Can you Feel it?

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Can you Feel it?

• Karen George
• Clinical Nurse Advisor/Independent Providers

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Overview of the session

• Atrial Fibrillation
• Early signs and symptoms of stroke and TIA
• Theory of taking a pulse
• Practical session on taking pulses
• Recording findings when to refer

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Atrial Fibrillation

• Karen George
• Clinical Nurse Advisor/Independent Providers

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Learning Outcomes

• Define Atrial Fibrillation (AF)
• Understand the causes of AF
• List some of the common symptoms
• Recognise the complications associated with AF

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Can You Feel it?

• Atrial Fibrillation is the most common heart
  rhythm disturbance and affects up to 500,000
  people in the UK
• AF can affect adults of any age and becomes more
  common the older you get
• In the over 75year- old age group it affects
  about 10 of people
• It accounts directly for over 96,000 hospital
  admissions per year
• It consumes 1 of the NHS total budget
• Left untreated AF can lead to serious
  complications such as heart failure and stroke

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The Heart

• The heart is a muscular organ that generally
  situated in the middle of the chest, slightly
  towards the left
• Structurally, the heart consists of two sides, a
  right and left
• The right side pumps the blood through the lungs
  to collect oxygen before travelling to the left
  side of the heart
• From here it is pumped through the body. To
  return eventually to the right side once more
• Both sides of the heart contract at the same time
  in a single coordinated action to produce a
  heart beat

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What happens in AF?

• When the heart beats normally, its muscular walls
  contract (tighten and squeeze) to force blood out
  and around the body. Then they relax, so that the
  heart can fill with blood again. This process is
  completed every time the heart beats
• In AF, the upper chambers of the heart (the
  atria) contract randomly and sometimes so fast
  that the heart muscle cannot relax properly
  between contractions

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What causes AF?

• High blood pressure
• Coronary heart disease
• Mitral valve disease (caused by rheumatic heart
  disease, valve problems at birth, or infection)
• Congenital heart disease (abnormality of the
  heart present since birth)
• Pneumonia
• Lung cancer
• Pulmonary embolism
• Overactive thyroid

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Symptoms of AF

• Palpitation
• Tiredness
• Shortness of breath
• Dizziness
• Chest pain (angina)
• Low blood pressure
• Heart failure
• Some AF patients have no symptoms at all and it
  is only discovered at a routine medical
  examination

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Complications of AF

• When the atria (upper chambers of the heart) are
  not pumping efficiently, as in AF, there is a
  risk of blood clots forming
• The blood clots may move into the ventricles
  (lower chambers of the heart) and get pumped into
  the lungs or the general blood circulation
• Clots in the general circulation can block
  arteries in the brain, causing a stroke
• The risk of stroke in people with AF is about
  double that of the general population

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Complications of AF

• However the risk depends on a number of factors,
  including
• Your age
• Whether you have high BP
• Heart failure
• Diabetes
• Previous history of embolism

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Early Recognition of a Stroke/TIA

• Karen George
• Clinical Nurse Advisor/Independent Providers

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Learning Outcomes

• Define what a Stroke and TIA is
• Understand the causes of a stroke/TIA
• Recognise the signs and symptoms of a Stroke/TIA
• Understand why recognition of the onset of signs
  and symptoms is essential
• Justify the need to access emergency/urgent
  services for prompt assessment.
• Understand F.A.S.T

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Stroke/TIA causes and risk factors

• High blood pressure
• Cardiovascular disease
• Diabetes
• Age
• Gender
• Ethnic background
• Genetic inheritance

• Smoking
• Unhealthy diet
• Lack of exercise
• Alcohol

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What is a Stroke/TIA?

• A stroke is an attack on the brain.
• It happens when the blood supply to part of your
  brain is cut off.
• For the brain to function, it needs a constant
  blood supply.
• Which supplies vital nutrients and oxygen.
• A stroke happens when the blood supply to part of
  the brain is cut off.
• The brain cells die or are damaged.

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Types of Stroke

• There are two main types of stroke.
• The most common type of stroke (about 80 of
  cases) is caused by a blockage. This is called an
  Ischaemic stroke and may be caused by
• cerebral thrombosis - when a blood clot
  (thrombus) forms in a main artery to the brain.
• cerebral embolism - when a blockage forms in a
  blood vessel somewhere else in the body . Caused
  by a blood clot, air bubble or fat globule
  (embolism) and is carried in the bloodstream to
  the brain.

