1 cardio lecture Flashcards
Angina
- the main manifestation of the coronary artery disease (CAD)
-
Typical angina (definite):
1) Substernal chest discomfort with a characteristic quality and duration that is2) provoked by exertion or emotional stress and 3) relieved by rest or NTG. - Atypical angina (probable): meets 2 of the above characteristics.
- Noncardiac chest pain: meets one or none of the typical anginal characteristics. (AHA 2009
CAD
discrepancy between the amount of oxygen supplied to the cardiac tissue and the needs;
- other cause of angina: inflam.involving the coronary art.(syphilis, vasculitis); angina“with normal coronary arteries“
Typical angina
- S:Precordial area
- R:left uper limb cubital side to last 2 fingers
- C:Constriction ppressure squeezing
- T:no more than 15 minutes
- E:Extra demand on the heart exercise, an emotional upset, exposure to cold, a heavy meal
- rest nitroglycerine
- S:Aanxiety dyspnea
Atypical angina
- S:Interscapular, upper part of the body, epigastrium; sometimes: just in areas of radiation
- R: jaw Posterior limbs posterior Thorax
- C: weakness discomfort
[*] Prinzmetal angina (variant angina):
- Coronarian spasm – hyperactivity of sympathetic nervous system
- During sleeping (REM phase- rapid eye movement)
- Severe pain, anxiety, dyspnea
- Same hour of the night (or day)
- Elevation of the ST segment (diff.dg. with acute myocardial infarction)- occurs only during the crisis !!!
Non-ischaemic pain:
Pericarditis
Pericarditis
- Substernal pain, like a “knife”(dry p.) or pressure (p.effusion) or absent
- Left border of the sternum or epigastrium radiating to the neck and arms
- increases: pressure over the thorax, respiratory movements
- decreases: leaning forward – antalgic position in dry pericarditis and against dyspnea in pericardial effusion !
Pain due to aortic causes
- Aortitis (syphilis)
- Aortic aneurysm
- Acute dissection of aorta:
–suddenly and maximal intensity onset;
–anterior thoracic pain is associated with anterior arch or aortic root dissection
Forms of dyspnea in cardiac patients:
–Exertional d. – progressive: the intensity of the effort leading to dyspnea declines progressively
–Dyspnea at rest with orthopnea
–Paroxysmal d.: ACUTE LVF- 3 types:
–Paroxysmal dyspnea
Nocturnal paroxysmal dyspnea
- a sudden awakening of the patient, after a couple hours of sleep, with a feeling of severe anxiety, breathlessness, and suffocation- orthopnea
- the manifestations are relieved spontaneously
- Episodes of this may be so frightening that the patient may be afraid to resume sleeping
Cardiac Asthma
- Bronchial obstruction is associated
Acute pulmonary Edema
- Transsudate al alveoli level
- Severe dyspnea and cough- frothy pink sputum
Exertional d. – progressive: the intensity of the effort leading to dyspnea declines progressively
- the degree of activity necessary to induce this symptom: difference between healthy-cardiac subjects
- CHRONIC LVF (CAD, hypertensive cardiopathy, valvular heart diseases etc)
- The severity of d. decreases when RIGHT cardiac failure occurs !!! – pulmonary stasis decreases when peripheral (sistemic) stasis develops
–Dyspnea at rest with orthopnea
[*] LV advances
[*] is relieved with elevation of the head - “how many pillows do you need?”
[*] develops when the patient is awake, within min.after the recumbency
[*] Cough- nonproductive, during recumbency- an “orthopnea equivalent.”
Palpitations:
- An unpleasent sensation in which a person is aware of an irregular, hard, or rapid heartbeat.
- Due to hyperexcitability of the central nervous system or abnormal cardiac function (rhythm, the force of contraction)
- A very common symptom
- Physiological cond. (coffee, smoking, effort, stress)
- Cardiac diseases- arrhythmias (any cardiopathy)
Palitations
The correlation with a cardiopathy is supposed when:
- Palpitations- persistent and frequent
- Associatedwith chest pain,dyspnea
- history of a cardiac disease
Orthopnea
Acute LVF
Immobile
during crisis off angina
