An introduction to Ischaemic Heart Disease Flashcards
Autoimmune disease that results from Group A Strep [GAS] infection in throat. Linked to environmental factors poor housing etc. If untreated can develop into _____ heart disease where valves may need to be replaced.
Rheumatic fever. Can develop into rheumatic heart disease where valves may need to be replaced.
Ischemia occurs when
there is insufficient blood flow & blood volume to supply the O2 needs of the myocardium
The underlying pathophysiology of IHD and MI is usually
atherosclerosis
Angina is
symptom of reversible myocardial ischaemia
[it describes the chest pain from lack of blood flow to the heart]
A heart attack is this. It results from ischaemia or complete blockage of coronary artery. Can be partial thickness [NSTEMI] or full thickness [STEMI]. Complications include VF > DEATH.
Myocardial Infarction (MI)
Difference between STEMI and NSTEMI **important to know.
STEMI - Full thickness damage to the myocardium (transmural)
Sudden complete blockage of a coronary artery
ST segment elevation on an ECG
No need to wait for bloods – ECG finding is definitive
NSTEMI - Partial thickness damage to the myocardium
Partial blockage of a coronary artery
Not visible on an ECG
Need bloods for cardiac biomarkers to diagnose
Unstable angina + STEMI or NSTEMI =
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS) is….
ACS is the term for an imbalance of O2 supply & demand. The underlying pathophysiology is atherosclerosis which can lead to plaque rupture and thrombus formation
Precipitants of angina/ACS = Exercise / how does this lead to anigina/acs
↑ HR, ↑ CO[cardiac ouput], ↑ myocardial O2 demand
In absence of O2, cell function will deteriorate:
Ischaemia:
Injury:
Infarction:
Ischaemia: lack of O2
Injury: potentially
reversible damage
Infarction: necrosis →
permanent damage
If you had a patient with chest pain,what assessments would you use?
How would you assess?
RR, WOB, SOB, Colour, Diaphoresis, HR, BP, COLDSPA, Pain scale,
If you had a patient with chest pain,what is your priority?
relieve pain and they need IV line, if they have an arrhythmia we need to access straight away. Anxiety and safety.
ACS/MI is diagnosed by: also diffrentiate by STEMI and NSTEMI
History – chest pain & related symptoms
12 lead ECG - ST elevation height and area of heart - very clear on ECG
Blood tests - if it is not STEMI blood tests will need to be taken to confirm NSTEMI.
When diagnosing an NSTEMI what specific things are you looking for in Blood tests
T&I – cardiac enzymes. Electrolytes K+ and NA+. Full blood count and CRP
Priority goals in management?
Increase oxygen supply to the myocardium → give nitrates and consider O2 if SpO2 < 93%
Relieve pain, reduce O2 demand & signs of ischaemia
Heart attack[MI] OR Cardiac arrest? What are the differences? Important to know **
Heart attack is a MI
Results from a blocked coronary artery
This prevents oxygen-rich blood from reaching the myocardium
Without oxygen the myocardial cells begin to die
Cardiac arrest a sudden, cessation of the heart’s functioning
Triggered by electrical malfunction in the heart that causes an arrhythmia (irregular heart beat)
Disrupts the pumping action
Differences between MI and cardiac arrest - what are these problems classified as?
MI[Heart attack] is a CIRCULATION problems
Cardiac arrest is an ELECTRICAL problem
What are some common cardiovascular disease?
Coronary artery disease (CAD)→angina, myocardial infarction Cerebrovascular disease (CVD) Peripheral vascular disease (PVD) Heart failure (HF) Hypertension Rheumatic heart disease Congenital heart disease
What conditions fall under IHD?
STEMI or NSTEMI, results from sustained ischaemia or sudden complete blockage of coronary artery
What conditions fall under the ACS umbrella?
Group of clinical symptoms – unstable angina, STEMI or NSTEMI. Imbalance of 02 supply & demand. Underlying patho is artherosclerosis.
What is a NSTEMI and a STEMI?
NSTEMI [partial thickness damage to myocardium, partial blockage of coronary artery, NOT visible on ECG, requires bloods to diagnose]. STEMI [Full thickness damage to myocardium, sudden complete blockage of coronary artery, ST elevation on ECG, No need to wait for bloods, definitive by ECG]
What is the underlying pathophysiology of Coronary Artery Disease (CAD)
Coronary artery disease (CAD)→angina, myocardial infarction. Coronary Artery Disease(CAD)Coronary artery diseaseis caused by plaque buildup in the wall of the arteries that supply blood to the heart
What is the goal of management of angina or a MI?
Increase oxygen supply to the myocardium → give nitrates and consider O2 if SpO2 < 93%
Relieve pain, reduce O2 demand & signs of ischaemia
