between the heart rate and the palpable pulse
Pulse defiit
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A pulse that alternates between strong and week beats, characteristic of left ventricular systolic damage
Pulse alternans
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Focused history that relates to cardiovascular compromise
- Cardiac medications
- Past MI
- Past procedures
- Pacemaker / defibrillator
- Heart failure
- Hypertension
- Diabetes
- Lung disease
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Signs for rapid intervention for Pt. in cardiovascular compromise
- Apprehension
- Diaphoresis
- Dyspnea
- Nausea / Vomiting
- Impending doom
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Indications for transcutaneous pacing
- Bradycardia
- (Mobitz type II second-degree block or third-degree AV block)
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Possible complications of pacing
- Severe hypothermia
- Confused pt. (discomfort will increase the agitation)
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Causes and implications of pacemaker failure
- Battery depletion
- Loose or broken wire
- Electromagnetic interference
- Electronic circuit failure
- Electrolyte abnormality (high potassium)
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Cardiovascular disease
Common chief complaints
- Chest pain / discomfort (incl. shoulder, arm, neck, jaw pain)
- Dyspnea
- Syncope
- Palpitations
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Myocardial infarction
Common chief complaints
- Pulmonary embolus
- Pleurisy (sharp chest pain)
- Reflux esophagitis
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Common causes of dyspnea unrelated to heart disease
- COPD
- Respiratory infection
- Pulmonary embolus
- Asthma
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Anticipated clinical problems with chest pain
- Myocardial infarction
- Left ventricle failure w/ Pulmonary edema
- Right ventricular failure
- Cardiogenic shock
- Cardiac tamponade
- Aortic aneurysms
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Conditions that may mimic signs and symptoms of coronary artery disease and angina pectoris
- Gastroesophageal
- Pulmonary
- Musculoskeletal
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Gastroesophageal causes of chest pain
- Reflux esophagitis
- Esophageal spasm
- Esophageal perforation
- Gastritis
- Peptic ulcer
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Pulmonary causes of chest pain
- Pneumothorax
- Pulmonary embolism
- Bronchitis
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The paramedic responsibilities associated with management of the patient with angina pectoris
Chest pain protocol
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Anticipated life-threatening clinical problems of chest pain
- MI
- Cardiac tamponade
- Dysrhythmia
- Cardiogenic shock
- CHF
- ACS
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Epidemiology, morbidity and mortality of myocardial infarction
- Elderly
- Smokers
- Diabetes
- Obesity
- Drug users
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Mechanisms by which an Ml may be produced by traumatic event
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Mechanisms by which an Ml may be produced by non-traumatic event
- Past medical
- ACS
- Diabetes
- Drug usage
- Genetic (abnormalities)
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Primary hemodynamic changes produced in myocardial infarction
- Low BP
- Difficulty breathing
- ALOC
- Decreased pre & after load
- Dysrhythmias
- Death
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Anticipated clinical presentation of a patient with a suspected acute myocardial infarction
- Cardiac history
- STEMI
- BP / Pulse abnormalities
- Respiratory compromise
- Pulmonary compromise
- Present illness
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The difference in characteristics of suspected angina pectoris & MI
- Angina is exertion (relief by rest)
- MI = blockage or damage (death of tissue)
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The most common complications of AMI
- Damaged myocardium
- Dysrhythmias
- Decreased pre-load (R) pedal edema
- Decreased after-load (L) CHF
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Reperfusion of MI as it pertains to the
"window of opportunity"
- The first 3 hours
- "time is tissue"
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Measures to prevent or minimize complications in suspected MI
- Chest pain protocol
- M.O.N.A
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