cardiovascular conditions - component 18 Flashcards
Risk factors associated with coronary heart disease:
high blood cholesterol and triglyceride levels
High BP
what is coronary heart disease?
Condition in which the heart muscle is damaged, or prevented from achieving its full potential, because of diminished or inadequate blood supply due to obstruction.
coronary artery disease
Condition that causes narrowing or obstruction of coronary arteries, resulting in reduced or obstructed blood flow through the heart.
causes of coronary artery disease
ATHEROMA
atheroma:
Development of thick, hard plaques or lesions of hardened lipid material. Commonly found at greatest areas of turbulent blood flow such as bifurcation. The Plaque, restricts blood flow and increases pressure
causes of coronary artery disease
ATHEROSCLEROSIS
Long term degenerative disease of the arteries.
characterised by progressive narrowing of the lumen of medium and large arteries due to the build up of plaque. So no recoil or movement, cant expand, effect on blood flow and BP.
causes of coronary artery disease
ARTERIOSCLEROSIS
A gradual loss of elasticity in the walls of arteries due to thickening and degenerative processes. Can cut off blood supply
causes of coronary artery disease
THROMBUS
A blood clot formed in an unbroken blood vessel. Stop blood getting to the major organs
causes of coronary artery disease
EMBOLUS
Any debris transported by the blood stream e.g. plastic, air, blood clot, fat.
anything that flows until becoming blocked in a small vessel.
Acute coronary syndrome
Coronary artery disease can lead to the reduction in blood flow through an artery to the heart muscle (myocardium)
as a result, the patient may develop signs and symptoms of acute coronary syndrome. (ACS)
ACS occurs when
Abrupt reduction in blood supply to the myocardium leading to myocardial ischaemia.
acute is when it happens straight away
Presentation of ACS
Central chest pain
crushing or constricting in nature
Persists >15minutes
pain may also present in shoulders, upper abdomen, neck arms and jaw
Umbrella terms for ACS
unstable angina
ST- elevation myocardial infarction
Non ST elevation myocardial infarction
angina
Condition caused by reduction in blood flow through a coronary artery causing ischaemia. Two main types - stable (will normally respond to a vasodilator) and unstable (won’t respond, complete exclusion of blood flow to heart)
Obtain a history
OLDCARTS
Basic observations should be completed
respirations pulse Pallor check - look at your patient sp02, BP 12 lead ECG - on all patients suspected of ACS Pain score pre and post treatment be prepared to defibrillate
Stable and unstable angina clinical presentation
pain or heaviness in arms and chest
Pallor/diaphoresis
pain may be referred to the throat, jaw and teeth and also armpits and often into the arm
Nausea/vomiting
Stable angina
Pain typically related to exertion
pain normally subsides on resting within a few minutes and therefore would not be categorised as ACS.
If pain persists for more than 15 mins or doesn’t go away with normal treatment then may be ACS.
unstable angina
May occur at rest, sleeping and walking
what is prinzmetal angina
A form of unstable angina.
often occurs when resting, no predictable pattern
Myocardial infarction
an interruption of normal coronary blood flow resulting in a portion of cardiac muscle being deprived of oxygenated blood.
Results in cardiac muscle becoming necrotic and replaced by non contractile scar tissue.
myocardial clinical features
Severe central chest pain, neck jaw arm and back
pallor, nausea and vomiting, anxiety
Hypotension/hypertension
shallow breathing, grey with cyanosed extremities
Irregular pulse
ECG irregularities
ACS management
Reassure and place the patient at physical and emotional rest
no 02 unless under 94% but check JRCALC guidlines
Administer glyceryl trinitrate spray and consider aspirin
consider etonox for prolonged pain
Paramedic intervention for morphiine
obtain and record base line interventions
ECG in a STEMI
Elevation of ST segment
in hospital blood testing
A troponin test measures the levels of troponin T or troponin I proteins in the blood. We don’t give paracetamol as this raises troponin levels.
these proteins are related when the heart muscle has been damaged e.g. heart attack. The more damage the greater amount of troponin in the blood.
Help to differentiate between MI and other causes of chest pain
heart failure
Heart failure is not a specific disease
Causes can include:
myocardial infarction
hypertension
Valvular heart disease
what is orthopnea
Trouble lying down and breathing
left ventricular failure presentations:
(can cause fluid in the lungs)
Pulmonar oedema
orthopnoea
Coughing frothy pink sputum
abnormal lung sounds e.g. wheezing/crackles
cyanosis
Elevated blood pressure
extended neck veins
Right ventricular failure
Slightly different affects than LVF
GTN (JRCALC) - indications
Indications - cardiac chest pain due to angina or MI, when systolic pressure is greater than 90mmHg.
breathlessness due to pulmonary oedema in acute heart failure when systolic BP greater than 110mmHg
Patients with suspected cocaine toxicity presenting with chest pain
Contra indications - hypotension, hypovaleamia, head trauma, cerebral haemorrhage, patients who have taken viagra, unconscious patients, known severe aortic or mitral stenosis.
what is rheumatic fever?
A serious complication that can develop following an untreated throat infection.
Symptoms include joint pain, swelling, inflammation of the heart causing chest pain and shortness of breath.
the body senses infection so sends antibodies, these sometimes affect the joints and heart
Can cause heart valves to swell leading to scarring
the valves can become damaged and stiffen, resulting in a disruption in blood flow through the heart. Can cause back flow of blood
Cardiac tamponade
accumulation of blood in the pericardial sac causing increase in pericardial pressure.
Bunt or penetrating trauma that have cause damaged to heart wall but pericardial has stayed in tact.
does not allow blood to expand and refill
Cardiac tamponade signs and symptoms
muffled heart sounds Narrowing pulse pressure hypotension Distended neck veins pallor etc.
Cardiac tamponade management
life threatening and so require rapid treatment in hospital
Administer oxygen
rapid transport to hospital
What is pericarditis?
swelling of the pericardium which is the fluid filled sac surrounding heart.
main symptoms are chest pain. Can Alleviates when sat up and worse when lie down. Pain worse when breathe in.
Vascular emergencies -thoracic and abdominal aortic aneurysms
a non specific dilation or out pouching of a blood vessel, developing a weak point in the wall of an artery that results from degenerative changes in the intimal and medial layers.
Progressive enlargement occurs over time as pressure increase, resulting in life threatening rupture of the vessel.
what is sickle cell
Condition affecting the haemoglobin in red blood cells. The cells are irregular in shape and occlude the microvasculature leading to tissue ischaemia.
Can be painful
Acute chest syndrome is a common and potentially fatal complication of a painful crisis and often precipitated by a chest infection.
