Cardiology Flashcards
Symptoms of cardiovascular problems
Chest discomfort (pain)
Breathlessness
Palpitations
Syncope/dizziness
Oedema
Finger clubbing
Cardiovascular causes of chest pain
Angina pectoris (stable or unstable)
– usually caused by atherosclerosis and there is many types
– causes:
—- aortic stenosis
—- hypertrophic cardiomyopathy
Myocardial infarction
– causes:
—- coronary artery occlusion
Pericarditic pain:
– cause:
—- pericarditis
Aortic pain:
– cause:
—- dissection of the aorta
Angina pectoris
Most common cause of cardiac pain.
Causes:
– coronary artery disease
– arotic stenosis
– hypertrophic cardiomyopathy
Aggravated:
– exertion
– emotional excitement
– cold weather
– exercise after meals
Releiving:
– rest
– glyceryl trinitrate
– warm-up before exercise
– can be grade 1-grade 4 depending how severe the angina is
Symptoms:
– retrosternal pain- tight and central
– may radiate up to the arm and jaw (can be both sides but is more often and more seriously on the left)
– unusual for vomiting or nausea usually
– can be stable or unstable (unstable will stay after exercise)
—- unstable angina is a type of acute coronary syndrome
Myocardial infarction
Decreased or completely stopped blood flow to an area of the myocardium
Causes:
– coronary artery occlusion (thrombosis)
Symptoms:
– symptoms are similar but more severe to them of angina pectoris
– retrosternal pain that radiates up the neck, arm and jaw
– often comes on spontaneously
– not relieved by anything
– nausea and vomiting are common
– restlessness and breathlessness
– feeling of an impending sense of doom
Increased sympathetic activity and autonomic stimulation:
– sweating
– pallor
– nausea
– vomiting
– diarrhoea
– pain is absent in up to 30% of people with myocardial infarction, especially those who are elderly or people who have DM
Pericardial pain (pericarditis)
Inflammation of the lining around your heart. (pericardial sac)- usually secondary to myocardial infarction
Causes/triggers:
– usually secondary to:
—- myocardial infarction
—- viral infection
—- iatrogenic causes
—- catheter ablation
—- angioplasty
—- radiotherapy
Symptoms:
– sharp anterior central chest pain, exacerbated by inspiration and movement (particularly leaning forward)
—- may be confused with angina but both can co-exist with each other
– pain may radiate to the left shoulder or back
– tends to fluctuate in intensity
– pain often described as stabbing or raw pain
Acute coronary syndrome
3 types:
– unstable angine
– ST elevation myocardial infarction
– non ST elevation myocardial infarction
Cause:
– usually the rest of a thrombus (atherosclerotic plaque rupture) blocking a coronary artery.
Symptoms:
– central constricting chest pain associated with:
—- nausea and vomiting
—- sweating and clamminess
—- feelings of impending doom
—- shortness of breath
—- palpitations
—- pain radiating to the jaw or arms
Due to the fact that when a thrombus forms it is made up of mostly platelets, anti-platelets such as:
– aspirin
– clopidogrel
– ticagrelor
are ver good treatments
Cor pulmonale
Right sided heart failure that is caused by respiratory disease (COPD is the most common cause).
the increased pressure in the pulmonary arteries (pulmonary hypertension), can result in the right ventricle being unable to efficiently pump the blood out the ventricles and into the pulmonary arteries.
– leading to a lack of pressure in the right atrium, the vena cava and the systemic venous system
Respiratory causes:
– COPD (MC)
– pulmonary embolism
– interstitial lung disease
– cystic fibrosis
– primary pulmonary hypertension
Symptoms:
– early cor pulmonale is often asymptomatic
Main complaint- shortness of breath
– peripheral oedema
– increased breathlessness of exertion
– syncope
– chest pain
Examine for sigs of cor pulmonale:
– hypoxia
– cyanosis
– raised JVP
– peripheral oedema
– third heart sound S3
– murmurs
– hepatomegaly (due to back pressure in the hepatic vein)
Prognosis:
– often poor unless there is a reversible underlying cause
Chronic heart failure
Essentially the chronic version of acute heart failure.
