cardiovascular conditions Flashcards
chest pain
=discomfort/ pain felt on anterior thorax
caused by: pericarditis (irritated pericardial sac), angina, heartburn/ indigestion, chest sprain/ strain, anxiety, chest infection, pneumonia, shingles
pop: 20-45% of pop, 45-64 YOA, women, black people
risk factors: smokers, obese people, high blood pressure, diabetes, high cholesterol, history of heart attacks/ angina in family
s&s: tight chest/ feeling of pressure, crushing/ searing pain spreading to back/ neck/ shoulders/ arms, pain lasting more than a few mins, pain worse with exercise, shortness of breath, cold sweats, dizziness/ weakness, nausea/ vomitting
treatment: aspirin, blood thinners, thrombolytics
cardiovascular disease
=disease of the heart or blood vessels
caused by: angina pectonis (blood insufficiency), myocardial infarction (blood supply stopping), pericardial pain (swelling of sac surrounding heart), aortic dissection (leak/ tear in aorta)
pop: black people and adults >65
risk factors: unhealthy diet, physical inactivity, tobacco use, alcohol abuse, high blood pressure, high blood glucose, obese people
s&s: chest pain, breathlessnes, palpitations, fatigue, dizziness, oedema, sweating, poor mouth hygiene, precordium scarring, basal crackles, thrills and heaves
treatment: blood thinners to prevent clotting, statins to lower cholesterol, beta blockers, nitrates to widen bloo vessels, ACE inhibitors to treat high blood pressure, coronary artery bypass graft, heart transplant
DDX: acute pericarditis, myocarditis, prinzmetal angina, acute bronchitis, pneumonia, pleuritis, pleural effusion, aortic dissection, GERD, peptic ulcer disease, esophageal motility disorders, costochondritis
angina
=severe chest pain
caused by: myocardial ischaemia due to the reversible mismatch between myocardial oxygen supply and demand. This mismatch can occur during exercise, emotional stress or even spontaneously. Restriction of myocardial blood flow most commonly results from the narrowing of an epicardial (surface) coronary artery, usually from atherosclerosis
pop: 45-84YOA
risk factors: hypertension, elevated lipid levels (hyperlipidemia), diabetes mellitus, obesity, smoking, family history
s&s: fatigue, dizziness, sweating, nausea, shortness of breath
treatment: lifestyle management, beta blocker/ calcium blocker channel blocker to stabilise, if no change- long acting nitrate, ivabradine, nicorandil and ranolazine, percutaneous coronary intervention
myocardial infarction (heart attack)
=irreversible necrosis of heart muscle secondary to interruption of coronary blood supply
caused by: usually due to build up or rupture of atherosclerotic plaque that results in occlusion and ventricular fibrillation
pop: 600/100,000, most common 60+y.o, male > female under 70 (equal risk after), Genetics: Lymphotoxin (LTA) and Galectin-2 (LGALS2) assoc. with higher risk
risk factors: obesity, poor nutrition, physical inactivity, hyperlipidemia, family history, diabetes, high stress lifestyle, alcohol, tobacco, drug use, elevated homocysteine and uric acid levels
s&s: severe chest pain occuring at rest for at least a few hours, sweating, breathlessness, nausea/ vomitting, restlessness, paleness
treatment: variable depending on factors such as age and size of infarction. 50% of patients die during the acute event. A further 10% die in hospital care, and a further 10% die within 2 years of the event. aspirin (and other anticlotting agents, thrombolytic drugs to dissolve drugs, oxygen, Nitroglycerin to widen coronary vessels
ddx: cardiac related–> angina pectoris, aorti stenosis, dissection, regurgitation, pericarditis/ myocarditis, congestive heart failure, pulmonary embolism
non cardiac related–> rib/ vertebral subluxation/ dislocation, anxiety, asthma attack, gall stones, oesophageal reflux, pleuritis, pneumothorax
valvular heart disease
=any disease causing damage to one or more heart valves
e.g. : Ischaemic heart disease, cardiomyopathy (dilated) , Hypertension. Other: Congenital heart disease, Alcohol and drugs, Pulmonary embolism, Tricuspid incompetence
types include: regurgitation (The valve flaps don’t close properly, causing blood to leak backward in your heart), stenosis (valve flaps become thick or stiff and possibly fuse together. This results in a narrowed valve opening and reduced blood flow through the valve), atresia (The valve isn’t formed, and a solid sheet of tissue blocks the blood flow between the heart chambers)
risk factors: Older age, History of certain infections that can affect the heart, History of certain forms of heart disease or heart attack, High blood pressure, high cholesterol, diabetes and other heart disease risk factors, Heart conditions present at birth (congenital heart disease)
