Glossary of Terms

A

 

Acute

A disease or condition that starts suddenly and may be severe. It is usually of short duration but could cause long-lasting or chronic problems.

Acute Coronary Syndrome (ACS)

Acute coronary syndrome is an umbrella term for when blood supplied to the heart muscle is decreased or blocked, leading to a heart attack. The common signs of acute coronary syndrome are chest pain or discomfort, which may involve pressure, tightness or fullness; pain or discomfort in one or both arms, the jaw, neck, back or stomach; shortness of breath; feeling dizzy or lightheaded; nausea; or sweating.

Advanced Airway

An advanced airway requires special training to insert and is more invasive than a mask. It is used to deliver oxygen or connected to a bag or machine to provide ventilation.

Angiotensin-converting enzyme (ACE) inhibitor

Angiotensin-converting enzyme inhibitors, also called ACE inhibitors, are drugs used to treat high blood pressure and heart failure. ACE inhibitors alter the body's ability to produce angiotensin II, a hormone that causes the arteries to narrow. By blocking the making of angiotensin, these drugs help the blood vessels relax and widen, which lowers blood pressure, increases blood flow to the heart and reduces the heart's workload.

Angiotensin II receptor blocker (ARB)

Angiotensin II receptor blockers, also called ARBs, are drugs used to treat high blood pressure and heart failure. They block the effects of angiotensin II, a hormone that causes the arteries to narrow. By relaxing arteries, blood flow to the heart increases, blood pressure goes down and the heart's workload is reduced. Angiotensin II receptor blockers are often used in patients who cannot tolerate ACE inhibitors.

Angiotensin-Receptor Neprilysin Inhibitors (ARNI)

ARNIs are a new drug combination of a neprilysin inhibitor and an ARB used to treat heart failure. Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By inhibiting (or limiting) the effect of neprilysin, this drug increases the effects of these natural substances and improves artery opening and blood flow, reduces sodium (salt) retention, and decreases strain on the heart.

Anticoagulant

Anticoagulants (sometimes known as “blood thinners”) are medicines that delay the clotting of blood. They are used to treat certain blood vessel, heart and lung conditions. They are also given to some people at high risk for blood clots, including those with atrial fibrillation or artificial heart valves. Anticoagulants make it harder for clots to form or keep existing clots from growing in your heart, veins or arteries. Blood clots can block the blood flow to your heart muscle and cause a heart attack. They can also block blood flow to your brain, causing a stroke.

Antiplatelet

Platelets are small particles in the blood that can clump together to form blood clots. These blood clots can lead to a heart attack or stroke. Antiplatelet medications help stop blood clots from forming by preventing platelets from sticking together.

Antithrombotic

Antithrombotics is a category of medications, including antiplatelets and anticoagulants, that prevent blood clots from forming in your arteries.

Aortic Aneurysm

Also called abdominal aortic aneurysm, occurs when the large blood vessel (the aorta) that supplies blood to the abdomen, pelvis and legs becomes abnormally large or balloons outward. This type of aneurysm is most often found in men over age 60 who have at least one or more risk factor, including emphysema, family history, high blood pressure, high cholesterol, obesity and smoking.

Artery

One of a series of vessels that carry oxygenated blood from the heart to the various parts of the body. The thick elastic walls expand as blood flows through the arteries.

Asystole

Asystole is a life-threatening heart rhythm characterized by an absence of electrical activity. Because there is no electrical activity, there is no heartbeat. This condition can lead to death if it's not treated and reversed immediately.

Atherosclerotic Cardiovascular Disease (ASCVD)

Includes acute coronary syndrome (ACS), those with history of myocardial infarction (MI), stable or unstable angina or coronary or other arterial revascularization, stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD) including aortic aneurysm, all of atherosclerotic origin.

Arterial Revascularization

A procedure to restore blood supply to a body part or organ that has suffered inadequate blood supply or ischemia.

