6.15: Cardiovascular Disorders - (Part 1 of 3, GOL) Flashcards
3 definitions of heart failure
Heart unable to maintain adequate circulation for metabolic requirements of body
Preserved ejection fraction (HFpEF): EF ≥ 50%, ↓ diastolic function
Reduced ejection fraction (HFrEF): EF ≥ 40%, ↓ systolic function
Underlying cause of heart failure
Secondary to cardiac damage - ischaemia, myopathy
Hypertension, valve disease
Signs and symptoms of heart failure
Exertional dyspnoea - breathlessness during exertion
Two test to diagnose heart failure
Blood test: elevated brain natriuretic peptide (BNP)
Chest X ray: cardiomegaly
Treatment options for heart failure
Drugs that reduce the exertional pressure on heart
Two types of heart failure
Systolic
Diastolic
Characteristics of systolic heart failure
Weakened heart muscle
Greater valve diameter
Reduced ejection fraction
Characteristics of diastolic heart failure
Thicker heart muscle
Smaller valve diameter
Preserved ejection fraction
Which feature can be seen on the ECG of person with heart failure?
Larger QRS complex
Name a cardiac muscle disorder
Heart failure
Name an electrical transmission disorder
Atrial arrhythmias
Definitions of atrial arrhythmias
Atrial fibrillation- disorganised electric activity and contraction
Wolff-Parkinson-white (WPW)- syndrome causing tachycardia and abnormal cardiac electrical conductance
Underlying cause of AF
Spontaneously active cells throughout atria
Underlying cause of WPW
Additional accessory conduction pathway (bundle of Kent) between the atria and ventricles
Signs and symptoms of AF and WPW
Palpitations and chest pain
ECG findings in a patient with AF
Absent p-waves and irregularly irregular rhythm
ECG findings in a patient with WPW
QRS pre-excitation and biphasic/inverted T-wave of ECG
Treatment options for AF
Strategies to maintain sinus rhythm (e.g. cardioversion, anti-arrhythmics, catheter ablation)
Treatment options for WPW
Benign, no treatments required
3 types of conduction block
First degree block
Second degree block
Third degree block
What happens during a first-degree block
Slowing down of conduction through AV node
What happens during a second-degree block
Reduced transmission of signal from atria to ventricles
What happens during a third-degree block
Complete block of current from atria to ventricles
Underlying cause of conduction blocks
Damage - (fibrosis, calcification, necrosis) to the conduction system (AV node or His Purkinje system)
ECG findings in a patient with a First-degree block
Increased P-R interval
ECG findings in a patient with a second-degree block
Increased P-R interval or missing QRS complexes, depending on type of block
ECG findings in a patient with a third-degree block
P-waves not followed by QRS complexes
Treatment options for Conduction blocks
Discontinuation of AV-blocking drugs (e.g beta blockers, calcium channel blockers)
pacemaker implantation in severe cases
Definition of hypertension
Clinical BP ≥ 140/90 mmHg & ambulatory BP daytime average ≥ 135/85 mmHg for prolonged period
Underlying cause of primary and secondary hypertension
Primary - unknown
Secondary - resulting from another medical condition (e.g. kidney disease, adrenal disease)
Investigations used to diagnose hypertension
Blood pressure measurement: readings ≥ 135/85 mmHg
Treatment options for hypertension
Lifestyle changes followed by anti-hypertensive medication
Two vasculature disorders
Hypertension
A true coronary syndromes
3 steps of progression of acute coronary syndromes
Angina
Non-ST-elevated myocardial infarction (NSTEMI)
ST-elevated myocardial infarction (STEMI)
What is angina
Chest pain due to myocardial ischaemia caused by atherosclerosis
What is Non-ST-elevated myocardial infarction (NSTEMI)
Myocardial tissue damage due to prolonged ischaemia caused by atherosclerosis and artery blockage
What is ST-elevated myocardial infarction
Serious myocardial tissue damage due to prolonged ischaemia caused by severe atherosclerosis and complete artery blockage
Underlying cause of acute coronary syndromes
Atherosclerotic lesions of the coronary artery causing ischaemia (angina), artery blockage (NSTEMI) and then complete artery blockage STEMI
Symptoms experienced with angina
Chest pain on exertion or at rest
Symptoms experienced with NSTEMI
Chest pain
Sweating
Nausea and vomiting
Symptoms experienced with STEMI
Radiating chest pain
Sweating
Nausea and vomiting
ECG and Blood test results for NSTEMI
ST-depression
High troponin levels
ECG and blood test results for STEMI
ST- elevation
reciprocal ST-depression
High troponin levels
Treatment for angina
Vasodilators
Treatment for NSTEMI
Coronary stents, antiplatelets, vasodilators, anti-emetics, oxygen and pain relief
Treatments for STEMI
Coronary stents, anti-platelets, vasodilators, anti-emetics, oxygen and pain relief
