Common Cardiovascular Emergencies - Evaluation and Management

Introduction:

Cardiovascular disease (CVD) is a umbrella term used for diseases of the heart and blood vessels. Clogged arteries of the heart (coronary heart disease) that lead to emergencies such as heart attacks, stroke caused by blocked blood flow to the brain, congenital heart diseases, heart failure, and other conditions affecting the blood vessels and heart are considered to be cardiovascular diseases. All heart diseases are cardiovascular diseases, but not all cardiovascular diseases are heart diseases. Diseases of the blood vessels, such as peripheral artery disease that causes decreased blood flow to the legs, are also considered cardiovascular diseases. Heart attack and stroke are common acute cardiovascular emergencies requiring immediate medical attention.

How Are Cardiovascular Diseases Classified?

Cardiovascular diseases are classified into the following:

1. Coronary Heart Disease: In coronary heart disease, the major blood vessels (arteries) supplying oxygen to the heart are blocked. Clogged arteries can lead to heart attacks that require emergency management.

2. Cerebrovascular Disease: When the blood flow to the brain is affected due to diseased or clogged blood vessels supplying the brain, it results in cerebrovascular disease. The acute form requiring immediate medical attention is stroke.

3. Congenital Heart Disease: Certain heart malformations can be present from birth. These birth defects affect the heart's normal function and development, leading to congenital heart disease and complications.

4. Peripheral Arterial Disease: This disease affects blood flow to the arms and legs (disease of the blood vessels or vascular disease).

5. Rheumatic Heart Disease: This is a condition in which the heart muscles and valves are damaged by rheumatic fever (caused by Streptococcal bacteria).

6. Deep Vein Thrombosis and Pulmonary Embolism: Blood clots occur in the leg veins due to various underlying chronic conditions. These blood clots have the potential to dislodge and move to vital organs such as the heart and lungs, clogging their blood supply.

What Are the Common Cardiovascular Emergencies?

Cardiovascular emergencies are life-threatening. It is important to recognize their warning signs immediately and to initiate treatment without delay. Common cardiovascular emergencies include the following:

1. Heart attack.

2. Cardiopulmonary arrest.

3. Stroke.

4. Unstable angina.

5. Heart failure.

6. Hypertensive emergency.

What Happens in a Heart Attack?

Heart attacks (myocardial infarction) are the leading cause of death in the United States (US). Clots or fat accumulation in the heart's major blood vessels prevent oxygen supply to the heart muscles. Gradually, the oxygen-deprived heart muscles stop functioning, leading to heart attacks and eventually death if left untreated. A heart attack is a medical emergency that requires immediate action. Being familiar with the warning signs of heart attack can help save lives. A few common symptoms of heart attack are:

• Chest discomfort that does not go away, pressure or tightness in the chest.

• Chest pain radiating to the left arm.

• Intense central chest pain.

• Radiating pain (to both arms, jaws, back, or stomach).

• Dizziness or fainting.

• Breathlessness or shortness of breath.

• Cold sweats.

• Increased heart rate.

• Faint heartbeat.

What To Do in Case of Heart Attacks?

Suppose a person has a heart attack; call the emergency services immediately. If unsure, when in doubt, call for help. Stay with the person till the ambulance arrives. The emergency medical service dispatcher may give pre-arrival instructions such as Aspirin or nitroglycerin administration. Follow the instructions as per advice. If the patient becomes unconscious, loosen the person's clothing on the chest and waist and make them lie flat on their back. Check airway, breathing, and pulse and perform cardiopulmonary resuscitation if trained.

What Is a Cardiopulmonary Arrest?

Cardiac arrest or cardiopulmonary arrest are heart emergencies that occur due to sudden and abrupt loss of heart function. When the blood flow to the heart is not sufficient or absent, the heart’s electrical activity is affected. As a result, the heart starts beating irregularly and eventually stops pumping blood to other body parts, including the brain. In most cases, there are no warnings before a sudden cardiac arrest. However, some may present with symptoms of cardiac arrest, including the following:

• Unconsciousness.

• Loss of pulse.

• Increased heart rate.

• Irregular (fluttering) heartbeat.

• Breathlessness.

• Sudden collapse.

• No breathing.

• Chest discomfort.

Cardiac arrest differs from a heart attack, though heart attacks can cause cardiac arrests. Cardiac arrest involves irregular or weak electrical activity in the heart muscles leading to irregular heartbeat and pulse. It is life-threatening and can cause permanent brain damage and death without immediate emergency care. Cardiopulmonary arrests are generally associated with the following:

• Five H’s:

  • Hypovolemia: Low liquid or fluid component of the blood.

  • Hypoxemia: Low oxygen level in the blood.

  • Hydrogen Ion (acidosis): Increased acid levels in the body.

