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Inside the Operating Room: Heart Attacks, Strokes, and Falls Presentation by: Stephanie Scully, RN BSN CHR Cardiac Operating Room NCP Health Ministry Chair

Inside the Operating Room: Heart Attacks, Strokes, and Falls

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Inside the Operating Room: Heart Attacks, Strokes, and Falls. Presentation by: Stephanie Scully, RN BSN CHR Cardiac Operating Room NCP Health Ministry Chair. Objectives. To discuss three of the most common causes of death in the elderly population - PowerPoint PPT Presentation

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Inside the Operating Room: Heart Attacks,

Strokes, and Falls

Presentation by: Stephanie Scully, RN BSN

CHR Cardiac Operating RoomNCP Health Ministry Chair

Objectives

To discuss three of the most common causes of death in the elderly population

To describe heart attacks, strokes, and falls and how they occur

To demonstrate what surgical interventions are available to treat heart attacks, strokes, and falls

What are the Top Causes of Death Amongst the Elderly Population?

Heart Disease Cancer Stroke COPD Flu/ Influenza Diabetes Injuries

Topics We Will Focus On Today

Heart Attacks

Strokes

Falls

HEART ATTACKSaka Myocardial Infarction (MI)

Heart Attack Prevalence Heart disease and cancer

› Leading causes of death for >65 for 2 decades

35% of all deaths are due to heart disease, including heart attacks and chronic ischemic heart disease

What is a Heart Attack? Damage and death of

heart muscle from the sudden blockage of a coronary artery by a blood clot

Sudden blockage= blood and oxygen deprivation-> injury to the heart muscle= chest pain and chest pressure

How do these blockages occur?

Coronary arteries provide heart with blood Blood= oxygen and nutrients CAD= Coronary Artery Disease

› Fatty matter, calcium, proteins, inflammatory cells= plaque

› Plaque is hard on the outside, mushy on the inside When the plaque is hard, outer shell cracks=

plaque rupture -> platelets form around rupture = blood clot

**Total or near-total occlusion by blood clot = heart attack

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What are the symptoms of a Heart Attack?

Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone

Discomfort radiating to the back, jaw, throat, or arm

Fullness, indigestion, or choking feeling Sweating, nausea/ vomiting, or dizziness Weakness, anxiety, or shortness of breath Rapid or irregular heartbeat*No symptoms= silent heart attack

Time is of the Essence Why is time important

in treatment of heart attacks?› 20-40 minute window

Lack of blood flow restoration= irreversible death of the heart muscle begins

› Muscle continues to die for 6-8 hours, or until the heart attack usually is "complete.“

What is the damage?

Amount of damage depends on size of area supplied by the blocked artery and time between injury and treatment

Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. › Scar tissue will form in the damaged area› Scar tissue does not contract= the heart's

pumping ability is lessened after a heart attack

How do we minimize damage during Heart Attacks?

Medications› Aspirin

Prevent additional clotting Heart Codes

› Cardiac Catheterizations Angioplasty and stenting

› Surgical intervention Coronary Artery Bypass Grafting (CABG)

Depending upon blockage location and severity

Coronary Artery Bypass Grafting

CABG is one treatment for CAD› A healthy artery or vein from the body is

connected, or grafted, to the blocked coronary artery.

› The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery.

› This creates a new path for oxygen-rich blood to flow to the heart muscle.

Surgeons can bypass multiple coronary arteries during one surgery.

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CABG Surgery

Benefits of CABG Surgery

Results are usually excellent Improves or completely relieves angina

symptoms Most people remain symptom-free for as

long as 10 - 15 years May lower your risk of having a heart

attack and help you live longer You may need repeat surgery if blockages

form in the grafted arteries or veins or in arteries that weren't blocked before.

After CABG Surgery Treatments do not cure

CAD It CAN happen again

› Take medicines Reduce blood pressure Relieve work of heart Prevent blood clots Lower cholesterol

› Make lifestyle changes Dietary changes Exercise Quit smoking

STROKEaka Cerebrovascular Accident (CVA)

Stroke Prevalence The third leading cause of death in

America is stroke Strokes are debilitating and lethal Stroke kills almost 130,000 Americans

each year—that’s 1 out of every 19 deaths.

On average, one American dies from stroke every 4 minutes.

Every year, more than 795,000 people in the United States have a stroke.

What is a Stroke? A stroke occurs when the blood supply

to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food.

Within minutes, brain cells begin to die. Strokes are treatable and preventable

What are the Signs of Stroke?

