Cardiovascular Disease Flashcards
What is the primary focus of this chapter?
Coronary artery disease (CAD)
CAD is the most common form of cardiovascular disease (CVD)
What are the main responsibilities of BACPR instructors regarding patients with CAD?
Development and delivery of safe and effective exercise programmes
In accordance with BACPR protocols
List four other cardiovascular conditions associated with CAD discussed in this chapter.
- Hypertension
- Stroke
- Peripheral arterial disease (PAD)
- Valvular heart disease
True or False: The diagnosis and treatment of CAD are straightforward and uniform for all patients.
False
Two individuals with similar symptoms may undergo different investigations and treatments.
What is the abbreviation for Acute Coronary Syndromes?
ACS
What type of heart failure is referred to as congestive cardiac failure?
CCF
What does the abbreviation ECG stand for?
Electrocardiogram
Fill in the blank: The _______ valve may require repair or replacement in patients with valvular heart disease.
Mitral
What is the abbreviation for Percutaneous Coronary Intervention?
PCI
Name two types of myocardial infarction mentioned in the text.
- ST elevation myocardial infarction (STEMI)
- Non-ST elevation myocardial infarction (NSTEMI)
What does the term ‘Angina Pectoris’ refer to?
A type of chest pain caused by reduced blood flow to the heart
It is a symptom of coronary artery disease.
What is the function of the Sinoatrial node?
It acts as the natural pacemaker of the heart.
List two imaging techniques used for diagnosing CAD.
- Echocardiogram
- Myocardial perfusion scan
What does the abbreviation TAVI stand for?
Transcatheter aortic valve implantation
True or False: Atrial fibrillation is represented by the abbreviation AF.
True
What does the abbreviation BNP stand for?
Brain Natriuretic Peptide
Fill in the blank: _______ is the most common presentation of coronary artery disease.
Angina Pectoris
What is the role of medications in the management of CAD?
To diagnose and manage individuals with coronary artery disease
More details are provided in Section II entitled Guide to Medication.
What is the abbreviation for Left Anterior Descending artery?
LAD
What is the term used to denote the disease characterized by reduced blood flow to the myocardium?
coronary artery disease (CAD)
Another term commonly used is ischaemic heart disease (IHD).
What does the term ‘ischaemia’ mean?
diminished blood supply
It specifically refers to reduced blood flow to a tissue.
What is the main cause of diminished blood flow through the coronary arteries?
atherosclerosis
Atherosclerosis is the narrowing of blood vessels due to atheroma formation.
What is atherosclerosis?
narrowing of blood vessels due to atheroma formation
It can affect coronary arteries, arteries supplying blood to the brain, and peripheral circulation.
What is the difference between atherosclerosis and arteriosclerosis?
Atherosclerosis involves atheroma formation, while arteriosclerosis refers to the hardening of arteries due to calcium deposition
The terms are often used interchangeably, but they denote different processes.
What occurs when the endothelial cells are damaged?
LDL cholesterol attaches and moves through the endothelium into the intima
This process leads to the attraction of monocytes.
What happens to monocytes that engulf LDL cholesterol?
They become stuck in the intima and develop into foam cells
This results in the formation of fatty plaques.
What is the role of foam cells in atherosclerosis?
They die and release lipids, stimulating smooth muscle cells to migrate to the intima
This contributes to plaque growth.
Fill in the blank: Atherosclerosis is characterized by the development of _______ in the blood vessels.
atheroma
Atheroma formation leads to the narrowing of blood vessels.
What is formed as foam cells die and release substances during atherosclerosis?
A fibrous cap
The fibrous cap helps contain the atherosclerotic plaque.
True or False: Atherosclerosis can lead to coronary artery disease, stroke, and peripheral arterial disease.
True
Atherosclerosis affects various blood vessels, leading to these conditions.
What is atherosclerosis?
A progressive, localised inflammatory process due to injury of the endothelial surface of medium and large arteries
Atherosclerosis involves the growth of plaque or lesions within the intima of arteries.
What results from the inflammatory response in atherosclerosis?
Growth of tissue known as plaque or a lesion
Over time, this plaque can lead to narrowing of the lumen (stenosis) and reduced blood flow.
What does plaque in arteries impair?
Endothelial function
This impairment includes reduced vasodilation and an increased likelihood of clot formation.
What causes injury to the endothelium in atherosclerosis?
Factors such as shear stress, nicotine, elevated glucose levels, oxidised low-density lipoprotein cholesterol, and chronic inflammatory conditions
These factors contribute to endothelial damage and subsequent plaque formation.
Where are lesions commonly found in coronary artery disease (CAD)?
In one or more of the three primary coronary arteries or their larger branches
These lesions can significantly affect blood flow and heart function.
What are proximal lesions?
Lesions near the origin of an artery
Proximal lesions are considered more serious than distal lesions due to the risk of ischemia in downstream tissue.
What are distal lesions?
Lesions towards the end of an artery
Distal lesions generally have a lesser impact on overall blood flow compared to proximal lesions.
Fill in the blank: The presence of plaque in arteries causes _______.
narrowing of the lumen (stenosis)
This narrowing reduces blood flow and can lead to serious cardiovascular issues.
True or False: Proximal lesions are less serious than distal lesions.
False
Proximal lesions are more serious because they can cause ischemia in downstream tissues.
What is angina pectoris?
Angina pectoris is chest pain or discomfort caused by reduced blood flow to the myocardium due to ischaemia.
What typically causes myocardial ischaemia?
Myocardial ischaemia is usually caused by atheromatous narrowing of the coronary arteries.
What are two less common causes of myocardial ischaemia?
- Vessel spasm constricting the artery lumen
- Aortic valve disease causing diminished blood flow
What is the difference between a sign and a symptom of disease?
A ‘sign’ is observed in a patient, while a ‘symptom’ is experienced by the patient.
List some typical signs and symptoms of angina.
- Chest pain or tightness
- Burning or dull sensation
- Pain or heavy feeling in the arms
- Pain/discomfort in the throat, abdomen, or back
- Breathlessness on exertion
- Fatigue
What is silent ischaemia?
Silent ischaemia is when individuals, particularly those with diabetes, do not experience chest pain despite having myocardial ischaemia.
What can be the first indication of coronary artery disease in individuals with silent ischaemia?
The first indication may be an acute event such as myocardial infarction.
What are the four main triggers of angina that start with the letter ‘E’?
- Exercise
- Emotional stress
- Extremely cold environment
- Eating a main meal
How does exercise trigger angina?
Exercise increases myocardial workload due to increases in heart rate, blood pressure, and sympathetic activity.
How does emotional stress trigger angina?
Emotional stress increases myocardial workload due to increases in heart rate and blood pressure.
What effect does a cold environment have on angina?
A cold environment causes vasoconstriction, increasing blood pressure and reducing coronary blood flow.
What is ‘post-prandial’ angina?
