Cardiac Pathologies Flashcards
What are some modifiable cardiac risk factors?
- Smoking
- Unhealthy diet
- Obesity
- Physical inactivity
- Hypertension
- Associated conditions (i.e.: diabetes)
- Dyslipidaemia
- Social isolation
- Depression
- Stress
What are some non-modifiable cardiac risk factors?
- Age
- Sex M>F
- Family history
- Poor socioeconomic status
- Indigenous
- Inflammation from diseases (e.g.: arthritis, lupus or infections, or inflammation of unknown cause)
What is a common cause of ischaemic heart disease?
Atherosclerosis of the coronary arteries
What is ischaemic heart disease?
Characterised by a relative decrease in myocardial perfusion such that perfusion is inadequate to meet the metabolic demands of the myocardium
What is atherosclerosis?
a chronic + progressive inflammatory disease of the cardiac endothelium
formation of plaques
Where are plaques most common?
- Aorta
- Coronary arteries
- Circle of Willis
What are the signs & symptoms of ischaemic heart disease?
- Angina (stable or unstable)
- Acute myocardial infarction
- Patients c/o heaviness, severe tightness or dull ache in their chest
- May spread to arms, neck, jaw, back or stomach.
- Shortness of breath
- Heartburn feeling
What is angina?
a pain or discomfort felt in your chest, which is usually caused by coronary heart disease
When does stable angina occur?
When coronary perfusion fails to meet the metabolic demand
- May occur during exercise or tachycardia
How does stable angina typically present?
retrosternal pain/discomfort
How can stable angina be relieved?
- Rest
- Nitrate medications-Glyceryl TriNitrate (GTN) Sublingual spray
What is unstable angina?
Angina not proportional to exertion
- Can be life threatening
- Can disrupt plaque & trigger thrombosis
- Thrombosis-formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system
- Frequent or prolonged episodes of retrosternal pain at rest or with minimal exertion
What are (4) triggers for angina?
- Cold weather
- Emotional upset
- Activity & Exercise
- Eating a heavy meal
What are (4) common treatments for heart disease?
- Statins
- Blood thinners
- Beta blockers
- Lifestyle changes
How do statins treat heart disease?
Cholesterol-lowering drugs
- reduce level of plaque-forming low density lipoprotein (LDLs) in bloodstream
(lower risk of heart attack by 25%)
How do beta blockers treat heart disease?
- Lower blood pressure
- Reduce heart rate
(so you need less oxygen)
How do blood thinners treat heart disease?
Anti-coagulants
- prevent formation of dangerous blood clots in arteries (which could block blood flow)
What are the risks of surgery?
- Irregular heartbeat/arrythmias
- Infection (Wound and/or systemic)
- Bleeding
- Adverse reaction to anaesthetic
- Fever
- Pain
- Blood clot
- Stroke
- Heart attack
- Death
What is heart failure?
a long-term condition characterised by the inability of the heart to pump blood efficiently or properly
What are the causes of heart failure?
- Coronary artery disease
- High BP
- Cardiac inflammation (and long-term systemic inflammation)
- Chronic arrythmias
- Myocardial Infarction (MI)
- Cardiomyopathies
- Infections (endocarditis, pericarditis etc)
- Valve disease/problems
- Chronic kidney disease
- Heavy alcohol use
- Recreational drugs
- Chemotherapy
What are the symptoms of heart failure?
- Dyspnoea
- Angina
- Fatigue
- Ankle, foot, leg and/or abdominal oedema
- Arrythmias
- Apnoea and sleep apnoea
- Orthopnoea
- Peripheral cyanosis and clubbing
- Syncope
- Chronic cough (with minimal expectoration or blood)
- Decreased alertness or trouble concentrating
How can pain effect the cardiovascular system?
- increase heart rate & blood pressure
- increased need for oxygen
- water retention, potential fluid overload
What are some complications of cardiac surgery?
- Increased heart rate variability
- Haemorrhage
- Wound infection
Which chamber of the heart pumps oxygenated blood into the systemic circulation?
left ventricle
What is a likely cause of heart failure?
chronic hypertension
Which symptom is most associated with a myocardial infarction?
crushing chest pain that may radiate to/across the left arm
What is coronary artery disease mainly caused by?
accumulation of fatty plaques
What vessel is commonly used as a graft in coronary bypass grafting (CABG) ?
Saphenous vein
How do myocardial cells respire?
aerobically
What is infarction?
tissue death caused by ischaemia
What is myocardial infarction (MI)?
a sudden irreversible injury (‘heart attack’) where localised cell death causes a defined region of necrosis, inflammation + scarring
What is myocardial infarction (MI) caused by?
- Rupture of atherosclerotic plaque in a coronary artery
- This causes a thrombus (blood clot) to form, plugs the artery, blood supply to the region of the heart it supplies is stopped
What is the most common symptom of myocardial infarction (MI)?
Chest pain/discomfort - can travel into the shoulder, arm, back, neck, or jaw
What is the procedure for a coronary artery bypass surgery?
- A coronary artery bypass graft involves taking a blood vessel from another part of the body (usually the chest, leg or arm) and attaching it to the coronary artery above and below the narrowed area or blockage.
- This new blood vessel is known as a graft.
(number of grafts needed depends on severity of coronary heart disease + how many of the coronary blood vessels are narrowed).
What are the proposed benefits of open heart surgery?
- Less blood trauma
- Decreased risk of adverse events (stroke, etc.)
- A more rapid return to normal activities
What are the problems with open heart surgery?
- Poorer graft patency
- Higher incidence of revascularisation
- Major adverse cerebrovascular events
What must a surgeon do during open heart surgery?
must use a stabilization system to steady the portion of the heart where the suturing takes place.
What happens to the heart during an open heart surgery?
Heart remains beating throughout surgery
(Avoids need for bypass machine)
How can pain effect the respiratory system?
- increased respiratory rate
- shallow breathing
- increased risk of infection
How can pain effect the immune system?
- increased susceptibility to infection
- increased or decreased sensitivity to pain
- activation of HPA axis
How can pain effect the endocrine system?
- increased blood glucose
- increased cortisol production
How can pain effect the gastrointestinal system?
- reduced gastric emptying + intestinal motility
- nausea & vomiting
- constipation
How can pain effect the urinary system?
- urge to urinate/incontinence
How can pain effect the musculoskeletal system?
- tense muscles local to injury
- shaking or shivering
- Pilo-erection (goose bumps)
How can pain effect the nervous system?
- changes in pain processing
- risk of pain becoming chronic
How can pain effect the brain?
- anxiety/fear
- depression
- poor concentration
- inhibition or promotion of pain
What is an example of non-opioid analgesics?
paracetamol
What is are examples of non-steroidal anti-inflammatory drugs (NSAIDs)
- Aspirin
- Ibuprofen
- Naproxen (prescription)
- Diclofenac (prescription)
What is an example of a compound analgesic?
Co-codamol (combined paracetamol with codeine)
What are examples of opioid analgesics?
- Codeine (prescription)
- Tramadol (prescription)
- Morphine (prescription)
What is epidural pain relief?
- Needle is inserted followed by a fine catheter at the appropriate level of the spinal column into the epidural space.
- Band of anaesthesia will form depending on which nerve roots have been selected.
- Sensory block not motor (motor fibres are larger making them more resistant to anaesthetic).