  • Hypokalemia or Hyperkalemia: The potassium level in the blood is altered (low or high).

  • Hypothermia: Reduced body temperature.

• Five T’s:

  • Tension Pneumothorax: Air is trapped in the space between the chest wall and the lungs compromising cardiopulmonary function.

  • Tamponade: The heart cannot beat properly as the space around the heart is filled with blood or other fluid, putting pressure on the heart. As a result, the blood pressure drops significantly.

  • Toxins: Blocked airway and respiratory arrest leading to death can occur due to reduced consciousness after using toxic substances such as alcohol and certain drugs such as Opiates and Benzodiazepines.

  • Thrombosis: Blood clots can block the blood vessels of the lungs (pulmonary) and the heart, leading to cardiopulmonary arrest.

What Is Stroke and How to Identify Its Warning Signs?

A stroke is a medical emergency where the blood supply to a part of the brain is cut off, leading to brain damage and death. There are two causes of stroke - a blocked artery (ischemic stroke) or a leak or burst of a blood vessel in the brain (hemorrhagic stroke). Prompt and early treatment reduces brain damage and helps prevent disability from stroke. Sudden weakness of the face, arm, or leg, often on one side of the body, are stroke's common symptoms. Patients experiencing the following warning signs of stroke should seek medical care immediately:

• The face, mouth, and eye droop on one side.

• Inability to smile.

• Arm numbness or weakness. Inability to lift both arms and keep them there.

• Slurred or garbled speech.

• Confusion.

• Difficulty understanding speech.

• Difficulty walking.

• Dizziness and loss of balance or coordination.

• Unconsciousness or fainting.

• Severe headache.

What Is Unstable Angina?

Unstable angina (chest pain) is also known as acute coronary syndrome. It presents as worsening or persistent pain in the chest or chest discomfort, often during rest. The coronary arteries supply blood to the heart. When blocked by fatty build-ups or clots, blood flow to the heart is reduced or cut off. Unstable angina requires emergency care. It puts the person at risk of life-threatening cardiac arrests and heart attacks. Immediate medical attention to unstable angina can help prevent progression to other heart emergencies and save lives. Unstable angina must be suspected if the chest discomfort or pain:

• Occurs during rest or sleep.

• It is unexpected (during little physical activity).

• It is persistent.

• Worsens with time.

• Does not go with rest or medicine.

What Is a Heart Failure?

Coronary artery diseases, heart attacks, heart valve diseases, high blood pressure, and alcohol and drug abuse can cause heart failure (congestive heart failure). Heart failure can be chronic (long-standing) or acute (sudden onset). It is a heart condition where the heart cannot pump blood efficiently to other body parts. As a result, the heart’s wall becomes thick or thin to normalize blood flow. In addition, the pressure in the heart increases over time, leading to fluid retention in the legs (lower body parts). Shortness of breath is also commonly seen in heart failure patients as the blood backs up to the lungs, causing fluid build-up. Proper treatment and lifestyle changes can improve the signs and symptoms of chronic heart failure. But acute heart failure with sudden severe symptoms is life-threatening and requires immediate medical attention. Emergency medical care is essential in case of:

• Pain in the chest.

• Unconsciousness (fainting).

• Sudden and severe breathlessness or shortness of breath.

• Sudden and severe cough (with foamy, white, or pink mucous).

• Fluttering heart (rapid irregular heartbeat).

• Severe fatigue and weakness.

What Is a Hypertensive Emergency?

An acute elevation in blood pressure with end-organ compromise (damage) is considered a hypertensive emergency. The systolic blood pressure is greater than 180 millimeters of mercury (180 mmHg), and the diastolic blood pressure is greater than 120 millimeters of mercury (120 mmHg) in a hypertensive emergency. The major organs such as the heart, kidney, brain, and eyes are damaged due to high blood pressure leading to health emergencies related to these organ systems. Hypertensive emergencies result from the acute exacerbation of chronic uncomplicated hypertension or can be secondary to other conditions such as kidney diseases, nerve, and vascular conditions, pregnancy, medications, and hormonal and autoimmune problems. Hypertensive emergencies require immediate medical attention as they can cause strokes, heart attacks, and other health emergencies.

Conclusion:

Cardiovascular emergencies such as heart attacks, cardiopulmonary arrests, unstable angina, hypertensive emergencies, and shock are life-threatening. The cornerstone of emergency management in cardiovascular emergencies is time. If a heart-related emergency is suspected, quick action is mandatory. It is advisable to call for emergency care as soon as possible to improve survival. Every minute delay in medical treatment reduces the chance of survival and recovery. To enhance the chance of survival in a cardiovascular emergency, seek immediate medical attention and initiate prompt cardiopulmonary resuscitation (only when trained) till medical help arrives. Advanced emergency medical treatment in a hospital setup on time without delay can save lives and prevent disabilities.