Sudden severe headache Weakness Numbness Vision problems Confusion Trouble walking Difficulty talking Dizziness Slurred speech

Different Types of Strokes When blood supply to

the brain is interrupted or reduced-> oxygen and nutrient deprivation= brain cell death

Two types› Ischemic stroke ->

blocked artery› Hemorrhagic stroke ->

leaking or burst blood vessel

Ischemic Stroke

85% of strokes are ischemic› Occur when one or both carotid arteries (supplying the brain with blood) become narrowed or blocked= severely

reduced blood flow (ischemia) Thrombotic stroke

› A blood clot (thrombus) forms and blocks vessel› Blood clot= fatty deposits (plaque)

Embolic stroke › A blood clot or other debris is swept through your

bloodstream to lodge in narrower brain arteries This type of blood clot is called an embolus.

Thrombotic vs. Embolic Strokes

Time is of the Essence

A stroke is a MEDICAL EMERGENCY

Prompt treatment is crucial to survival

Early action can minimize brain damage and potential complications

Interventions for Ischemic Stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.

Medications › TPA- Clot buster

Within 4.5 hours› Aspirin

Reduce additional clotting Emergency procedures

› Catheter- administered TPA Directly into the area where the stroke is occurring

› Mechanical clot removal= = thrombectomy› Angioplasty and stenting the carotid artery› Carotid endarterectomy

Carotid Endarterectomy (CEA)

Surgical removal of plaque from arteries that run along each side of your neck to your brain (carotid arteries)

May be done for someone that had a stroke, or someone at high risk for stroke› Determined by vascular ultrasound

Steps include: › Incision along side of neck› Opens up carotid artery› Blood may be rerouted temporarily through a shunt› Scrape out plaque› Stitch or patch artery shut› Close incision

Carotid Endarterectomy

When Surgery is Most Beneficial

CEA can be done several months after a stroke or TIA

Most benefit from the surgery within 2 weeks of the stroke or TIA

> 2 week surgery delay increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.

Benefits of a CEA

Symptomatic patients with blockages of 70% or more benefit greatly

Less than 50% narrowing of the carotid do not seem to benefit from surgery

CEA works better than treatment with medicine alone in preventing stroke › (For people who have symptoms that can

be attributed to a 70% to 99% blockage of the carotid arteries)

After Carotid Surgery

Medications› Aspirin› Anti-platelet (prevent clots)› Cholesterol lowering

Exercise Diet

› Low fat, low cholesterol Quit Smoking

Falls

Prevalence of Falls

Falls are one of the top causes of death among people 65 years of age and older

One in three older adults falls every year› Less than half report it

Falls are the leading cause of both fatal and nonfatal injuries in older adults

In 2010, the direct medical costs of falls was $30 billion

The Truth about Falls

A fall can change your life Falls lead to:

› Disability› Loss of independence› Breaking bones and hips

Falls seldom “just happen’› Preventing falls is important

Regular eye exams Eliminating tripping hazards Wearing non-skid shoes Using assistive deices

Falls Lead to Fracture, Trauma

Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries.

Falls are the number one cause of fractures in older adults

Fall- related Fracture injuries:› Hip› Pelvis› Spine› Arm › Hand › Ankle

Hip Fractures

One of the most serious types of fall injuries Leading cause of injury and loss of independence among older adults Healthy, independent older adults may

be able to return home or live on their own after treatment and rehab

Long term care is always necessary

What is a Hip Fracture?

A hip fracture is a break in the upper quarter of the femur (thigh) bone

The extent of the break depends on the forces that are involved

Type of surgery required› Bones and soft tissues involved› Level of fracture

What causes a hip fracture?

Most commonly from a fall or from a direct blow to the side of the hip

Some medical conditions increase susceptibility › Osteoporosis› Cancer› Stress injuries

In severe cases, standing on a leg and twisting

Surgical Treatment for Hip Fractures

Type of surgery depends on location, severity, and age› Repair with hardware

Metal screws into bone to hold it together until healed Screws to metal plates along bone Rods down center of bone through marrow (aka nails)

› Replace femur Partial hip replacement

If ends aren’t properly aligned, head and neck of femur removed and replaced

› Replace hip joint Total hip replacement

Replace upper femur and socket in pelvis

**If blood supply to ball joint is damaged, bone healing compromised-> hip replacement necessary

Hip Fracture Repair

Hip Fracture Repair

After Hip Repair/ Replacement

Take medications› Pain› Clot prevention

Rehabilitation› Programs available

Lifestyle adjustment› Long-term care and

rehab› Assistive devices

Future fall prevention

Preventing Falls Preventing falls is key to older adults

› Exercise regularly Leg strength increases, balance improves

› Review medications Dizziness side effect

› Regular eye exams Maximizes vision during age-related changes

› Lower hip fracture risk Enhance calcium and vitamin D intake Weight bearing exercises Screening and treatment for osteoporosis

References

http://www.cdc.gov/nchs/data/ahcd/agingtrends/01death.pdf

www.webmd.com www.medicinenet.com https://www.nhlbi.nih.gov/health/health

-topics www.mayoclinic.com www.stoke.org http://www.nlm.nih.gov/medlineplus http://nihseniorhealth.gov