Cardiac Flashcards
Acs how does it occur
Atherosclerosis where ldl deposits into the tunica intima
Angina is
Pain when there is a mismatch between demand and supply
Results in pain may see ecg changes
Risk factors for angina
Hypertension Hyperlipidaemia Diabetes Sendentary lifestyle Obesity Smoking Family history
Stable angina
Episodic
Recurrent, predictable,
Will have own gtn
Unstable angina
Deterioration of stable
May occur at rest increase in frequency, severity and duration
May not relieved by gtn and aspirin
MI occurs when
Occlusion to coronary artery resulting in infarction
Clinical features of MI
Change in biochemical marker like troponin
Symptoms of ischaemia
St changes
Q wave development
Imaging evidence
Give for STEMI
Oxygen guided by SpO2
Antiplatelet - aspirin, clopidogrel
Nitrates - GTN
Pain management
Cocaine toxicity can cause
Coronary spasms as stimulates the CNS
Can then result in stroke, MI, seizures
Heart failure is
Heart can not maintain adequate cardiac output will compensate for this
Treatment for acute LVF
Sit upright - reduces preload
High flow oxygen - corrects hypoxia
Nitrates - reduced preload and after load
Furosemide - combats fluid overload
Cpap - in hospital it increase the pressure in the lungs
Cardiac tamponade is when
An increase in pericardial fluid leads to pericardial effusion and tamponade.
The heart then gets squished and can’t pump blood
Clinical signs of tamponade
Looks very ill
SOB, chefs tightness, faint
Becks triad - JVD, hypotension, muffled heart sounds
Cold pale mottled cyanosis
Tachycardia
Narrowing pulse pressure (early sign)
Pulsus paradoxus - change of 10 mmhg in inspiration phase (late sign)
What is becks triad
Indication of
JVD
Hypotension
Muffled heart sounds
Tamponade
What hospital do for cardiac tamponade
Pericardiocentesis - needle inserted into pericardial space to drain (aspirate)
Infective endocarditis
Infection of lining of heart can affect valves as well
Seen in in drug users, after major operation
Pericarditis is
Will see
Infection of pericardium
See widespread ST elevation
Kusmaulls sign
Increase in JVP that occurs during inspiration
Canon wave indicates
Complete heart block
Where is apex beat
5th intercostal mid clavicular
Remember the heart valves
All paramedics take medicine
Aortic - 2nd ic right eternal
Pulmonary - 2nd ic left sternal
Tricuspid - 4th/5th lower left sternal
Mitral - 5th right sternal edge
S2 is the
Closure of pulmonary and aortic valves
Why do we give IV fluids in MI
Possibility for reduced preload due to MI this keeps blood flow up
What happens if right coronary artery occluded
Get bradycardia as blood supply for SA node is supplier by the RCA
What proportion of pts does mi not show on ecg
30-40%
Where does the right coronary artery supply
Right atrium
Both portions of ventricles
Where does left coronary artery supply
Blood to the left ventricle
Left atrium
Interventricular septum
What is the Cardiac cycle
Systole
Ventricles contract and blood is ejected
Diastole
Ventricles relax and blood fills the heart
What is stroke volume
Difference between end diastolic and end systolic
What is ejection fraction
Stroke volume divided by end diastolic
What is preload
Work or load imposed on the heart before the contraction begins
What is Starlings law
The stroke volume of heart increases in response to an increase in volume of blood in ventricles before contraction when all other factors remain constant
What is after load
Resistance left ventricle has to overcome to circulate blood
What is cardiac output
Volume of blood pumped through the heart per minute
How to work out cardiac output
CO=SVxHR
Types of shock
Cardiogenic Hypovolaemia Neurogenic Anaphylaxis Septic
Definition of shock
A failure of the cvs system to adequately perfuse the tissue
Leads to disruption in the cell metabolism
Leads to organ failure
Why does hypovolaemic shock occur
What will they arrest into to
Most commonly due to blood loss, heart is working but reduced circulating volume
Will arrest into PEA
Why does cardiogenic shock occur
Cardiac output too low to deliver oxygenated blood to the cells Causes Decreased contractility Impaired diastolic volume Obstruction So pump is not working
What is neurogenic shock and causes
Wide spread vasodilation Imbalance between parasympathetic and sympathetic nervous system Causes Stimulation of parasympathetic activity Inhibition of sympathetic activity Damage to spinal cord or medulla Drugs
What is anaphylactic shock
Begins as an allergic reaction - hypersensitivity
Immune and inflammatory response
Vascular affects include vasodilation and increase vascular permeability
Swelling in airway
What is septic shock
Bacteria can cause fever, local inflammation and increased vascular permeability
When bacteria or toxins enter the blood stream
Reduce blood pressure - vasodilation
Oxygen demand higher
Causing organ damage and potentially death
Chest pain differentials
Acute coronary syndrome Chest infection/pneumonia Pericarditis LVF Pulmonary embolism Pneumothorax Aortic dissection Indigestion Peptic ulcer Msg reasons
Management of STEMI
Aspirin Gtn Pain scores Pain relief SpO2 recorded
Inferior MI what to do …
V4R 40% of stemis are inferior Preload sensitive so can develop severe hypotension Consider fluids Cautious with gtn
What decreases venous return
Nitrates, beta blockers, diuretics and morphine
Causes of heart failure
Coronary artery disease Hypertension Dilated cardiomyopathy Valvular heart disease Secondary to an mi
Difference between systolic heart failure and diastolic heart failure
Systolic - contraction problems
Diastolic - filling problems
How to assess congestion (heart failure)
Pulmonary oedema
Peripheral oedema
Elevated jugular venous pressure
12 lead ecg unlikely to be normal
Hospital consideration for heart failure
CPAP
BiPAP
Opens the alveoli and increased alveolar pressure helps shift fluid into alveoli back into capillaries
How does aortic aneurysm dissect
Separation of the arterial wall
Begins once intima is torn
Creates a false channel between the intimal and medial layers of the wall
What does chronotropic mean
Affects the rate
What does inotropic mean
Affects force of contraction
What does dromotropic mean
Alters the rhythm or electrical conduction through the heart muscle
What do beta blockers do
Inhibit activity and decrease the rate and force of contraction as act on beta -1 and beta-2 receptions
Blocks the release of adrenaline and noradrenaline
What do calcium channel blockers do
Inhibit the calcium influx into muscle that initiates contraction
Vasodilator acts directly on smooth muscle
Decrease contractility, av conduction and automaticity
What is ischemia
More negative than surrounding tissues not getting enough oxygen
Causes st deferment depression and flipped Ts
What is injury (heart)
Remains more positive than surrounding tissue leading to st segment elevation
Zone of injury does not repolarise
What is infarction
Dead tissue
Does not generate any action potentials is electrical neutral
Which artery is anterior on ecg
LAD (left anterior descending)
Which artery is inferior
Right coronary artery sometimes the left circumflex artery
What artery is posterior
Right coronary artery or left circumflex artery
Left bundle branch block criteria
QRS complex wider than 0.12
Then look in V1
Positive - RBBB
Negative - LBBB