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Types of Stroke

• The second type of stroke is caused by a bleed
  (in about 20 of cases).
• This is called a Haemorrhagic stroke and happens
  when a blood vessel bursts, causing bleeding
  (haemorrhage) in the brain. May be caused by
• intracerebral haemorrhage, when a blood vessel
  bursts within the brain.
• subarachnoid haemorrhage, when a blood vessel on
  the surface of the brain bleeds into the area
  between the brain and the skull (subarachnoid
  space).

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Transient ischaemic attack (TIA)

• A Transient Ischaemic Attack (TIA) happens when
  your brains blood supply is interrupted for a
  very brief time. This is often called a
  mini-stroke.
• It is an episode where some brain function is
  temporary lost due to a short lived disruption in
  the blood supply to the brain.
• With a TIA, part of your brain goes without
  oxygen for just a few minutes.
• A TIA is a sign that this part of your brain is
  not getting enough blood and that you may be at
  risk of a more serious stroke in the future.

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What are the common symptoms of stroke?

• Sudden, severe headache
• Numbness, weakness or paralysis on one side of
  your body (signs of this may be a drooping arm,
  leg or lower eyelid, or a dribbling mouth)
• Slurred speech or difficulty finding words or
  understanding speech
• Sudden blurred vision or loss of sight
• Confusion or unsteadiness

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Recognition !
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CAN YOU FEEL IT?

• Karen George
• Clinical Nurse Advisor/Independent Providers

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Can You Feel it?
The opportunistic detection of Atrial
Fibrillation (AF) to prevent the risk of stroke
and other serious medical conditions associated
with the presence of AF
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Learning Outcomes

• Understand how to detect a pulse
• Identify /describe a regular pulse
• Identify/ describe an irregular pulse
• Demonstrate manual palpation of a radial pulse
• Explain how to document your residents pulse
  readings
• Identify what action to take when an irregular
  pulse is detected
• Record outcome of action taken

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What is your pulse?

• When the heart beats blood is pushed out of the
  heart into the body causing a bulge in the
  arteries. This bulge of pressure is called a
  pulse, and the pulse can be felt anywhere an
  artery passes close to the skin.
• The pulse indicates the heart rate and the heart
  rhythm. Being aware of your pulse is important
  because it may indicate an abnormal heart rate or
  rhythm. The pulse can be taken in several points
  on your body. Can you name two of the easiest
  places?

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On the wrist between the end of the thumb and
where a watch strap would rest (radial pulse)
On the neck below the earlobe between the muscle
of the neck and the wind pipe (carotid pulse)
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Regular/Irregular Pulse

• The pulse should be regular, i.e. the bulges
  caused by the heart beating occur with the same
  rhythmical timing.
• Irregular pulse when palpated will not have the
  rhythmical timing of the regular pulse and
  therefore should be palpated for longer.
• Bom bom bom bom bom Regular
• Bom bom bombom bom bombom - Irregular

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Why it is important?

• An irregular pulse strongly indicates that the
  heart is not beating in a uniformed way and
  moving the blood through its chambers swiftly,
  this can result in the blood flow becoming
  sluggish and lead to clots which can break loose
  and travel to the brain or to other parts of the
  body.
• Can you think of things that can affect our pulse
  rate?

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What Can affect your pulse rate?

• Age
• Medication
• Caffeine
• Level of fitness
• Anxiety
• Stress
• Exercise

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How to take a Pulse
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How to take a Pulse

• Using three fingers, place them on the inside of
  the wrist between the watch strap and the base of
  the thumb.
• Keep firm pressure on the wrist with your fingers
  in order to feel the pulse.
• The rate of the pulse can be found by counting
  for 60 seconds and multiplying by two, this can
  give the number of beats per minute
• The heart rate naturally varies, depending on
  activity and time of day.
• Normal pulse rate falls between 60 bpm and 100
  bpm.

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GROUP ACTIVITY

• To assess the resting pulse rate in your wrist,
• sit down for 5 mins beforehand. Remember
• that any stimulus taken before the reading
• will affect the rate. You will need a
  watch/clock
• with a second hand.

Bone

• With your hand, place your index
• and middle fingers on your wrist
• at the base of your thumb. Your
• fingers should sit between the bone
• on the edge of your wrist and the
• stringy tendon attached to your thumb.
• Once you have found your pulse, keep
• firm pressure on your wrist with your
• fingers in order to feel your pulse

Pulse
Tendon
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GROUP ACTIVITY

• Count for 30 seconds and multiply
• by 2 to get your heart rate in beats
• per minute. If your heart rhythm is
• irregular, you should count for 60 seconds
• and do not multiply.

• Record your findings and
• follow the pathway.

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Pulse Check Pathway
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QUESTIONS

• karen.george_at_shropcom.nhs.uk

Further Information www.nice.org.uk www.heartrhy
thmcharity.org.uk www.bhf.org.uk