EMT-Basic Exam: The Basics of Medical Emergencies - Cardiovascular Emergencies

This section of the EMT-Basic exam covers emergency situations related to the heart and cardiovascular system. Possible question topics include signs of angina, heart attack, and ischemia. You may also encounter questions related to OPQRST, ventricular defibrillation, caring for the patient, administering nitroglycerin, and using an automated external defibrillator.

1. Signs of Angina or Heart Attack
Angina is chest pain that occurs when blood flow to the heart muscle is reduced. Angina pain is commonly described as heaviness, tightness, squeezing, or pressure in the chest. There are three forms of angina:
- Stable angina is a persistent, recurrent chest pain that is often brought on by exertion. Stable angina can sometimes be relieved by rest or the use of nitroglycerin.
- Unstable angina, which is the most dangerous form of angina, is not related to exertion and has an unpredictable pattern. It’s often a signal of an impending heart attack.
- Variant angina is caused by a coronary artery spasm and usually occurs without exertion. Variant angina often presents with particularly severe symptoms.

Tip: Angina alone doesn’t cause damage to the heart muscle.
A heart attack occurs as a result of a blood vessel blockage in the heart. The muscle tissue around the blockage loses blood flow and becomes oxygen deprived. This results in physical damage to the heart muscle.
Patients suffering from angina or a heart attack are experiencing cardiac compromise and may exhibit a variety of symptoms that include chest pain, excessive or sudden sweatiness, breathing difficulties, abnormal or irregular pulse rate, abnormal blood pressure, abdominal or epigastric pain, nausea, and vomiting. Patients may also become irritable or anxious.

2. Ischemia
Ischemia is a drop in the supply of blood to tissues, organs, or other body parts. It’s frequently caused by blood vessel constriction or obstruction. During cardiac compromise, ischemia occurs when a section of heart muscle is not being supplied with enough oxygen for adequate function. This leads to the onset of angina.

3. OPQRST Questions
The OPQRST questions are a series of questions that EMT-Basics commonly use to assess patients experiencing cardiac compromise. OPQRST stands for onset, provocation, quality, radiation, severity, and time.
- Onset questions help you determine when the pain began, how long it took for the pain to reach its worst level, and how long the patient has had a cardiac condition.
- Provocation questions are used to determine what the patient was doing when the pain started, what causes the pain to improve or worsen, and whether more pain is experienced upon inhalation or expiration.
- Quality questions help you to determine exactly what the pain feels like to the patient.
- Radiation questions allow EMT-Basics to figure out whether the pain is spreading to other areas of the body outside of the chest.
- Severity questions help to determine how bad the pain is. EMT-Basics will usually ask the patient to rate his or her pain on a scale of 0 to 10, with 0 meaning no symptoms are present and 10 indicating that the patient is in severe pain.
- Time questions allow you to estimate how long the patient has been experiencing chest pain. These questions will also tell you whether the pain has been consistent or intermittent.
The answers to these questions provide you with vital information about the patient’s condition and treatment needs.

4. Defibrillation
Defibrillation is an emergency treatment for patients experiencing a condition called ventricular fibrillation.
Ventricular fibrillation is a form of irregular heartbeat characterized by rapid, electrical impulses. In the event of ventricular fibrillation, heart ventricles quiver helplessly, failing to pump any blood. This causes a severe drop in blood pressure and a loss of blood supply to the organs. This very serious condition can become fatal very quickly.
Defibrillation involves delivering an electrical shock to the heart through the chest wall. This shock temporarily stops the heart and, by extension, the irregular cardiac activity. If successful, this will cause the heart to resume normal function. CPR is also a vital part of the treatment for patients in this condition and is commonly performed along with defibrillation.

5. Automatic External Defibrillator
EMT-Basics may perform defibrillation with an automatic external defibrillator, commonly called an AED. The AED is a computer-controlled defibrillator that requires very little human interaction or decision making. Almost anyone can operate this device. Defibrillation is critical in many cases of cardiac arrest and treatment should be immediate. Because EMT-Basics are not qualified to use a manual defibrillator, the AED makes it possible for EMT-Basics to administer this potentially life-saving treatment even when there are no advanced EMTs on the scene.
There are two types of AEDs: fully automatic and semi-automatic. When using a fully automatic AED, EMT-Basics only need to apply two electrode patches to the patient’s chest, connect the leads, and turn on the AED. The AED then analyzes the patient’s heart rhythm and, if necessary, delivers a shock.
Semi-automatic AEDs require a little more input from the user. After the patches and leads have been attached and the AED is turned on, the user must push a button to analyze the rhythm. The AED will then suggest the best course of action and, if instructed to do so, the EMT-Basic pushes another button to initiate a shock.
Before using an AED, it’s important to be certain that the patient is unresponsive and does not have a carotid pulse. Shocking a patient who has a pulse can lead to ventricular fibrillation or asystole, which is a lack of rhythm that will not respond to further shocks.

6. Administering Oxygen/Positioning Patient
When you confirm that a patient is experiencing cardiac compromise, he or she should be placed in a comfortable position and administered oxygen. Most patients with cardiac or respiratory distress will prefer to sit upright rather than lie down. Once the patient is comfortable, you should administer oxygen. The oxygen should be delivered through a nonrebreather mask at a rate of 15 liters per minute. Because you are attempting to decrease the oxygen demand on the heart with this treatment, the patient should not be allowed to walk or move about.

7. Nitroglycerin
EMT-Basics may administer nitroglycerin tablets or sublingual sprays to patients suffering from chest pain who have a prescription for this drug. Nitroglycerin dilates the blood vessels and decreases the workload of the heart. This may relieve chest pain or discomfort.
Before you administer nitroglycerin, you must determine the patient’s normal dosage and find out how many doses the patient took before you arrived. You should also determine how the medication was taken and what effect it had on the patient. If the patient doesn’t have a nitroglycerin prescription, you should consult with the medical direction physician and wait for approval before administration. After administration, the patient should be reassessed. If there is no change in the patient’s condition, you may administer a second or third dose with approval from the medical direction physician.
Blood pressure should be carefully monitored during nitroglycerin administration. If the patient experiences a sudden drop in blood pressure after nitroglycerin has been administered, you should place the patient in the Trendelenburg position (flat on the back with the feet higher than the head) and reassess his or her vital signs. If systolic blood pressure drops below 100, it’s important to look for signs of shock and treat the patient accordingly. An instance of the systolic blood pressure dropping to this is also an indication to cease nitroglycerin administration.

Related Topics You Should Review:
- Signs of shock
- Cardiovascular anatomy
- Cardiovascular physiology
- CPR