Atrial Fibrillation (AFib)

In atrial fibrillation (AFib), the heart’s two small upper chambers (atria) don’t beat the way they should. Instead of beating in a normal pattern, the atria beat irregularly and too fast, quivering like a bowl of gelatin. Blood that isn't pumped completely out of the atria when the heart beats may pool and clot. If a piece of a clot enters the bloodstream, it may lodge in the brain causing a stroke.

Atrial Flutter

Atrial flutter is a very rapid beating of the heart's upper chambers, or atria. It typically is not a stable rhythm and may lead to atrial fibrillation. Atrial flutter occurs most often in people who have heart disease.

B

 

Beta Blocker

Beta blockers are drugs that slow the heartbeat, lessen the force with which the heart muscle contracts and reduce blood vessel contraction in the heart, brain and throughout the body to relieve stress on the heart.

C

 

Cardiac Arrest [or Cardiopulmonary Arrest (CPA)]

Cardiac arrest, also known as sudden cardiac arrest, occurs when the heart's electrical system malfunctions and the heart suddenly stops beating, often without warning. Cardiac arrest is often fatal, if appropriate steps aren’t taken immediately.

Cardiac Monitor

A medical device used to observe and record the heart rate and electrical activity to determine baseline values and identify any variations or other abnormal cardiac activity.

Cardiac Rehabilitation

Cardiac rehabilitation is a professionally supervised program to help people recover from heart attacks or surgery to the heart. Cardiac rehabilitation programs usually provide education and counseling services to help survivors increase physical fitness, reduce cardiac symptoms, improve health and reduce the risk of future heart problems.

Cardiopulmonary Resuscitation (CPR)

CPR is an emergency lifesaving procedure performed when a person stops breathing or the heart stops beating. It can be performed as Hands-Only CPR, with rapid compressions on the chest; or it can be performed as chest compressions and mouth-to-mouth breathing. Immediate CPR can double or triple chances of survival after sudden cardiac arrest. The American Heart Association develops CPR guidelines and techniques, and is a leader in CPR training.

Cardiovascular

Cardiovascular is a medical term that means pertaining to the heart and blood vessels. The circulatory system of the heart and blood vessels is the cardiovascular system.

Cardiovascular disease

Cardiovascular disease is a term that refers to the entire group of heart and blood vessel diseases. Cardiovascular diseases include heart attack, heart rhythm disorders, atrial fibrillation, and several other conditions.

CHA2DS2-Vasc risk score

The CHA2DS2-VASc score is a risk factor scoring system used for patients with atrial fibrillation that allows health care professionals to quickly assess, interpret and explain the patient’s stroke risk and the recommended therapy, in particular, whether or not anticoagulant medication is needed. The CHA2DS2-VASc score assigns points for each risk factor assessed. The more points on the CHA2DS2-VASc score, the higher the annual stroke risk in general.

Chest compressions

Chest compressions are used to manually pump blood through the heart of someone who has suffered sudden cardiac arrest. Compressions are part of Hands-Only CPR®, which should begin as soon as possible and be continued until more advanced treatment can be started.

Cholesterol

Cholesterol is a waxy substance that circulates in the blood, and when cholesterol levels rise so does the risk for heart disease and stroke. Together with other substances, cholesterol can form a thick, hard deposit that can narrow the arteries and make them less flexible. If a clot forms and blocks a narrowed artery, a heart attack or stroke may result. There are two types of cholesterol: "bad" and "good." LDL cholesterol is the bad kind. HDL is the good kind. Too much of the bad kind — or not enough of the good kind — increases the risk for heart attack, stroke and peripheral vascular disease. Cholesterol comes from the body (specifically your liver) or from foods from animals.

Composite Score

A combination of two or more component measures, each of which individually reflects quality of care, into a single performance measure with a single score.

Congestive Heart Failure

Also called heart failure, congestive heart failure is when the heart can't pump enough blood to the organs. The heart works, but not as well as it should. Heart failure is almost always a chronic, long-term condition. The older you are, the more common congestive heart failure becomes. Your risk also rises if you are overweight, diabetic, smoke, abuse alcohol or use cocaine. When a heart begins to fail, fluid can pool in the body; this manifests as swelling (edema), usually in the lower legs and ankles. Fluid also may collect in the lungs, causing shortness of breath. The most common cause of heart failure is coronary artery disease (CAD).