Post-prandial angina occurs when myocardial workload increases after eating due to increased cardiac output.
How much blood volume is redirected to the stomach and small intestine during digestion?
About 20% of blood volume is redirected to the stomach and small intestine.
Fill in the blank: Angina is most commonly induced by an increase in _______.
[physical exertion]
What characterizes stable angina in terms of exertion?
It follows a pattern of ‘exertion-pain’ and ‘rest-relief’
Stable angina is predictable based on similar situations that induce chest pain.
What are the predictable aspects of stable angina?
Onset, severity, relief methods, reproducibility
Stable angina is characterized by its consistent nature regarding when it occurs and how it can be alleviated.
How is the diagnosis of stable angina primarily made?
Based on a patient’s history and symptoms
Symptoms include chest pain on exertion, which leads to referrals for further evaluation.
What is the purpose of a Rapid Access Chest Pain Clinic (RACPC)?
To provide prompt assessment for individuals with new angina symptoms
Patients are seen more quickly than through standard outpatient referrals.
Which factors are assessed to estimate the risk of coronary artery disease at the RACPC?
Nature of chest discomfort, triggers, duration of pain, relief methods, risk factors
These factors help determine the necessary investigations for the patient.
What is performed as a baseline test for all patients at the RACPC?
A resting electrocardiogram (ECG)
The ECG typically does not show ischaemia unless taken during an angina episode.
What does an electrocardiogram (ECG) record?
Electrical events during the cardiac cycle
Leads placed on the chest and limbs provide different views of the heart’s electrical activity.
What information can an ECG provide?
- Rhythm (regular or irregular)
- Heart rate (fast or slow)
- Normal atrial electrical activity
- Coordination between atrial and ventricular activity
- Normal ventricular electrical activity
- Adequacy of blood flow to heart muscle
- Diagnosis of acute infarction (ST Elevation MI)
- Site of infarction
- Disturbances in electrical activity
Each lead offers a unique perspective on the heart’s electrical performance.
Fill in the blank: The presence of ischaemia is seen as ______ in an ECG.
ST depression
ST depression indicates inadequate blood flow to the heart muscle.
True or False: An ECG can diagnose previous infarcts.
True
ECGs can identify signs of past heart attacks based on electrical activity.
What is the estimated risk percentage range for CAD that qualifies a patient for CT calcium scoring?
10-29%
Patients with this estimated risk will be offered CT calcium scoring as the first line diagnostic investigation.
What type of scan is used for CT calcium scoring?
Myocardial Computerised Tomography (CT) Scan
This scan is used to assess the presence of calcium in coronary arteries.
What does a CT scan involve in terms of imaging technology?
A sophisticated type of X-ray that provides images of internal organs
It uses a special dye injected into the vein and rotates around the body to capture images.
What does the CT coronary calcium score measure?
How much calcium is in the coronary arteries
A higher calcium score indicates a greater risk of coronary artery disease.
What does the presence of calcium deposits in a CT scan suggest?
Evidence of atheroma in the coronary arteries
Normal healthy coronary arteries do not contain calcium.
What does a zero score in CT coronary calcium scoring indicate?
No atheroma present
The individual would not need further investigation if a zero score is obtained.
What is the follow-up procedure if narrowings are detected in the coronary arteries?
Standard coronary angiogram
This is a more invasive procedure to further investigate the condition.
Is CT coronary calcium scoring recommended for individuals at low risk of CAD?
Yes
It is now recommended as the first line diagnostic investigation.
What is the estimated risk percentage for patients offered functional imaging for CAD?
30-60%
Patients with this risk are offered a myocardial perfusion scan as the first line investigation.
What does a myocardial perfusion scan assess?
Adequate oxygen supply to the myocardium at rest and during exercise
It involves capturing radiation emitted from a patient after a radioisotope is administered.
What is the purpose of using a radioisotope in myocardial perfusion scanning?
To create an image of the heart by visualizing areas that take up the radioisotope
Thallium is a commonly used radioisotope in this procedure.
What happens to cardiac cells that are ischaemic or necrotic during a myocardial perfusion scan?
They do not take up the radioisotope
Viable cardiac cells that are well oxygenated will appear bright on the image.
What indicates reversible ischaemia in a myocardial perfusion scan?
Perfusion defects present during exercise but not at rest
These indicate that the tissues are viable but have inadequate blood supply under stress.
What is a key benefit of identifying areas of reversible ischaemia?
They will benefit from revascularisation procedures
Such procedures include percutaneous coronary intervention and coronary artery bypass graft surgery.
When is myocardial perfusion scanning used?
To diagnose coronary artery disease and determine eligibility for revascularisation procedures
It is also used in patients who can only perform minimal exercise or cannot exercise at all.
What is the estimated risk percentage for patients who will be offered invasive coronary angiography?
61-90%
These patients are considered to have a high risk of CAD.
What does coronary angiography involve?
Passing a catheter into the radial or femoral artery to inject radio-opaque dye
This allows visualization of the coronary arteries on X-ray.
What is the main use of coronary angiography?
To visualize the site and size of stenoses and potential treatment options
It is particularly used for patients with a high likelihood of CAD.
What type of anesthesia is used during coronary angiography?
Local anaesthetic
This allows the procedure to be performed with minimal discomfort.
True or False: Coronary angiography can determine if a patient is a candidate for percutaneous coronary intervention.
True
This applies to patients with acute coronary syndrome at high risk of further events.
Fill in the blank: Patients with a strongly positive _____ can undergo coronary angiography.
ECG ETT
This indicates a high likelihood of coronary artery disease.
When is coronary angiography indicated?
When stable angina has not responded to medication
* When angina persists after myocardial infarction (residual angina)
* If the diagnosis of angina is uncertain
* Prior to valve replacement surgery to identify whether the patient also has coronary artery disease
Angiography helps in assessing the need for further interventions.
What information does the angiogram provide?
The site and severity of blockages (stenoses) in the coronary arteries
* The number of stenoses
* The location of stenoses
* The severity of stenoses
This information is crucial for determining suitable treatment options.
What are some treatment options determined by angiogram findings?
Percutaneous coronary intervention
* Coronary artery bypass graft surgery
* Medical management only (e.g., aspirin, nitrates, beta blockers, statins)
Treatment options depend on the specific findings from the angiogram.
What advice is given to patients regarding lifestyle management?
Advice on lifestyle management and actions to take in the event of chest pain
* Use of glyceryl trinitrate (GTN)
Patients are educated on managing their condition effectively.
What is the recommended procedure for the use of GTN?
Stop activity, sit down and rest
* If no immediate relief, take GTN spray/tablets
* Repeat at 5-minute intervals up to 2 doses
* If no relief after 2nd dose, dial 999
* If symptoms relieved, rest for 5 minutes before resuming exercise
Following these steps ensures patient safety during an angina episode.
What medications are typically prescribed to patients with coronary artery disease?