s&s: heart murmur, chest pain, abdominal swelling, fatigue, shortness of breath, swelling of ankles/ feet, dizziness, fainting, irregular heartbeat
treatment: lifestyle change, blood thinners, heart valve surgery, heart valve repair, heart valve replacement
aneurysm
=localised permanent abnormal dilation of a blood vessel (true or false) true-> arterial wall forms wall of aneurysm. false–> surrounding tissues form wall
(read aneurysm notes for types)
caused by: true= congenital, atherosclerosis, hypertension, vasculitis, hereditary disorder etc
false= trauma e.g. femoral artery puncture
risk factors: smoking, high blood pressure, family history, previous ruptures
s&s: depends on type- but commonly presents as abdominal pain/ location of aneurysm, back pain, hypertension, nervous system symptoms, palpable pulsating mass
treatment: again depends on type- quit smoking, surgical repair, EVAR
atrial fibrillation
=A disease of the heart characterized by irregular and often faster heartbeat (often with blood clots)
caused by: Abnormal electrical activity in atria causes contraction which overrides normal cardiac cycle often caused by drinking excessive amounts of alcohol, particularly binge drinking, being overweight, drinking lots of caffeine, such as tea, coffee or energy drinks, taking illegal drugs, particularly amphetamines or cocaine and smoking
pop: >60 and female. common in people with previous heart conditions
risk factors: age, poorly controlled high blood pressure, alcohol, obesity, family history
s&s: heart palpitations, shortness of breath, weakness, tiredness, chest pain, dizziness, confusion
treatment: lifestyle changes (e.g. healthy diet, exercising regularly), beta blockers, anti-arrythmic drugs, ablation, cardioversion and having a pacemaker fitted
palpitations
=Increased awareness of normal heartbeat, or the sensation of slow, rapid or irregular heart rhythms.
caused by: many things. Anxious, excitement, smoking, caffeine, illegal drugs, too much alcohol, obesity, panic attacks, medications, medical conditions; overactive thyroid, low blood sugar level, diabetes, atrial fibrillation
pop: very common (16% of pop)
risk factors: an overactive thyroid, low blood sugar level, anaemia, infection, diabetes and/or are dehydrated
s&s: racing, pounding, uncomfortable feeling, heart misses a beat/ an extra beat, fluttering rhythm
treatment: can last a few mins/ hours/ lifetime. relaxation techniques, avoidance of stimulants and illegal drugs. certain medications may help longlife palpitations
Dyspnoea
=shortness of breath. Left ventricular failure causes it due to oedema of the pulmonary interstitium and alveoli. This makes the lungs stiff; this increases the respiratory effort required to ventilate them.
caused by: Following strenuous activity, it may have trouble taking in enough oxygen to meet the body’s demands. Other causes include allergies, anxiety, illness (heart attack/blood clot), obesity, asthma, pneumonia, COPD
pop: 1 in 4 people that go A&E have it
risk factors: Heart disease, Respiratory infection or pneumonia, Cancer, especially lung cancer, Emphysema or chronic bronchitis, Asthma, Allergies, Reflux, Obesity
s&s: Shorten of breath lasting 1-2 mins after exercise (can be much longer / lifetime with chronic illness),feel like suffocating, hear wheezing, tightness in chest, heart palpitations and coughing
treatment: treat the underlying cause such as diet, exercise, pulmonary and cardiac.
syncope
=Loss of consciousness due to inadequate cerebral blood flow, this leads to fainting / passing out
caused by: often idiopathic. cardiac syncope = Arrhythmia/falls to ground without warning are caused by very low pulse from lack of oxygenated blood to brain. Vasovagal attacks (most common)= pooling of blood, leading to a reduction in the amount of blood returned to the heart. This makes the heart contract vigorously which triggers reflexes via central nervous system to reduce ventricular stretch which caused a drop in blood pressure which causes syncope. Aortic dissection, Aortic valve stenosis, Reflex syncope, artificial pacemaker failure
pop: 3.5% women, 3% men under 75 years old and after this age increases to 6% equally
risk factors: age over 60, heart diseases, family history of inheritable conditions, frequent nausea, vomiting and/or coughing
s&s: blacking out, falling suddenly, fainting, dizzy
treatment: Depends on the underlying cause, can come and go or be a regular occurrence in lifetime.
