cardiac

Question 1

what are the two types of angina?

Answer 1

stable angina and unstable angina

Question 2

what is stable angina

Answer 2

it is heart pain that resolves with rest

Question 3

what is angina

Answer 3

chest pain upon exertion caused by heart ischemia (lack of blood supply)

Question 4

what is unstable angina?

Answer 4

Chest pain that is not caused by exertion and does not go away with rest or medication.

Question 5

why is angina dangerous?

Answer 5

It is a sign that someone could be going into cardiac arrest, or having a MI.

Question 6

how do you treat angina?

Answer 6

With nitrates, GTN spray, and rest.

Question 7

what are risk factors for an MI (heart attack)

Answer 7

non modifiable factors:
- older adult age
- family genetics/ history
- male sex

modifiable risk factors:
- hypercholesteremia
- hypertension
- obesity
- physical inactivity
- tobacco use
- hyperlipidemia
- hyperglycemia

Question 8

what are signs and symptoms of an MI?

Answer 8

• pallor/ pale peripheries
• chest pain or discomfort
• SOB
• anxiety like feeling
• pain/ discomfort in shoulder, neck, arm and jaw
• sweating (diaphoresis)
• nausea/ vomiting

Question 9

what is an MI?

Answer 9

it occurs when there is a sustained myocardial ischemia due to blockage of a coronary artery. Most commonly occurs when a thrombus forms after an atherosclerotic plaque in a coronary artery ruptures. this leads to irriversible hypoxia damage to the effected section of the heart wall, resulting in necrotic tissue

Question 10

what is myocardial stunning, hibermation and remodelling

Answer 10

• myocardial stunning: temporary loss of contraction
• myocardial hibernation: stop contracting to preserve life
• myocardial remodelling: permanent loss of contraction

Question 11

what is a STEMI MI

Answer 11

• S-T elevation
• full thickness nectosis

Question 12

what is a NSTEMI MI

Answer 12

• no S-T elevation
• partial thickness necrosis

Question 13

what tests are done for an MI

Answer 13

• chest X-ray
• ECG
• angiogram
• blood tests (full blood count, cardiac enzymes, u’s & e’s, thyroid function and blood glucose)

Question 14

what are cardiac enzyme markers

Answer 14

Due to the breakdown of the myocardial cell membrane (sarcolemma), proteins leak out of the myocytes and become detectible in blood. Elevated cardiac enzymes are significant markers for cardiac injury/MI. Troponin T is a contractile protein that is only released from myocytes when necrosis has occurred, and thus it is highly sensitive, and specific, to cardiac muscle cell damage. Troponin levels may not be detectable for up to six hours after the onset of myocardial cell injury. It is usually measured at presentation and again 10-12 hours after the onset of symptoms or presentation

Question 15

what is management of an MI?

Answer 15

• decrease heart workload
• increase oxygen delivery to the heart
• re-perfuse the heart wall
• dietary and lifestyle changes

MONA drugs
M- morphine to relieve chest pain
O- oxygen to ensure 02 stats are increased
N- nitroglycerin to reduce chest pain, vasodilation and decreases MI oxygen consumption and cardian workload
A- aspirin to slow platelet aggregation, reduce the risk of further occlusion

Question 16

what is an angiogram and angioplasty for management of an MI

Answer 16

angiogram:
performed by injecting a contrast agent into the bloodstream, which makes the blood vessels surrounding the heart visible on an x-ray.

angioplasty:
This is a technique used to widen a narrowed or obstructed artery. In the procedure, a collapsed metal tube (stent) surrounding a collapsed balloon is passed into the vascular system using a guide wire (catheter). The balloon is positioned in the narrowed area and then inflated. This squashes the deposits causing the narrowing and expands the stent, thus opening the blood vessel. The balloon is then deflated and removed, while the stent remains to keep the artery open, thus allowing the return of normal blood flow.

Question 17

what is an ECG

Answer 17

A test that checks for electrical activity in the heart.

Question 18

what are the segments of an ECG

Answer 18

P-Q-R-S-T

Question 19

what does ST elevation mean?

Answer 19

Usually indicates someone is having a MI.

Question 19

where are the electrodes placed on a patient?

Answer 19

V1- 4th intercostal space to the right of the sternum
v2- 4th intercostal space to the left of the sternum
v3- midway between v2 and v4
v4- 5th intercostal space at the midclavicular line
v5- anterior axillary line at the same level as v4
v6- midaxillary line at the same level as v4 and v5
RL- anywhere above the right ankle and below the torso
RA- anywhere between the right shoulder and the wrist
LL- anywhere above the left ankle and below the torso
LA- anywhere between the left shoulder and the wrist

Question 19

what are the 4 different types of arrythmias (alterations of cardiac conduction)

Answer 19

atrial fibrillation: chaotic signals in the atria cause them to quiver, leading to an irregular, and often rapid, heart rate. Atrial fibrillation is the most common type of arrhythmia, particularly in the elderly

ventricle tachycardia: abnormal and rapid discharge of electrical signals in the ventricles. This manifests as a very high HR (~150-200 bpm) which decreases filling time (diastole) and therefore decreases CO and subsequently BP. This may manifest with palpitations, shortness of breath, chest pain, dizziness and loss of consciousness. If lasting for more than a few seconds, this arrhythmia becomes life threatening as CO will rapidly drop, eventually leading to cardiac arrest

ventricle fibrillation: ventricles quiver instead of contracting. There will be a loss of consciousness and breathing stops

asystole: cessation of electrical signals (also known as a ‘flatline’). Without electrical activity in the heart, there is no mechanical activity (so no pumping). This is the terminal rhythm of cardiac arrest. This is not a shockable rhythm, thus defibrillation will not work. Instead, high quality CPR must be instigated, usually with the use of adrenaline (epinephrine) to first try and establish some electrical activity.