Contraindication

A symptom or medical condition that makes a particular treatment or procedure inadvisable because a person is likely to have a bad reaction. For example, having a bleeding disorder is a contraindication for taking aspirin because treatment with aspirin may cause excess bleeding.

Coronary Artery

The coronary arteries are the two arteries arising from the aorta. They arch down over the top of the heart and branch out in additional arteries that provide blood to the heart muscle

Coronary Artery Disease (CAD)

Also called coronary heart disease, coronary artery disease is the most common type of heart disease. It is when plaque builds up in the heart's arteries, a condition called atherosclerosis. As plaque builds up, the arteries narrow, making it more difficult for blood to flow to the heart. If blood flow becomes reduced or blocked, angina (chest pain) or a heart attack may occur. Over time, coronary artery disease can also lead to heart failure and arrhythmias.

D

 

Defibrillation

Defibrillation involves the use of an electrical device to give an electric shock and help restore a normal heartbeat. It is used in cardiac arrest and for dangerous arrhythmias, or abnormal rhythms.

Dual Antiplatelet Therapy (DAPT)

Platelets are small particles in the blood that can clump together to form blood clots. These blood clots can lead to a heart attack or stroke. Antiplatelet medications help stop blood clots from forming by preventing platelets from sticking together. Many heart attack and stroke patients are treated with two types of antiplatelet medications (aspirin and a P2Y12 inhibitor) to prevent blood clotting and help prevent a future heart attack or stroke. This is called dual antiplatelet therapy (DAPT).

E

 

Echocardiogram

An echocardiogram (echo) is a test that uses high frequency sound waves (ultrasound) to make pictures of your heart. The test is also called echocardiography or diagnostic cardiac ultrasound. An echo can show: The size and shape of the heart How well the heart is working overall If a wall or section of heart muscle is weak and not working correctly If there are problems with the heart’s valves If there is a blood clot

Electrocardiogram (ECG)

An electrocardiogram — abbreviated as EKG or ECG — is a test that records the electrical activity of the heart including the timing and duration of each electrical phase in a heartbeat. An ECG is the standard clinical tool for diagnosing arrhythmias (abnormal rhythms) and to check if the heart is getting enough blood or if areas of the heart are abnormally thick.

Endotracheal tube (ET)

A hollow tube that is directed into the trachea from the mouth or through the nose. Endotracheal tubes are used to open the airway to allow air to move into and out of the lungs. If the patient is not breathing on their own, the tube may be connected to a bag or mechanical ventilator.

Epinephrine

Epinephrine causes blood vessels to constrict, or narrow, which increases blood pressure and can help improve blood flow and oxygen delivery to the heart and brain when a person has a cardiac arrest. It may help improve the chances of having a normal heart rhythm return.

F

 

First Medical Contact (FMC)

First medical contact is the date and time date when the patient was first evaluated by medical personnel for an acute problem, such as, a heart attack or stroke. This may be the time the patient was first evaluated by emergency medical services (EMS), if 911 was called, or the time first evaluated by a health care provider in a outpatient clinic or the emergency room of a hospital, if the patient was not transported by EMS.

H

 

Heart Attack (or Myocardial Infarction)

A heart attack occurs when the blood flow to a part of the heart is blocked (often by a blood clot). This happens because coronary arteries that supply the heart with blood slowly become thicker and harder from a buildup of fat, cholesterol and other substances, called plaque. If the plaque breaks open and a blood clot forms that blocks the blood flow, a heart attack occurs. If the blocked artery is not reopened quickly, the part of the heart normally supplied by that artery begins to die. The longer a person goes without treatment, the greater the damage.