Cause:
– impaired left ventricular contraction (systolic heart failure)
OR
– impaired left ventricular relaxation (diastolic heart failure)
This impaired left ventricular function results in chronic back-pressure of blood trying to flow into and through the left side of the heart
– when the blood cant efficiently flow around the body, the blood is backed up into the left atrium, pulmonary veins and the lungs (which is why it will cause breathlessness)
Presentation:
– breathlessness that is worsened by exertion
– cough. may produce white/pink sputum (bloodstained)
– orthopnoea (sensation of being short of breath when lying flat, it is relieved by sitting or standing)
– paroxysmal nocturnal dyspnoea
– peripheral oedema
Some other mechanisms of heart failure:
– increased metabolic demand (pregnancy, fever, anaemia, Paget’s disease)
– arrhythmia (particularly AF)
– valvular or structural cardiac lesions
– fluid overload
Paroxysmal nocturnal dyspnoea
The sudden breathlessness which wakes someone up from sleep either choking or gasping for air
It has a similar mechanism to orthopnoea
Cause:
– the gradual accumulation of alveolar fluid during sleep
There are other proposed mechanisms to why it happens:
– during sleep the respiratory centre in the brain becomes less responsive so their respiratory rate and effort does not increase (leading to pulmonary congestion and hypoxia)
– there is less adrenalin circulating during sleep. And less adrenaline means that the myocardium is more relaxed and there is a reduce cardiac output.
Presentations:
– pt’s will often sit on the edge of the bed feeling ‘sufffocated’. they may open a window and the symptoms will gradually get better.
Causes:
– heart failure
– ischaemic heart disease
– aortic valve disease
– hypertension
– cardiomyopathy
– AF
– mitral valve disease
– atrial tumours
Pulmonary embolism
Where a blood clot usually embossing from the lower leg (DVT).
Where the blood clot will travel through the venous system, causing a blockage in the pulmonary arteries.
PATIENTS WHO HAVE A SEPTAL DEFECT:
– a DVT can lead to a stroke as it can move into the left side of the heart and cause a stroke (cerebral embolism)
DVT is associated with virchows triad:
– hypercoagulability
– venous stasis
– endothelial injury
Risk factors:
– immobility
– recent surgery
– current DVT or history of DVT
– long haul flights
– hormone therapy with oestrogen
– pregnancy (anything that can increase coagulability of blood)
– malignancy
– systemic lupus erythematosus
– thrombophilia
Symptoms:
– can present with only subtle signs and symptoms
– shortness of breath (73%)
– pleuritic chest pain (66%)
– hypoxia
– tachycardia
– raised respiratory rate
– low grade fever
– haempodynamic instability causing hypotension
Murmurs
S1 and S2 sound:
– S1- is the first heart sound, and is caused by the closing of the atrioventricular valves (tricuspid and bicuspid) at the start of the systolic contractions
– S2- is the second heart beat, the closing of the semilunar valves (pulmonary and aortic) once the systolic contraction is complete
3rd heart sounds:
– S3- roughly 0.1 seconds after the second heart sound.
– it is thought of as a rapdid ventricle filling, causing the chord tendinae to pull their full length, and they will twang like a guitar.
– this can be normal in healthy athletes (15-40_, as their heart functions so well that it fills quicker.
– however if this is heard in the elderly it can indicate heart failure (as their heart is more stiff and weak)
4th heart sounds (S4):
– heard directly before S1. This sound is always abnormal and relatively rare
– caused by a really stiff or hypertrophic ventricle, and the sound is caused by turbulent flow from the contraction of the atria against the hypertrophied ventricle
Valvular problems and how they can lead to murmurs
Mitral stenosis:
– leads to left atrium hypertrophy
– leads to a diastolic murmur
– cause- general age related stiffening of the valve
Aortic stenosis:
– leads to left ventricle hypertrophy
– ejection-systolic murmur (crescendo-decrescendo murmur)
– cause- age related stiffening of the valve
Mitral regurgitation-
– leads to left atrium dilatation
– pan-systolic murmur
– cause- idiopathic, connective tissue disorders
Aortic regurgitation:
– leads to left ventricle dilatation
– early diastolic murmur or an Austin flint murmur
– cause- idiopathic, connective tissue disorders
