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Adult Cardiovascular Distress - Coggle Diagram
Adult Cardiovascular Distress
Symptoms of Ischaemia
Chest pain
Upper extremity mandibular pain - Pain affecting both the upper extremity (arm, shoulder, or hand) and the mandible (jaw).
Epigastric discomfort - pain in the upper central part of the abdomen, located just below the ribcage and above the navel.
Dyspnea or fatigue
Nausea
ECGS
Shockable rhythms
Ventricular Tachycardia (VT) – A fast, abnormal heart rhythm originating in the ventricles. If pulseless, it is a shockable rhythm requiring defibrillation.
Ventricular Fibrillation (VF) – A chaotic, disorganised electrical activity in the ventricles, leading to loss of effective contraction. It is a shockable rhythm and requires immediate defibrillation.
Shock is a life-threatening condition where there is inadequate tissue perfusion and oxygen delivery to meet the cellular demands of the body. This leads to circulatory failure, which can cause organ dysfunction and failure if not treated promptly.
Arterial monitoring
Accurate measurement in low-flow states
Real-time monitoring, beat to beat
Evaluation of circulatory compromise
Peak= max pressure during systolic ejection
Systolic decline = contraction ending
Types of shock
Cardiogenic
Hypovolemic
Distributive
Obstructive
Central venous pressure
The pressure in the thoracic vena cava near the right atrium directly reflects right atrial pressure and indirectly indicates preload, which is a key determinant of filling pressure. This measurement is crucial in assessing circulatory status and fluid balance.
Oxygen therapy in ACS
A Cochrane review found no supporting evidence for routine oxygen therapy in acute coronary syndrome (ACS). Similarly, Cabello et al. (2016) concluded that no randomized trials support oxygen use in normoxic patients and that potential harmful effects cannot be ruled out.
ACS includes STEMI NSTEMI unstable angina
A 12 lead ECG is essential if suspicion of MI, don’t forget to repeat!
Acute coronary syndrome may lead to cardiogenic shock
Categories of shock & how they affect CO or SVR
The treatment of cardiogenic shock is to optimize haemodynamics
Monitoring is essential when commencing inotropes
Inotropes are dangerous
Inotropes or vasopressors should be considered in patients with acute heart failure complicated by potentially reversible cardiogenic shock, with administration taking place in a cardiac care unit (CCU), high dependency unit (HDU), or a setting providing at least level 2 care (NICE, 2017).
STEMI is a heart attack characterized by significant ST segment elevation on the ECG, indicating complete blockage of a coronary artery that causes a transmural (full-thickness) myocardial infarction.
NSTEMI is another type of heart attack but without the significant ST elevation seen in STEMI. It’s often caused by a partial occlusion of a coronary artery, leading to less extensive damage than STEMI.