Heart Failure

See congestive heart failure

Hemorrhagic Stroke

A hemorrhagic stroke, also called a brain or cerebral hemorrhage, occurs when a weakened blood vessel or an aneurysm bursts in the brain, causing bleeding inside the brain. The blood accumulates and compresses the surrounding brain tissue. Hemorrhagic stroke can also be caused by a head injury. It is different from a subarachnoid hemorrhage, which occurs when a blood vessel on the brain's surface ruptures and bleeds into the space between the brain and the skull.

Hospital ward

A hospital ward is a part or unit of a hospital that provides care to adult patients with a variety of general medical needs.

I

 

Intensive Care Unit

An intensive care unit is a specialized area within a hospital that is equipped with monitoring devices and staff who are specifically to treat patients who are seriously injured or ill.

International Normalized Ratio (INR)

The blood test used to measure the time it takes for blood to clot is referred to as a prothrombin time test, or protime (PT). The PT is reported as the International Normalized Ratio (INR). The INR is a standardized way of expressing the PT value. The INR ensures that PT results obtained by different laboratories can be compared. It is important to monitor the INR (at least once a month and sometimes as often as twice weekly) to make sure that the level of warfarin remains in the effective range. If the INR is too low, blood clots will not be prevented, but if the INR is too high, there is an increased risk of bleeding. This is why those who take warfarin must have their blood tested so frequently.

Intraosseous (IO)

Injection directly into the marrow of a bone. This provides a non-collapsible entry point into the systemic venous system. This technique is used to provide fluids and medication when intravenous access is not available or not feasible.

Intravenous (IV)

Administration of a drug within or into a vein or veins. Giving a drug directly into a vein provides a precise and continuous dose of medication.

Ischemia

A condition in which the blood flow (and thus oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is the name for decreased blood flow and oxygen to the heart muscle.

Ischemic Stroke

Ischemic stroke occurs when a blood clot or other particle blocks an artery in the brain or an artery leading to the brain. This causes brain cells to die or be injured. Fatty deposits lining the vessel walls, called atherosclerosis, are the main cause for ischemic stroke. Fatty deposits can cause two types of obstruction: Cerebral thrombosis is a thrombus (blood clot) that develops at the fatty plaque within the blood vessel. Cerebral embolism is a blood clot that forms at another location, usually the heart or large arteries of the upper chest and neck. Part of the blood clot breaks loose and travels through the brain’s blood vessels until it reaches vessels too small to let it pass. A main cause of embolism is an irregular heartbeat called atrial fibrillation, which can cause clots to form in the heart that break loose and travel to the brain.

L

 

Laryngeal mask airway (LMA)

A supraglottic airway device that is composed of an airway tube that connects to an inflatable elliptical mask on the distal end which is inserted through the patient's mouth, down the trachea, and inflated to form an airtight seal on top the glottis.

Left Ventricular Systolic Dysfunction (LVSD)

Left Ventricular Systolic Dysfunction is when the left ventricle (lower chamber of the heart) is not contracting efficiently and, therefore, not pumping out as much blood as normal with each heartbeat.

Left Ventricular Ejection Fraction (LVEF)

Left Ventricular Ejection Fraction measures the percentage of blood that is pumped out of the left ventricle (lower chamber) with each heartbeat. During each heartbeat, the heart contracts and relaxes. The heart never empties all of the blood from the lower ventricles. Ejection fraction is usually measured in the left ventricle because it is the heart's main pumping chamber. A normal ejection fraction in a person at rest is typically between 55 and 70 percent. If the heart muscle has been damaged by heart attack, heart muscle disease or heart valve problems, the ejection fraction may be below normal.

M

 

Myocardial Infarction (MI) (or heart attack)

A heart attack occurs when the blood flow to a part of the heart is blocked (often by a blood clot). This happens because coronary arteries that supply the heart with blood slowly become thicker and harder from a buildup of fat, cholesterol and other substances, called plaque. If the plaque breaks open and a blood clot forms that blocks the blood flow, a heart attack occurs. If the blocked artery is not reopened quickly, the part of the heart normally nourished by that artery begins to die. The longer a person goes without treatment, the greater the damage.