Anti-platelet therapy
* Aspirin
* Clopidogrel
* Ticagrelor
* Prasugrel
These medications help reduce the risk of heart attack or stroke.
What is the purpose of anti-platelet drugs in coronary artery disease?
To reduce the likelihood of blood clots forming
* To reduce the risk of arteries becoming completely occluded
Effective in managing partially blocked arteries.
True or False: The radial artery is easier to compress than the femoral artery.
True
This characteristic minimizes bleeding during catheterization.
Fill in the blank: The entrance into the radial artery is via the _______.
wrist
This method contrasts with the traditional approach that uses the groin.
What are Statins?
Statins are drugs that lower cholesterol levels and slow down further atheroma formation by reducing inflammation in the coronary artery.
Statins are commonly prescribed for individuals at high risk of developing coronary artery disease or other vascular diseases.
What is the role of PCSK9 in cholesterol metabolism?
PCSK9 is a proprotein involved in the destruction of LDL receptors in the liver.
PCSK9 inhibitors reduce this destruction, allowing for increased removal of LDL cholesterol from the blood.
What is the purpose of medications for angina?
Medications for angina aim to reduce the demand for oxygen by decreasing myocardial work and to increase the supply of oxygen by improving coronary blood flow.
Name a type of medication that improves coronary supply by dilation.
Nitrates, calcium channel blockers, and potassium channel activators.
These medications help to dilate coronary arteries and improve blood flow to the myocardium.
How do nitrates affect venous return?
Nitrates cause venodilation, which reduces venous return and preload.
This leads to less tension on the walls of the left ventricle and a less forceful contraction.
What effect does arterial vasodilation have on afterload?
Arterial vasodilation reduces arterial resistance and consequently reduces afterload.
This means the left ventricle does not need to contract as forcefully to pump blood.
True or False: Reducing sympathetic drive increases heart rate.
False. Reducing sympathetic drive decreases heart rate, blood pressure, and the force of each contraction.
Fill in the blank: By reducing sympathetic drive, myocardial work is _______.
reduced.
What is the benefit of extended diastole in terms of myocardial perfusion?
Extended diastole improves myocardial perfusion because coronary blood flow is greater during diastole than during systole.
What are the effects of dilating veins in the systemic circulation?
Dilation of veins reduces venous return, leading to reduced left ventricular filling and less tension on the left ventricular walls.
List three types of medications that can decrease sympathetic drive.
- Beta blockers
- Calcium channel blockers
- Nitrates
What is the primary function of beta blockers in cardiovascular treatment?
Increase blood supply by reducing heart rate, thus improving coronary perfusion and reducing workload.
Beta blockers lower heart rate, blood pressure, and contractility of the heart muscle.
How do calcium channel blockers improve blood supply to the heart?
By vasodilating coronary arteries and inhibiting smooth-muscle contraction.
They also reduce myocardial workload through more efficient contraction.
What is the effect of potassium channel activators on coronary arteries?
They dilate coronary arteries, reducing preload and afterload.
This increases perfusion and reduces workload.
What is the mechanism of action of Ivabradine?
Reduces heart rate, thus lengthening diastole and increasing time for coronary perfusion.
This directly improves blood supply to the heart muscle.
What is revascularisation in the context of angina treatment?
A procedure that restores blood flow to an ischaemic area.
It may involve PCI or CABG, depending on the patient’s condition.
What does PCI stand for and what is its purpose?
Percutaneous coronary interventions; restore blood flow by widening the lumen of a narrowed artery.
PCI often includes stent insertion.
What is the role of Drug Eluting Stents (DES) in PCI?
To prevent re-stenosis over time through slow-releasing drugs.
DES are now commonly used in PCI procedures.
What does CABG stand for and when is it usually favored?
Coronary artery bypass graft surgery; favored for widespread coronary artery disease.
It bypasses blocked arteries using veins or arteries from other body parts.
What are the three manifestations of acute coronary syndrome?
Unstable angina, NSTEMI, STEMI.
Each involves acute chest pain and symptoms of myocardial ischaemia.
What characterizes NSTEMI in an ECG?
The ST segment is normal or depressed.
This is a classification of myocardial infarction.
What characterizes STEMI in an ECG?
The ST segment is raised.
This indicates a more severe type of myocardial infarction.
What are the two common tests for diagnosing acute coronary syndrome?
Resting ECG and blood tests for cardiac markers.
These tests help assess the severity of ischaemia and myocardial damage.
What is the most sensitive marker of myocardial damage?
Troponin.
Troponin is released by ischaemic cardiac cells.
How soon can troponins be detected after myocardial damage?
As early as 34 hours.
Modern assays allow for early detection of troponins.
What is the significance of elevated troponin levels at baseline?
Indicates worse outcomes compared to those with elevated levels at 8 hours.
Normal serial troponin values can effectively rule out acute myocardial ischaemia.
What is unstable angina?
Unstable angina is thought to be the result of plaque disruption that results in the formation of a platelet plug that temporarily occludes the artery but dissolves spontaneously.
What is the significance of transient occlusion in unstable angina?
Because the occlusion is transient, no irreversible damage or death of myocardial cells occurs.
Who is at risk for developing unstable angina?
Individuals with a history of stable angina can develop unstable plaque and may then present with unstable angina.
What percentage of unstable angina cases progress to myocardial infarction?
5-15% of unstable angina cases progress to a myocardial infarction.
What are the three main presentations of unstable angina?
- New onset angina considered ‘unstable’ for one month
- Angina at rest
- Increases in angina indicating a change in previous pattern (increased frequency, increased severity)
What is a key characteristic of resting ECG in unstable angina?
The resting electrocardiogram may be normal but could show abnormalities like ST depression, especially if recorded during symptoms.
What is the expected result of a blood test for troponin in unstable angina?
There will not be a significant rise in troponin levels, indicating that myocardial cells did not die.
What is myocardial infarction commonly referred to as?
Heart attack.
What causes myocardial infarction?
Myocardial infarction is caused by the death (necrosis) of myocardial tissue as a result of prolonged ischemia.
What happens to myocardial cells during myocardial infarction?
Irreversible damage occurs within 6-8 hours due to deprivation of oxygen.
What is the timeline for scar formation after a myocardial infarction?
Within a few days, dead cells disappear, and by 6-8 weeks, scar formation is complete.
What are common signs and symptoms of myocardial infarction?
- Intense pain or pressure in the chest
- Radiating pain to the throat, jaw, or arms
- Mild discomfort similar to indigestion
- Discomfort in the abdomen or back
What is a critical action for BACPR instructors regarding myocardial infarction?
Recognize signs and symptoms of myocardial infarction to ensure individuals receive timely medical attention.
What complications can lead to death from myocardial infarction?
Death from MI usually occurs from complications such as arrhythmia or heart failure.
Fill in the blank: Myocardial infarction is characterized by the formation of a _______.
[large complex thrombus]
What are common symptoms of cardiovascular disease?
