Cardiovascular Conditions Flashcards
What is angina?
Acute chest pain caused by reduced blood flow to the heart
What is the difference between stable and unstable angina?
Stable angina is induced by effort and relieved by rest.
Unstable angina has a greater fequency and severity and occurs on minimal exertion or rest.
What is the main cause of angina and one other cause?
Atheroma is the main cause. Anaemia and coronary artery spasm.
What are the symptoms of angina?
- tight, dull, heaving feeling in chest
- pain triggered by exertion/stress
- breathlessness
- nausea
What are medication should be given during an angina attack?
GTN (glyceryl trinitrate) spray - causes vasodilation. Give second dose after 5 mins then ring 999 if pain not relieved 5 mins after second dose.
What medication should be used to treat angina?
- Beta-blockers (slow heart rate and dec contraction strength)
- Ca channel blockers (vasodilators)
- ACE inhibitors (dec blood pressure)
- Statins (reduce cholesterol)
Name 2 procedures used to treat angina.
Coronary artery bypass graft (CABG) - blood vessel implanted to bypass narrowed coronary vessel.
Percutaneous coronary intervention (PCI) - catheter used to insert stent in to widen narrowed vessel.
What is acute coronary syndrome? Give 2 examples
Umbrella term fro condition where the blood supply to the cardiac muscle is suddenly blocked/reduced.
Unstable angina, MI.
What is a myocardial infarction (MI)?
A sudden and complete blockage on the blood to the cardiac muscle.
What does STEMI stand for?
ST segment elevated myocardial infarction - more serious than NSTEMI.
What are the symptoms of a MI?
- chest pain - pressure, tightness, heaviness, may spread to arms/jaw
- shortness of breath
- feel weak or lightheaded
- palpitations
What are the signs of a MI?
- anxiety/distress
- pallor
- 4th heart sound
- tachycardia
- tachypnoea
What are the risk factors of a MI?
- hypertension
- family history
- smoking
- diabetes mellitus
- obesity
- sedentary lifestyle
How is a MI managed?
- control chest pain with GTN spray and opiates
- reduce risk factors
- cardioprotective medication (anti-platelets, anti-coagulants, anti-hypertensives)
- revascularisation (CABG, PCI, medication to resolve clot)
What are the complications of a MI?
- cardiac arrest (sudden loss of blood causing heart to stop pumping)
- cardiogenic shock (inadequate tissue perfusion due to cardiac dysfunction)
- arrhythmias
What is cardiac failure?
Heart is unable to pump blood sufficiently around the body
What is cardiac arrest?
Heart stops pumping blood around the body.
What are the signs of cardiac failure?
- tachycardia
- tachypnoea
- hypotension
- pulmonary rales (abnormal lung sounds)
What are the symptoms of cardiac failure?
- breathlessness
- tiredness (especially after exercise)
- oedema
What are the causes of cardiac failure?
- coronary heart disease (reduce blood to heart)
- hypertension
- cardiomyopathy
- damage to heart valves
- congenital heart disease
Describe the acute management of cardiac failure.
- oxygen treatment
- treat underlying cause
- diuretic (dec blood pressure)
- GTN (vasodilator)
Describe the chronic management of cardiac failure.
- treat cause (pacemaker, CABG)
- heart transplant
- reduce risk factors
- vasodilators
- ACE inhibitors
What is valvular heart disease? What are the 2 types of valvular heart disease?
Diseased or damaged valves which affect the blood flow through the heart. Valve stenosis and valve regurgitation.
What is valve stenosis?
Passage becomes narrowed due to stiffening of the heart valve.
What is valve regurgitation?
Valve does not close properly causing backflow of blood through the valve.
What are the causes of valve stenosis?
- calcification due to ageing
- genital conditions
- rheumatic heart disease
What are the symptoms of valve stenosis?
- chest pain
- shortness of breath
- syncope (temporary loss of consciousness)
- dizziness
What are the signs of valve stenosis?
- heaving
- systolic ejection murmur
- slowly rising pulse with narrow pulse pressure
How is valve stenosis treated?