N

 

Non-ST-elevation Myocardial Infarction (NSTEMI or NSTE-ACS)

A non-ST-elevation Myocardial Infarction (NSTEMI) is a heart attach that doesn’t produce elevations in the ST segment as measured on an ECG. NSTEMI’s are caused by a partial blockage in one or more of the arteries supplying the heart muscle. Treatments for a STEMI versus NSTEMI differ, but there can be some overlap.

P

 

P2Y12 inhibitor

P2Y12 Inhibitors are medications that keep blood clots from forming. If you had a heart attack and a coronary artery stent placed, or if you had a non-ST elevation myocardial infarction (NSTEMI) and are being medically managed (no surgery or PCI) for your heart attack you should be taking aspirin and you should also be on a P2Y12 inhibitor for approximately 6-12 months. In some cases, your doctor may recommend you stay on both medications for longer.

Percutaneous Coronary Intervention (PCI)

The arteries in the heart can become blocked or narrowed from a buildup of cholesterol, cells or other substances (plaque). This can reduce blood flow to the heart and cause chest discomfort or a heart attack. A PCI (also called an angioplasty) opens blocked arteries and restores normal blood flow to the heart muscle. It is done by threading a catheter (thin tube) through a small puncture in a leg or arm artery to the blocked artery in the heart. The blocked artery is opened by inflating a tiny balloon . It pushes plaque to the side and stretches the artery open, so blood can flow more easily. This may be done more than once. In many patients a wire mesh tube (stent) is inserted in the artery to help keep the artery open. The stent is left there permanently.

Peripheral Artery Disease/Peripheral Vascular Disease (PVD)

Peripheral artery disease (PAD) is the narrowing of the arteries to the legs, stomach, arms and head. PAD (also called PVD, or peripheral vascular disease) is most common in the arteries in the pelvis and legs. It is a form of atherosclerosis (cholesterol build-up) caused by the collection of fatty deposits and other substances in the arteries.

Positive Pressure Ventilation

Positive pressure ventilation is when a mechanical ventilator is used to force air into the lungs of a patient who is not breathing. It may be done with mask or via an endotracheal tube.

Primary PCI

A primary PCI is an emergent PCI performed as the initial or only treatment to reopen a blocked artery and restore blood flow to the heart muscle when a patient is having an acute ST-elevation myocardial infarction (STEMI).

Prophylaxis

Preventive treatment.

Prothrombin Time (PT)

See International Normalized Ratio

Pulse Oximetry

Pulse oximetry is a non-invasive method (a small device is placed on the patient’s fingertip) that uses wavelengths of light to estimate the oxygen concentration in the blood. It also measures heart rate.

Pulseless Electrical Activity (PEA)

Pulseless electrical activity (PEA) often occurs in patients who have a cardiac arrest. In PEA, the ECG shows electrical activity in the heart, but no pulse can be felt. Even though there is electrical activity, either the heart does not contract or there is not enough blood being pumped out to produce a pulse.

Pulseless Ventricular Tachycardia

Pulseless ventricular tachycardia is when there is a heart rate of > 150 beats per minute recorded on an ECG, but no pulse can be felt. This occurs because the ventricles (lower chambers) of the heart are not effectively pumping blood out of the heart and therefore is not producing a detectable pulse.

R

 

Receiving Center

A Receiving Center is a hospital with 24/7 capability to perform PCI for patients with STEMI. Because primary PCI is the preferred strategy to reopen blocked arteries when a patient is having a heart attack, hospitals without this capability (Referring Hospitals) should transfer patients with a STEMI to a Receiving Center if it can be done within 2 hours of first medical contact.

Referring Hospital

Hospitals without 24/7 capability to perform PCI. Because primary PCI is the preferred strategy to reopen blocked arteries when a patient is having a heart attack, hospitals without this capability should transfer patients with a STEMI to a Receiving Center if it can be done within 2 hours of first medical contact.

Resuscitation

Measures performed on a person who has had a cardiac arrest to restore cardiac function.