Breathlessness, nausea, vomiting, pale/cold/clammy skin, agitation, fear of impending doom, weakness, sometimes collapse
Symptoms apply equally to men, women, and all ethnic groups.
How can GTN be used to distinguish between angina and myocardial infarction?
GTN provides symptom relief in angina but not in myocardial infarction. Prolonged pain lasting more than 10 minutes must be treated as myocardial infarction.
GTN stands for glyceryl trinitrate.
What should a person do if they suspect they are having a heart attack?
Chew an adult aspirin tablet (300 mg), unless allergic to aspirin.
This recommendation is based on recent British Heart Foundation guidelines.
What are ‘silent infarctions’?
Myocardial infarctions that occur without obvious symptoms, detected later via ECG showing heart muscle damage.
Silent infarctions may reveal a Q wave on the ECG.
What does ST elevation on an ECG indicate?
It is a classic sign of myocardial infarction, indicating greater myocardial damage.
ST elevation is associated with STEMI (ST-Elevation Myocardial Infarction).
What are the common sites for myocardial infarctions?
Anterior and inferior regions of the left ventricle.
Other terms include septal, lateral, and posterior.
What is the prognosis for anterior infarcts compared to other types?
Anterior infarcts tend to be larger and are often associated with greater impairment of left ventricular function and a poorer prognosis.
Left ventricular function refers to the heart’s ability to pump blood.
What blood test is used to diagnose NSTEMI or STEMI?
A blood test to measure troponin levels.
Elevated troponin levels indicate cell death (infarction).
What does the peak troponin level indicate?
The size of the infarction and the severity of myocardial damage.
Higher values generally correlate with a larger infarct.
What does it indicate if troponin levels are elevated at baseline?
Patients tend to have worse outcomes than those whose troponin levels are elevated at 6 hours.
Baseline refers to the initial measurement before any treatment.
Is it possible to provide specific troponin levels for infarction diagnosis?
No, different laboratories use different assays, and there are many variables involved.
There are no specific levels that can determine size or risk correlation for use by cardiovascular rehabilitation professionals.
What is the definition of stable angina?
Predictable ischaemic discomfort, e.g. on exertion.
What does a negative ECG indicate in stable angina?
No obvious ECG changes but an ECG ETT may reveal ischaemic changes.
What characterizes unstable angina?
Unpredictable ischaemic discomfort, e.g. at rest, occurring more frequently, at lower thresholds, symptoms more severe.
What does a negative ECG indicate in unstable angina?
No persistent ST elevation but other changes may be present.
What is the management approach for acute coronary syndrome (ACS)?
Always treated as an emergency to establish diagnosis and commence appropriate treatment as soon as possible.
What medication is given for strong pain relief in suspected ACS?
Morphine.
What is the advantage of administering morphine in ACS?
Dampens down the level of circulating catecholamines (adrenaline and noradrenaline).
What are the risks associated with unstable angina and non-ST segment elevation myocardial infarction (NSTEMI)?
Significant risk of further adverse events.
What is a priority once the diagnosis of NSTEMI is confirmed?
Accurate predictions of a patient’s likelihood of further infarction or death.
What may differentiate treatment for patients with the same diagnosis of NSTEMI?
Using established risk assessment scoring systems.
What is a potential treatment for a patient with unstable angina?
Revascularisation.
When might a patient with STEMI not benefit from revascularisation?
If the damage to the myocardium is very extensive.
What investigation should patients with myocardial infarction undergo while in hospital?
An echocardiogram.
What does an echocardiogram determine in myocardial infarction patients?
The extent to which the event may have affected left ventricular function.
Fill in the blank: The presence of persistent ST elevation indicates _______ myocardial infarction.
STEMI
What is indicated by no persistent ST elevation but other changes?
Non-STEMI myocardial infarction.
What is the purpose of myocardial CT Scans?
To diagnose and assess the cause of chest pain and ischaemia during exercise
Myocardial CT Scans are non-invasive tests that can assess ischaemia during physical exercise or through drug-induced effects for those unable to exercise.
What is the method for performing a stress echo?
A resting echo is performed, followed by exercise on a treadmill or bike until peak HR is reached, and then the echo is repeated
This method determines whether the myocardium has become ischaemic during exercise.
What is Dobutamine stress echo used for?
To mimic the effects of exercise on the myocardium in patients who cannot perform exercise
Dobutamine is administered to induce ischaemia, followed by a repeated echo.
How does the reliability of a stress echo compare to an ECG ETT?
More reliable as a diagnostic tool and less likely to produce false positives or negatives
It assesses heart performance rather than just ECG and BP response.
What is a myocardial perfusion scan used for?
To identify areas of myocardium that may benefit from revascularisation
This scan provides insights into potential treatment needs for myocardial areas.
What does coronary angiography determine?
The site and severity of the disease within the artery
It is often used in complex cases or when the diagnosis is uncertain.
What does a magnetic resonance imaging (MRI) scan provide?
Higher resolution and clearer three-dimensional images of the heart
MRI is excellent for showing heart structure, blood vessels, and blood flow.
What is the preferred reperfusion treatment for STEMI patients near hospitals?
Primary Percutaneous Coronary Intervention (PPCI)
This involves immediate balloon angioplasty without thrombolytics and improves prognosis when done soon after symptoms occur.
What treatment is offered to patients in rural areas for STEMI?
Thrombolysis
Thrombolytics like Tenecteplase are used to dissolve blood clots in occluded arteries.
What is the function of thrombolytics?
To disperse the blood clot in the occluded artery and restore oxygen to the myocardium
‘Thrombus’ refers to a clot, and ‘lyse’ means to dissolve.
What does an echocardiogram involve?
Non-invasive technique using ultrasound to create a moving image of the heart
The chest is covered with gel, and ultrasound pulses are applied to reflect back images.
What information does the echocardiogram provide?
Ejection fraction and LV function, size of heart’s chambers, thickness of atrial and ventricular walls, motion of walls, valve competence, presence of abnormalities such as thrombus
See Section 4.3 for more on the diagnosis of heart failure.
When is an echocardiogram used?
Post-myocardial infarction, in left ventricular dysfunction and heart failure, in valve disease.
What does an MRI involve?
A scan using strong magnetic fields and radio waves to produce detailed images of the body.
Describe the MRI scanner.
A large tube ‘tunnel’ that contains powerful magnets.
What do short bursts of magnetic fields and radio waves allow in MRI?
Creation of images of the heart.
Can MRI be used in patients with large implanted metallic devices?
No, except for some MRI compatible pacing devices.
What can modern mechanical heart valves and coronary artery stents do during an MRI?
Be imaged safely.
What are the uses of MRI scans?
Plan treatments, diagnose conditions, assess treatment effectiveness.
What types of images does an MRI create?
Both still and moving pictures of the heart and major blood vessels.
What detailed information does an MRI provide?
Information about cardiac anatomy and function.
