Cardiovascular conditions Flashcards
What diseases fall under acute coronary syndrome (ACS)
- Unstable angina (not stable angina)
- ST-elevation myocardial infarction (STEMI)
- Non-ST-elevation myocardial infarction (NSTEMI)
What causes acute coronary syndromes
Supply/demand mismatch of oxygen to the myocardium
-Blockage of blood flow (narrowing or occlusion of a coronary artery)
-Increased demand (e.g. arrythmia, during acute illness)
What are the symptoms of ACS
Central, crushing chest pain ***
Pain radiating to the jaw or arms
Nausea and vomiting
Sweating and clamminess
A feeling of impending doom
Shortness of breath
Palpitations
What is the name of the substance that builds up on vessel walls
Atherosclerotic plaque
What does embolise mean
Plaque breaks off (or blood clot forms) and travels down the vessel
What is unstable angina
Partial occlusion of coronary artery
Ischaemia
No infarction
What is NSTEMI
Partial occlusion
Ischaemia
Infarction
What occurs with STEMI
Total occlusion
Infarction
What complications does ACS pose
Death (cardiac arrest) – Basic Life Support!
Arrythmia
Heart failure
Rupture of heart wall
New valvular disease (papillary muscle infarction)
What tests are used to diagnose ACS
ECG
Troponin (blood test)
-high troponin levels are bad as it is released when the heart muscle infarcts (dies)
How is ACS (heart failure) managed
Minimise tissue loss from infarction
Re-establish blood flow (reperfusion)
-break up and remove clot/dissolve
Prevent further episodes
-lifestyle management/medication
What is the procedure if a patient have acute onset of chest pain in the dental practice
At this point we do not know if stable angina, unstable angina, NSTEMI or STEMI
PHONE AN AMBULANCE AND GET TO HOSPITAL
100% oxygen via non-rebreather mask
Glyceryl trinitrate spray (GTN), 2 puffs, sublingual
-Repeated after 3 minutes if no improvement
Aspirin 300mg oral tablet
-Chewed
Why is oxygen given to patients with ACS
increase oxygen delivery to the ischemic myocardium and thereby limit infarct size
What is GTN
Glyceryl trinitrate spray
Why is GTN given to patients with chest pain
Vasodilator
Release of nitrous oxide (NO) in vascular smooth muscle
Dilates veins – reduces preload on heart (less hard work)
Dilates arteries – increases blood flow through coronary arteries
What role does aspirin do in releiving chest pain and reducing infarction risk
Prevents thrombus enlarging
Reduces platelet aggregation at clot
“inhibits COX enzyme, to reduce production of thromboxane A2, thereby reducing platelet aggregation”
What is reperfusion/types
Break-up/remove clot by a procedure
-Percutaneous coronary intervention (PCI)
-Access via coronary artery from peripheral artery
-Break-up clot
-Widen the artery (angioplasty)
-Place stent to maintain width
-Within 120 minutes of onset**
Dissolve blood clot
-“Thrombolysis”
-Clot-busting drug (alteplase), given IV
What ,medication can be prescribed to prevent ACS
Aspirin (75mg)
Another antiplatelet (e.g. clopidogrel for 12 months)
Atorvastatin (lipid lowering)
ACE-inhibitor (blood pressure)
Atenolol (or another beta blocker like bisoprolol)
Why is adrenaline risky for patients with ACS
Supply/demand mismatch of oxygen to the myocardium
Blockage of blood flow (narrowing or occlusion of a coronary artery)
Increased demand (e.g. arrythmia, during acute illness)
What is PAD
Peripheral arterial disease
What does PAD refer to
PAD refers to narrowing of arteries suppling limbs
Commonly legs
What do PAD and ACS have in common
Pathophysiology and risk factors
What are the symptoms of PAD
Leg, thigh, buttock, calf cramping pain particularly when walking (intermittent claudication)
Non-healing ulcers on toes, foot, leg
One leg cooler than the other
One leg paler than the other
Hair loss on leg
Necrosis of skin on digits
How is PAD diagnosed
CT angiography of limb