S

 

Statin

Statins are drugs used to reduce elevated cholesterol levels. High cholesterol is associated with increased risk of cardiovascular disease. Statins work in the liver to prevent cholesterol from forming.

ST-elevation Myocardial Infarction (STEMI)

A ST-elevation Myocardial Infarction (STEMI) is a heart attack that produces elevations in the ST segment as measured on an ECG. STEMI’s are caused by a complete blockage in one or more of the arteries supplying the heart muscle. Treatments for a STEMI versus NSTEMI differ, but there can be some overlap.

Stroke

A stroke occurs when a blood vessel that feeds the brain gets blocked or bursts. Then that part of the brain can’t work and neither can the part of the body it controls. Major risk factors for stroke include:

• High blood pressure
• Smoking
• Diabetes
• High cholesterol
• Heart disease
• Atrial fibrillation (abnormal heart rhythm)

T

 

Thrombolytic

Thrombolytics are drugs that break up blood clots. They are used in patients having an ischemic stroke or a heart attack to break up the clot that is blocking an artery and restore blood flow to the brain or heart.

Trachea

The airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs).

Tracheostomy tube

A hollow tube that is inserted in a surgically created opening into the trachea and is used to create an airway, to deliver oxygen or may be connected to a mechanical ventilator for a patient who is not breathing on their own.

Transient Ischemic Attack (TIA)

Just as with a stroke, a Transient Ischemic Attack (TIA) is caused by a clot blocking blood flow to the brain. The only difference is, with a TIA, the blockage is temporary, usually less than five minutes. Typically, there is no permanent brain injury.

U

 

Unmonitored hospital bed

A part or unit of a hospital that provides care to adult patients with a variety of general medical needs, but does not provide cardiac monitoring.

Unstable Angina

Sometimes referred to as acute coronary syndrome, causes unexpected chest pain, and usually occurs while resting. The most common cause is reduced blood flow to the heart muscle because the coronary arteries are narrowed by fatty buildups (atherosclerosis) which can rupture causing injury to the coronary blood vessel resulting in blood clotting which blocks the flow of blood to the heart muscle.

V

 

Venous Thromboembolism (VTE)

Venous thromboembolism (VTE) is a blood clot that starts in a vein. There are two types: Deep vein thrombosis (DVT) — is a clot in a deep vein, usually in the leg, but sometimes in the arm or other veins. Pulmonary embolism (PE) — occurs when a DVT clot breaks free from a vein wall, travels to the lungs and blocks some or all of the blood supply. Blood clots in the thigh are more likely to break off and travel to the lungs than blood clots in the lower leg or other parts of the body. DVTs form in the legs or arms when something slows or changes the flow of blood. The most common triggers for DVT and PE are surgery, cancer, immobilization (as may occur after a stroke) and hospitalization.

Ventilation

A method to mechanically assist or replace spontaneous breathing in patients by use of a powered device that forces oxygenated air into the lungs.

Ventricular Fibrillation (VF)

Ventricular fibrillation, or V-fib, is considered the most serious cardiac rhythm disturbance. Disordered electrical activity causes the heart’s lower chambers (ventricles) to quiver, or fibrillate, instead of contracting (or beating) normally. This keeps the heart from pumping blood, causing collapse and cardiac arrest. This type of arrhythmia is a medical emergency. It’s life-threatening.

Ventricular Tachycardia (VT)

Ventricular tachycardia is a fast heart rate that starts in the heart’s lower chambers (ventricles). Electrical signals in the heart’s lower chambers fire abnormally. causing a faster than normal heart rate. This rapid heartbeat keeps the heart’s chambers from filling completely between contractions, which decreases blood flow to the rest of the body. The seriousness depends largely on whether other cardiac problems are present and on the degree of the ventricular tachycardia. It may be well-tolerated or life-threatening, requiring immediate diagnosis and treatment.

W

 

Witnessed cardiac events

Changes on a cardiac monitor or patient collapse caused by a cardiac arrest observed directly by a health care provider or bystander