What are the main clinical uses of cardiac MRI in cardiovascular disease?
To determine the:
* size of the heart’s chambers
* thickness of the atrial and ventricular walls
* motion of the atrial and ventricular walls
* ejection fraction
* competence of the valves
* presence of abnormalities such as a thrombus within the ventricles
Cardiac MRI can also assess myocardial viability, identify stress-induced myocardial ischaemia, and differentiate forms of cardiomyopathies.
What is the purpose of the ECG ETT?
An incremental test designed to induce ischaemia with or without symptoms during exercise.
It continuously records the electrocardiogram and measures blood pressure response.
What protocols are used during the ECG ETT?
The Modified Bruce and Full Bruce Protocols.
These protocols increase the rate and incline of the treadmill every 3 minutes.
What symptoms are recorded during the ECG ETT?
Symptoms such as chest pain.
The ECG is monitored closely for evidence of ST segment depression, which denotes evidence of ischaemia.
What information does the ECG ETT provide regarding ischaemia?
It determines whether there is any persisting ischaemia and provides information regarding long-term prognosis.
The lower the intensity at which symptoms are provoked, the poorer the prognosis.
What additional information can the ECG ETT provide?
It provides information to:
* establish the extent and severity of the disease in someone with established symptoms
* confirm residual (persisting) ischaemia in patients post-myocardial infarction or post-surgery
* assess the effectiveness of treatment
This includes evaluations before and after surgery or after a cardiovascular prevention and rehabilitation programme, although this is not common.
What does a positive ECG ETT result indicate?
Presence of disease signs including:
* Chest pain during exercise
* ST segment depression (> 2 mm)
* Drop in BP indicating poor left ventricular function or severe coronary disease
* Serious arrhythmias like ventricular tachycardia
The lower the level of work at which these signs appear, the greater the likelihood of severe disease.
What conditions can lead to the termination of an ECG ETT?
Termination can occur if:
* Patient reaches age-adjusted maximal heart rate
* Patient is very fatigued or experiences excessive breathlessness
Especially at low workloads, excessive breathlessness may indicate serious problems such as heart failure.
What characterizes a negative ECG ETT result?
No signs or symptoms of disease provoked by the time the patient reaches age-adjusted maximal heart rate despite incremental workload.
Indicates good functional capacity.
What is the typical duration of patient admission to the coronary care unit following acute coronary syndrome?
24 hours
This is the most critical time in their recovery for monitoring abnormal rhythms.
What happens after a patient is stable in the coronary care unit?
They are transferred to a step-down unit to begin gentle mobilizing activities.
A cardiovascular rehabilitation nurse usually visits at this time to start the first phase of rehabilitation.
What is the typical hospital discharge timeframe for patients without complications after acute coronary syndrome?
3-5 days
If further infarction is likely, early revascularization will be considered.
What are revascularisation procedures?
Interventions that restore blood flow to jeopardized myocardial areas, including:
* Percutaneous coronary intervention (PCI)
* Coronary artery bypass graft (CABG)
These procedures are critical in managing coronary artery disease.
What is primary PCI (PPCI)?
Urgent restoration of coronary blood flow in patients diagnosed with ST segment elevation myocardial infarction.
It limits heart damage if reperfusion occurs soon after diagnosis.
What is staged PCI?
Elective PCI performed at a later date for other arterial blockages after the most urgent blockage is treated.
Ensures comprehensive management of coronary artery disease.
What is elective PCI?
Planned angioplasty with or without stenting for patients whose symptoms are not adequately controlled.
Suitable for patients with numerous lesions in other arteries.
What is a common postoperative issue following PCI?
Recurrence of angina due to re-stenosis.
Most patients require only an overnight hospital stay.
What does percutaneous coronary intervention involve?
- Introduction of a ‘balloon’ catheter into an artery. 2. Inflation of the balloon compresses atherosclerotic plaque and widens the artery. 3. Insertion of a stent in at least 97% of cases to hold the artery open. 4. Many stents are drug-eluting stents that release medication to prevent re-narrowing.
A stent is a small metal or mesh coil that supports the artery after widening.
What is the purpose of drug-eluting stents?
To retard the tendency of the intima to grow through the stent and re-narrow the lumen.
Drug-eluting stents are coated with medication that helps prevent restenosis.
What is coronary artery bypass graft surgery (CABG)?
An invasive surgery used for revascularization in patients with severe coronary artery disease when PCI is not suitable.
CABG is often indicated when multiple arteries are affected or when the patient has poor left ventricular function.
When is CABG undertaken?
- When angina is disabling and not amenable to PCI
- When lesions affect large areas of the myocardium
- When there are two or more stenosed coronary arteries with poor left ventricular function
- When PCI fails
Patients must consent to bypass surgery before undergoing angioplasty due to the risk of myocardial infarction.
What is the expected outcome of bypass surgery?
Total relief from angina in the vast majority of cases and prolongation of life compared to medical management alone.
This is particularly true for patients with disease of the left main coronary artery.
What symptoms did Mr. X present with?
Chest tightness on exertion, shortness of breath, and fatigue.
Symptoms were relieved by rest and worsened in cold weather.
What was the estimated coronary artery disease risk for Mr. X?
Moderate.
This assessment was made following a review at the local RACPC.
What test was performed to assess Mr. X’s symptoms?
A Myocardial Perfusion scan.
This test determines whether there is any underlying ischaemia.
What did the Myocardial Perfusion scan reveal for Mr. X?
Reversible ischaemia.
This finding prompted a referral for a coronary angiogram.
What procedure did Mr. X undergo after the angiogram?
Percutaneous coronary intervention (PCI) to his LAD.
The LAD stands for left anterior descending artery.
What medications were prescribed to Mr. X?
- Aspirin
- Clopidogrel
- Beta blockers
- Statin
- GTN spray
Mr. X also received lifestyle advice and an action plan for chest pain.
What is a vein graft?
A surgical procedure using a vein to bypass obstructed coronary arteries
Commonly used in coronary artery bypass graft surgery.
What is the right coronary artery stenosis?
Narrowing of the right coronary artery, which can lead to cardiovascular issues
A significant condition that may require surgical intervention.
What does cardiovascular disease refer to?
A group of disorders affecting the heart and blood vessels
Includes conditions like coronary artery disease, hypertension, and heart failure.
What is the left internal mammary artery used for in heart surgery?
It is commonly used as a graft to bypass the left anterior descending artery
Known for its effectiveness in coronary artery bypass graft surgery.
What does coronary artery bypass graft surgery involve?
Obstructed coronary arteries are bypassed using an internal mammary artery, a radial artery, or a saphenous vein
The procedure is performed under general anaesthetic.
What type of anaesthesia is used for coronary artery bypass graft surgery?
General anaesthetic
Ensures the patient is unconscious during the procedure.
How is the surgery typically performed?
Through an incision in the sternum
This approach provides access to the heart for the bypass procedure.