- valve replacement
- percutaneous valvuloplasty (balloon used to enlarge valve)
- anti-coagulants
- beta-blockers
- ACE-inhibitors
What are the causes of valve regurgitation?
Acute -infective endocarditis -chest trauma Chronic -congenital defects -tissue disorders (Marfans) -rheumatic fever -cardiomyopathy
What are the symptoms of valve regurgitation?
- exertional dyspnoea
- orthopnea (short of breath lying down)
- palpitations
- angina
What are the signs of valve regurgitation?
- collapsing pulse (rapidly increasing then decreasing)
- wide pule pressure
- high pitched early diastolic murmur
How is valve regurgitation treated?
- valve replacement
- ACE inhibitors
- echocardiogram for monitoring
What is cardiomyopathy?
Condition where the cardiac muscle is structurally or functionally abnormal
What is the difference between primary and secondary cardiomyopathy?
Primary is idiopathic (unknown cause). Secondary is as a result of another condition.
Name 3 examples of conditions which result in secondary cardiomyopathy.
CKD, diabetes mellitus, thyroid disease, drugs/alcohol abuse, infection, genetic conditions
What is dilated cardiomyopathy and what are the symptoms?
Ventricles are enlarged so blood is pumped less efficiently.
- fatigue
- dyspnoea
- oedema
What is hypertrophic cardiomyopathy and its symptoms?
Myocytes increase in size causing thickening of the cardiac muscle.
- angina
- dyspnoea
- palpitations
What is restrictive cardiomyopathy?
Condition where the ventricle do not fill to max volume due to stiffening of the cardiac muscle.
What is arrhythmogenic cardiomyopathy?
Progressive replacement of cardiac muscle with fatty/fibrous tissue, due to abnormal proteins holding cells together which leads to cell death..
How is cardiomyopathy managed?
- beta-blockers (irregular heart beat)
- ECG and echocardiogram
- lifestyle changes
- anti-hypetensives
- diuretics
- anti-coagulants
- heart transplant
What is coarctation of the aorta and what are the symptoms?
Congenital narrowing of the aorta.
- palor
- irritability
- heavy sweating
- dyspnoea
How is coarctation of the aorta managed?
Angioplasty - stent with balloon is inserted into the aorta to widen it
What is a patent ductus arteriosus and how is it treated?
Ductus arteriosus remains open causing blood to flow from the aorta into the pulmonary artery. Closed surgically
What is a patent foramen ovale and how is it treated?
Foramen ovale remains open so blood flow from the LA into the RA. Surgically closed if hole is of a significant size.
What is hypoplastic left heart syndrome?
Congenital defect causing the left of the heart to be underdeveloped (small ventricles, ascending aorta, valves)
What are the symptoms of hypoplastic left heart syndrome?
- weak pulse
- dyspnoea
- pale skin
What are the causes of hypoplastic left heart syndrome?
- genetic mutations
- genetic risk factors
- antenatal environment
How is hypoplastic left heart syndrome treated?
- surgery
- diet control
- medication to strengthen the heart muscle
What are cardiac arrhythmias?
Abnormal heart rate/rhythm
What is supraventricular tachycardia?
Heart rate is not controlled by the SA node but by another part of the heart which is causing a fast heart rate
What is atrial fibrillation?
Random electrical impulses from the atria cause rapid and partial contraction of the atria.
What is atrial flutter?
Atria rapidly contract but ventricles don’t.
What is ventricular tachycardia?
Ventricles beat rapidly but atria don’t.
What is ventricular fibrillation?
Random electrical impulses originating from the ventricle cause weak heart contractions.
What is heart block?
Electrical impulses partially or fully blocked between the atria and ventricles.
What are the causes of cardiac arrhythmia?
- congenital
- hypertension
- ageing
- cardiomyopathy
- coronary heart disease
What are the symptoms of cardiac arrhythmias?
- palpitations (sensation of heart skipping of adding a beat)
- dizziness/faint
- short of breath
- chest pains
What are the treatments for cardiac arrhythmias?