oedema (pitting & non-pitting)
pitting= occurs when excess fluid builds up in the body, causing swelling; when pressure is applied to the swollen area, a “pit”, or indentation, will remain. Excess fluid mainly composed of water
non-pitting= associated with conditions affecting the thyroid or lymphatic system. Build composed of proteins, salts, and water.
non- pitting caused by: lymphedema, myxedema, severe or advanced hypothyroidism, lipoedema
Pitting caused by: heart valve problems, low protein levels, deep venous thrombosis, severe lung disease, congestive heart failure, venous insufficiency, liver disease, kidney failure, obesity, pregnancy, administration of intravenous fluids, medication, hot weather
pop: pregnant people and >65
risk factors: -Sitting or standing in one position for too long, Low protein levels, Obesity, Pregnancy, Medications (NSAIDs, steroids, oestrogens, certain diabetics), Venous insufficiency
s&s: Swelling or puffiness of the tissue right under the skin, especially in legs or arms, Stretched or shiny skin, Skin that holds a dimple (pitting), Increase in the size of the stomach area, Feeling of leg heaviness
treatment: Use pressure – compression stockings, Movement, Raise swollen limbs, Massage the affected area, Protected the affect area, keep it clean and free from injury, Reduce salt as it increases; build-up or worsens oedema, Mild oedema goes away on its own
ddx: Heart failure, Liver disease, Malnutrition, Thyroid disorder, Pelvic tumours, Infection,Trauma, Venous thrombosis
DVT
=a blood clot that develops within a deep vein in the body, usually in the leg
caused by: Changes in blood flow (stasis or turbulence), Vessel wall dysfunction, Changes in blood components, leading to hypercoagulability (Virchow’s triad)
pop: 25-50% of surgical patients, and many non-surgical patients
risk factors: >60 years old, overweight, smoke, previously had a DVT before, take the contraceptive pill or hormone replacement therapy, have cancer or heart failure, or have varicose veins, not moving for awhile
s&s: Pain and swelling in one leg (rarely both legs), leg may be warm to the touch, tenderness along the course of the deep and dilation of the superficial veins, throbbing or cramping in one leg (rarely both legs), usually in the calf or thigh, red or darkened skin around the painful area, or swollen veins that are hard or sore when touched
treatment: anticoagulant medicines (reduce blood clots by thinning blood), clot busters, filters, compression stockings
ddx: Ruptured Baker’s cyst, musculo-tendinous, superficial vein thrombosis, post-thrombotic syndrome, cellulitis, osteoarthritis, osteomyelitis, synovitis, fracture, tumour, acute arterial occlusion, lymphoedema, congestive cardiac failure and hypoalbuminaemia
hypertension
=where the blood vessels have persistently raised pressure.
Rarely shows many symptoms unless it is left untreated for a longer period of time
caused by: Unhealthy lifestyle (overweight, poor diet, low activity), Smoking, Pregnancy, Too much alcohol or caffeine, Poor sleep quality and quantity, High salt diet and little vegetables, underlying health conditions, Medications
pop: >65 are most at risk
African/black Caribbean descent
risk factors: Overweight, Unhealthy lifestyle (food and low activity), Heart disease, Heart attack, Strokes, Heart failure, Peripheral arterial disease, Aortic aneurysms, Kidney disease, Vascular Demetria
s&s: -Blurry/double vision, Fatigue, Headache, Heart palpitations, Nosebleeds, Shortness of breath, Nausea/vomiting
treatment: lifestyle changes (above 140/90mmHg)–> more activity, less alcohol, smoking, better diet etc
medications (above 160/100 mmHg)–> ACE inhibitors, Angiotensin-2 receptor blockers (ARBs), calcium channel blockers, dieuretics, beta blockers, alpha blockers
stroke (tia)
=temporary stroke like symptoms symptoms due to artery blockage and decreased blood to brain
Risks: head trauma, haemorrhage, men, obesity, high cholesterol, high age, hypertension, diabetes, smoking, genetics, contraception, previous tia/ heart conditions, vascular disease
S&s: face unilateral weakness/ palsy, slurred speech, arm weakness, Diplopia, vision disruption, disorientation, seizure, vomiting
Treatment: treat the cause. healthy lifestyle, control bp, control bp, surgery to remove any blockage, stent, statins
Ddx: aneurysm, heart attack, Ramsay hunt syndrome, aortic dissection