What is the significance of the heart-lung bypass machine during surgery?
It allows the surgery to be performed while the heart is stopped
Some operations may be performed with the heart still beating.
What is the typical hospital stay after coronary artery bypass graft surgery?
Several days in hospital and a short time in Intensive Care
Recovery duration is longer compared to less invasive procedures.
What is the recovery time frame for core (Phase II) cardiovascular rehabilitation after surgery?
Usually starts at 2-4 weeks post-surgery
Aimed at improving cardiovascular health and recovery.
True or False: Most coronary artery bypass graft surgeries are performed with the heart still beating.
False
Most surgeries are performed with the heart stopped.
Fill in the blank: The _______ artery is commonly used as a graft to bypass the left anterior descending artery.
left internal mammary
This graft is preferred for its long-term patency.
What are common short-term complications of heart surgery?
Pain and/or numbness around the chest wall, upper back (thoracic) pain, atrial fibrillation
Atrial fibrillation occurs in 20-30% of all patients 2-5 days post-surgery.
What can cause upper back pain after heart surgery?
Adopting a round-shouldered posture to minimize chest wound discomfort
This posture may lead to thoracic pain.
What are potential complications related to wound healing after heart surgery?
Wound infections and healing problems, especially in diabetics
Diabetics are particularly slow to heal.
What is a possible complication related to the sternum after heart surgery?
‘Clicking’ sternum or unstable sternum
Poor/slow healing of the sternal bone can cause a ‘clicking’ sound.
What is brachial palsy and how can it occur after heart surgery?
Brachial palsy due to nerve compression during surgery
This usually manifests as slight numbness in some fingers and may last up to 6 months.
What emotional or psychological side effects may occur post-surgery?
Loss of appetite and constipation, emotional and psychological side effects
These effects also occur in a significant number of patients following myocardial infarction.
What is standard drug therapy for acute coronary syndromes at discharge?
Anti-platelet therapy, statins, beta blockers, ACE inhibitors
Patients with ACS are prescribed aspirin and often a second anti-platelet drug.
What is the purpose of prescribing aspirin to patients with acute coronary syndromes?
To reduce the likelihood of blood clots forming
This helps to reduce the risk of a further event.
Which additional anti-platelet drugs may be prescribed after an acute myocardial infarction?
Clopidogrel, prasugrel, ticagrelor
These are prescribed in combination with aspirin for a period of time.
What are the roles of beta blockers post-myocardial infarction?
Reduce the risk of further myocardial infarction and sudden cardiac death
Clinical research trials support their effectiveness in reducing adverse events.
Under what condition might beta blockers not be prescribed?
If their use is contraindicated, such as in asthma
Beta blockade may exacerbate wheeziness in asthma.
What is the benefit of ACE inhibitors after a myocardial infarction?
Reduce the risk of future adverse events and deterioration of left ventricular function
ACE inhibitors help prevent the onset of chronic heart failure.
Which patients are likely to be prescribed ACE inhibitors?
Most patients following ST segment elevation myocardial infarction and non-ST segment elevation myocardial infarction
This is due to their proven benefits post-myocardial infarction.
What are the three common complications following acute coronary syndrome?
- Residual angina
- Left ventricular dysfunction and chronic heart failure
- Arrhythmias and sudden cardiac death
Residual angina indicates persistent angina and ischaemia after the cardiac event.
What is residual angina?
It means that angina and ischaemia has persisted after the cardiac event.
Treatment involves drug management and/or interventions like percutaneous coronary intervention or coronary artery bypass graft surgery.
What factors increase the likelihood of complications after acute coronary syndrome?
- Site of the infarction is anterior
- Size of the infarction is large
Anterior infarctions tend to be more serious and are associated with a poor prognosis.
What does an ECG inform about in the context of myocardial infarction?
It informs which site the infarction has occurred in.
It can diagnose MI and determine if there is ST elevation or depression.
What blood test helps to establish the size of the infarction?
Troponin test
A large anterior infarct is often associated with a poor prognosis.
What are some investigations used to diagnose cardiovascular disease?
- ECG
- Myocardial CT scans
- Myocardial Perfusion Scans
- Echocardiography
- Stress Echocardiogram
- Cardiac MRI scans
- Angiogram
These investigations provide various information critical for diagnosing CVD.
What information can an echocardiogram provide?
- Heart rhythm
- Size of the heart’s chambers
- Thickness of the atrial and ventricular walls
- Motion of the atrial and ventricular walls
- Ejection fraction
- Competence of the valves
It also assesses myocardial viability and presence of abnormalities like thrombus within the ventricles.
What does a stress echocardiogram help diagnose?
It helps diagnose the cause of chest pain and presence of ischaemia when the heart is under stress.
It can also assess whether areas of myocardium have been permanently damaged after MI.
True or False: Acute coronary syndrome complications are solely related to the syndrome itself.
False
Conditions like left ventricular dysfunction, chronic heart failure, and arrhythmias can have other causes.
Fill in the blank: A large anterior infarct is often associated with a _______.
poor prognosis
What does the calcium score in coronary arteries indicate?
Likelihood of coronary artery disease (CAD)
This score helps in assessing the risk of CAD.
What is the purpose of myocardial perfusion scans?
To identify reversible or irreversible ischaemia
These scans help in determining the viability of myocardial tissue.
What can differentiate forms of cardiomyopathies?
Stress induced myocardial ischaemia
This helps in understanding different heart conditions.
What does an angiogram identify?
Stenoses in coronary arteries and location and degree of blockage
This information is crucial for deciding on appropriate treatment options.
What can an echocardiogram measure regarding left ventricular function?
Ejection fraction and determining LV function
It assesses how well the left ventricle pumps blood.
What is the most common cause of left ventricular dysfunction?
Myocardial infarction
It is characterized by a reduction in ejection fraction to less than 50% of the end diastolic volume.
List some other causes of left ventricular dysfunction.
- Chronic hypertension
- Atrial fibrillation
- Valve disease
- Alcohol and illicit drug abuse
- Cardiomyopathy (heart muscle disorder)
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
Hypertrophic cardiomyopathy involves enlargement of the heart, while dilated cardiomyopathy features a large thin-walled left ventricle.
What happens to stroke volume following myocardial infarction?
It is reduced due to impairment of both the filling and emptying phases of the left ventricle
Impairment occurs because of damage to the left ventricle and loss of cardiac muscle mass.
Why is filling impaired in left ventricular dysfunction?
Damage makes the left ventricle less compliant (‘stiffer), reducing its ability to accommodate the same volume of blood
This results in reduced preload.
What contributes to the impairment of emptying in left ventricular dysfunction?
Loss of cardiac muscle mass reduces contractility
Consequently, a lower percentage of blood is ejected compared to a healthy left ventricle.
What compensatory mechanism occurs in significant left ventricular dysfunction?
Increase in sympathetic activity
This improves the frequency and force of contraction to maintain cardiac output despite reduced stroke volume.