- cardioversion (electrical shock given under anaesthetic to restart heart)
- pacemaker
- implantable cardioverter defibrillaters (small device in body which detects heart rate and triggers a small electrical shock when it is abnormal
- catheter ablations (small wire used to destroy part of the heart causing abnormal impulses)
What is an aortic aneurysm?
Enlargement/ballooing of the aortic artery
What are the causes of an aortic aneurysm?
- atheroma
- trauma
- infection
- connective tissue disorder
What are the symptoms of an aortic aneurysm?
Often asymptomatic, unless pressing on other structures then may cause pain
How is an aortic aneurysm managed?
- modify risk factors (dec BP, smoking cessation)
- monitor size
- EVAR (endovascular repair) if: expanding >1cm/year, >5.5cm, symptomatic
What are the complications of an aortic aneurysm?
- rupture (artery burst causing internal bleeding)
- thrombosis
- embolism
- fistula (abnormal connection between an artery and vein)
What are the symptoms of a ruptured aortic aneurysm?
- pain
- expansible abdominal mass
How is a ruptured aortic aneurysm managed?
41% mortality if treated
- ECG, crossmatch
- IV access
- O Rh-ve blood (universal donor - no antigens to be rejected)
- emergency surgery to clamp aorta above leak and insert graft
What is aortic dissection?
Inner layer of the aorta tears causing blood to pass through the tear and separate the inner and middle layers of the aorta
What are the causes of aortic dissection?
- hypertension
- aortic aneurysm
- Marfans (tissue disorder)
- strenuous exercise
- cocaine use
What are the symptoms of an aortic dissection?
- tearing chest pain (may radiate to the back)
- weakness in part of the body
- shortness of breath
What are the complications of aortic dissection?
limb ischaemia
- MI
- cardiac arrest
- aortic valve incompetence
How is an aortic dissection managed?
- ECG, CXR, CT scan
- hypotensives (beta blockers)
- surgery to repair artery
What is peripheral vascular disease?
Narrowing/blockage/spasm of the blood vessels outside the brain and heart (usually in the leg - femoral)
What causes peripheral vascular disease?
Atheroma
What are the risk factors for peripheral vascular disease?
- excessive alcohol consumption
- obesity
- diabetes mellitus
- hyperlipidemia
- genetics
- smoking
- immobility
What are the symptoms of peripheral vascular disease?
- pain in the legs after exercise which is relieved by exercise
- pain in the foot at rest
- ulceration
- gangrene (death of tissue due to ischaemia
What are the signs of peripheral vascular disease?
- weak pulse in the foot, popliteal, femoral
- pale/cold feet
- sores on feet
How is peripheral vascular disease managed?
- modify risk factors
- anti-platelets (Clopidogrel)
- anti-hypertensives
- statins
- surgery (amputate, angioplasty, bypass artery
What is cardiogenic shock?
Inadequate tissue perfusion due to cardiac dysfunction. Leading to
- hypoperfusion: dec blood flow to organ
- hypoxia: dec oxygen at the tissue level
What are the causes of cardiogenic shock?
- MI
- arrhythmias
- pulmonary embolus
- tension pneumothorax
- cardiac temponade
- myocarditis
- aortic dissection
- valve damage
- drugs
What is cardiac temponade?
Fluid accumulates in the pericardium (sac around the heart) causing compression of the heart. So the heart is unable to fill/pump properly
What are the symptoms of cardiogenic shock?
- chest pain
- dyspnoea
- sweating
- confusion
- faint
- nausea/vomiting
What are the signs of cardiogenic shock?
- pale skin
- hypotension
- tachycardia or bradycardia
- raised jugular vein pressure
How is cardiogenic shock managed?
- oxygen therapy to reach O2 sats of 94-98%
- diamorphine for pain
- correct any arrhythmias/electrolyte imbalances
- optimise filing pressure (underfilled = plasma expander, overfilled = ionotropic support)
- treat cause
Define:
Cardiac failure
Cardiogenic Shock
Myocardial infarctions
Cardiac failure = heart unable to pump blood sufficiently around the body
Cardiogenic shock = state of inadequate tissue perfusion due to dysfunction of the heart.
MI = sudden and complete blockage of blood to the heart causing serious damage.