What is the process known as remodelling in left ventricular dysfunction?
The left ventricle becomes bigger and thicker after an extensive myocardial infarction
This initially helps maintain cardiac output.
What happens when compensatory mechanisms cease to be effective?
Left ventricular dysfunction progresses to symptoms of heart failure becoming apparent
These mechanisms can increase the work of the heart over time.
What is heart failure?
It occurs when the left ventricle cannot maintain adequate cardiac output to meet the body’s oxygen demands
It is clinically characterized by symptoms like breathlessness, fatigue, and ankle swelling.
What are common symptoms of heart failure?
- Breathlessness
- Fatigue
- Ankle swelling
- Objective evidence of cardiac dysfunction
Symptoms may occur at rest or during exertion.
What occurs in right-sided heart failure?
Reduced ejection fraction causes blood to back up into the systemic circulation
This results in increased pressure in systemic capillaries, leading to fluid leakage into tissues.
What is ‘pitting oedema’?
Swollen tissue in which indentations can be made, usually seen as bilateral swollen ankles
It is a result of fluid leaking from the circulation in right-sided heart failure.
What occurs in left-sided heart failure?
Reduced ejection fraction causes blood to back up into the pulmonary circulation
This increases pressure in pulmonary capillaries, leading to pulmonary oedema.
What are the symptoms associated with pulmonary oedema?
Shortness of breath, particularly on exertion
This hinders gaseous exchange at the alveolar level.
What is the New York Heart Association classification used for?
To classify the severity of heart failure symptoms
It helps assess the effectiveness of treatment, although symptom severity does not always correlate with ventricular impairment.
List some signs and symptoms of heart failure.
- Shortness of breath
- Fatigue
- Pitting oedema in the feet, ankles, and sacrum
- Reduced exercise capacity
These symptoms can vary in severity among patients.
What is Class I in the New York Heart Association classification of heart failure?
No limitations. Ordinary physical activity does not cause undue fatigue, dyspnoea or palpitation.
Asymptomatic left ventricular dysfunction
What characterizes Class II heart failure?
Slight limitation of physical activity. Patients are comfortable at rest but ordinary physical activity results in fatigue, dyspnoea or angina.
Symptomatically mild heart failure
What is the definition of Class III heart failure?
Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity leads to symptoms.
Symptomatically moderate heart failure
What defines Class IV heart failure?
Inability to carry on any physical activity without discomfort. Symptoms present even at rest.
Symptomatically severe heart failure
What are the key components of heart failure diagnosis?
Assessment by a skilled practitioner including:
* Medical history and symptoms
* Diagnostic tests such as:
* Resting electrocardiogram
* Echocardiography
* Chest X-ray
* Blood tests
Diagnostic tests help determine the type and severity of heart failure
What does a resting electrocardiogram indicate in heart failure?
It may indicate left ventricular hypertrophy, previous myocardial infarction, or arrhythmias such as atrial fibrillation.
Useful for assessing heart function
What does echocardiography measure in heart failure diagnosis?
It measures left ventricular function and establishes the ejection fraction (EF).
It is a non-invasive ultrasound test
What does EF > 50% indicate?
Good left ventricular function.
Ejection fraction is a key indicator of heart function
What does EF between 35% and 49% indicate?
Moderate left ventricular function.
Important for assessing treatment options
What is indicated by EF < 35%?
Poor left ventricular function.
Critical for understanding severity of heart failure
What is the purpose of dividing heart failure into HFrEF and HFpEF?
To help determine the best treatment as drug treatments that improve prognosis are only effective in patients with HFrEF.
HFrEF refers to reduced ejection fraction, while HFpEF includes all other forms
What is the mean age of patients with heart failure?
78 years.
This reflects the increasing prevalence of heart failure
How does the degree of left ventricular impairment affect survival in heart failure?
The worse the impairment, the lower the survival.
Important for prognosis and treatment planning
What are the survival rates for heart failure patients in the UK after 1 year?
Mortality rate of 29.8%.
This is an improvement from the previous year’s rate of 31.6%
What factors contribute to improved survival rates in heart failure patients?
Factors include:
* Admission to a cardiology ward
* Seen by specialist doctors
* Followed up by heart failure nurses
* Prescribed optimum medications and treatments
* Referred to cardiac rehabilitation inpatient programmes after discharge
NHFA recommendations, 2020 highlight these factors
What are the aims of medical treatment for heart failure?
To relieve symptoms, improve quality of life, and improve survival rates for those with HFrEF.
What surgical intervention may benefit patients with heart failure caused by valve disease?
Surgery.
What are the main aims of medications for patients with low ejection fraction?
- Reduce myocardial workload
- Remove excess fluid
- Reduce remodelling
For which patients are ACE inhibitors indicated?
Patients with impaired left ventricle based on echocardiographic evidence, even if asymptomatic.
What is one effect of ACE inhibitors on arteries?
They vasodilate arteries, reducing afterload.
How do ACE inhibitors affect venous return?
They dilate veins, which reduces venous return and thereby preload.
What action do ACE inhibitors have on salt and fluid retention?
They counteract salt and fluid retention.
What is the role of ACE inhibitors in remodelling?
They slow down remodelling.
What do angiotensin receptor blockers do?
They directly block angiotensin II receptors, preventing vasoconstriction.
What is the purpose of neprilysin inhibitors?
To improve ejection fraction and induce vasodilation in heart failure.
What is valsartan classified as?
An angiotensin receptor inhibitor (blocker).
What is the effect of sacubitril?
It induces vasodilation.
What is the function of diuretics in heart failure treatment?
To reduce afterload by decreasing the volume of fluid in the central circulation.
What are beta blockers used for in heart failure?
Beta blockers are used to reduce heightened sympathetic activity in stable patients under supervision.
Beta blockers depress heart rate and myocardial contraction, making their use in heart failure seem counterintuitive.
What is the first line treatment in heart failure?
ACE inhibitors and diuretics.
These medications are essential for managing heart failure symptoms.
What is the role of diuretics in heart failure?
To reduce salt and fluid retention, thereby reducing preload and afterload.
This helps alleviate the workload on the heart.
What effect do ACE inhibitors have on the cardiovascular system?
Vasodilate veins to reduce venous return and preload.
This action helps lower blood pressure and improve heart function.
What is sinus rhythm?
The normal rhythm initiated by the sinoatrial node, characterized by a P, Q, R, S, T complex.
In a resting adult, the normal heart rate ranges from 60-100 bpm.
What is an arrhythmia?
An umbrella term for all types of heart rhythms that are not sinus rhythm or are outside the normal resting range.
Arrhythmias can arise from issues with the natural pacemaker or other points in the conduction system.
What are the three broad groups of arrhythmias?
Tachycardias, bradycardias, and irregular rhythms.
These are the most common types encountered in clinical practice.
What is the mechanism of action of dapagliflozin in diabetes?
Helps the kidneys lower blood glucose levels as a sodium-glucose co-transporter-2 (SGLT2) inhibitor.
This mechanism improves glycemic control in diabetic patients.
How does dapagliflozin benefit patients with heart failure?
Reduces preload and afterload, which decreases myocardial workload and slows renal failure.
This is especially useful in patients with reduced ejection fraction (HFrEF).
What is the effect of neprilysin inhibitors in heart failure?
They contribute to improving heart function alongside other medications.
Neprilysin inhibitors are part of the standard therapy for left ventricular dysfunction.
Fill in the blank: ACE inhibitors and ARBs are used to _______ the activity of the sympathetic nervous system.
reduce.
This helps in managing heart failure and hypertension.
What is the purpose of a continuous electrocardiogram?
To diagnose intermittent symptoms such as blackout, runs of tachycardia, or palpitations
It allows for recording of the electrocardiogram throughout periods of rest and activity.
How long are ambulatory electrocardiograms typically recorded?
24 to 48 hours
This allows for monitoring heart activity during daily activities.
What is tachycardia defined as?
A heart rate above 100 bpm
‘Tachy’ means fast, and ‘cardia’ means heart.
What is supraventricular tachycardia?
Tachycardia that originates in the atria
‘Supra’ means above.
Is supraventricular tachycardia usually life-threatening?
No, it is not usually life-threatening
However, it may cause faintness or collapse.
What are some normal physiological responses that can cause heart rates to exceed 100 bpm?
- Exercise
- Anxiety
- Pain
- Fear
- Fever
Stimulants like caffeine and alcohol can also increase heart rate.
What should be considered abnormal in terms of resting tachycardia?
A rate > 100 bpm that persists after 10-15 minutes of seated rest
This should always be investigated further.
What sensation do some people experience with supraventricular tachycardia?
Palpitations
This is the uncomfortable sensation of rapid beats.
What is the initial approach to diagnosing supraventricular tachycardia?
A detailed history of when the tachycardia occurs and in what circumstances
This helps determine if it is a normal response or requires further investigation.
What is the common treatment for supraventricular tachycardia?
An anti-arrhythmic medication
Treatment varies according to the underlying cause.
What is the most common cause of ventricular tachycardia and ventricular fibrillation?
Acute myocardial infarction
Other cardiac conditions can also trigger these arrhythmias.
Why is ventricular tachycardia treated as a medical emergency?
Many patients will not tolerate this abnormal rhythm
Initial symptoms may include palpitations and dizziness.
What happens during ventricular fibrillation?
The ventricles quiver and do not contract in a synchronized way
This leads to no cardiac output and potential cardiac arrest.
What is defibrillation?
The delivery of a large electrical shock through the chest wall
This may restore normal rhythm by depolarizing the myocardium.
What is the role of the sinoatrial node during defibrillation?
To resume the role of pacemaker and restore normal sinus rhythm
This occurs after successful defibrillation.
What is the only means of restoring the heart to a normal rhythm in ventricular fibrillation?
Defibrillation
This is also true for ventricular tachycardia where cardiac output is lost.
What investigations may survivors of ventricular tachycardia and ventricular fibrillation undergo?
Survivors may undergo:
* resting electrocardiogram
* electrophysiology studies
* echocardiogram
* blood tests for underlying causes
These investigations help assess the electrical system and identify potential causes.
What is the immediate treatment for ventricular tachycardia?
Immediate treatment includes:
* direct current cardioversion
* medication (intravenous anti-arrhythmic drugs like amiodarone)
Direct current cardioversion is performed under general anaesthetic.
What are the long-term management options for ventricular tachycardia?
Long-term management options include:
* medication (anti-arrhythmic drugs like amiodarone)
* radiofrequency ablation
* Implantable cardioverter defibrillator (ICD)
Radiofrequency ablation targets rogue cells causing arrhythmias.
What is an implantable cardioverter defibrillator (ICD)?
An ICD is a battery-driven device that detects and stops life-threatening ventricular arrhythmias by delivering a shock directly to the heart.
It is similar to a pacemaker and is implanted beneath the skin.
How does a subcutaneous ICD (SICD) differ from a traditional ICD?
A SICD is inserted under the skin of the chest and does not have leads placed into the heart; instead, the lead is tunnelled under the skin.
This design reduces complications associated with lead placement.
What is defined as sudden cardiac death?
Sudden cardiac death is an abrupt loss of unconsciousness and unexpected death due to cardiac causes within one hour of symptom onset.
The most common cause is ischaemic heart disease triggering ventricular arrhythmias.
What are the UK survival rates for cardiac arrest outside of a hospital?
Less than 10% survive to hospital discharge.
This statistic highlights the critical nature of timely intervention in cardiac emergencies.
Define bradycardia.
Bradycardia is usually defined as a heart rate below 60 bpm.
The term ‘brady’ means slow, and ‘cardia’ means heart.
What are some causes of sinus bradycardia?
Causes may include:
* coronary artery disease
* myocardial infarction
* valve disease or surgery
* electrolyte abnormalities
* abnormalities of the conduction system
Some individuals, like endurance-trained athletes, may have a normal slow heart rate.
What is sick sinus syndrome?
Sick sinus syndrome is when the sinoatrial node is diseased or damaged, but conduction pathways through the atria and ventricles are normal.
This condition can lead to bradycardia.
What is heart block?
Heart block is a condition where the sinoatrial node initiates the electrical impulse, but conduction is impeded or blocked somewhere in the normal pathway.
This can lead to bradycardia and various symptoms.
What symptoms may indicate the need for investigation in a patient with bradycardia?
Symptoms that may require investigation include:
* dizziness
* lightheadedness
* fainting
* sudden drop in heart rate
In the absence of symptoms, bradycardia is typically not a concern.
What investigations may be included in the diagnosis of bradycardia?
Investigations include:
* resting electrocardiogram
* blood tests for thyroid function
* electrolytes
* cardiac enzymes
* 24-hour electrocardiogram
* echocardiogram
These tests help determine the cause and assess the severity of bradycardia.
When is treatment for bradycardia usually not necessary?
Treatment is usually not necessary if the patient is not symptomatic and the heart rate is between 40-60 bpm.
What is a pacemaker?
A pacemaker is a pulse generator that is smaller than a matchbox and has one electrode lead placed in the right ventricle or one in the right atrium and one in the right ventricle.
How much does a pacemaker typically weigh?
Pacemakers weigh about 1-2 ounces.
Where is a pacemaker usually implanted?
A pacemaker is implanted just under the skin, usually below the left collarbone.
How are the leads of a pacemaker positioned inside the heart?
The leads are threaded into the heart through a vein near the collarbone and the tips are positioned inside the heart.
What powers most pacemakers and how long do the batteries last?
Pacemakers are normally powered by lithium batteries that last 6-10 years depending on usage.
What symptoms may indicate the need for a pacemaker?
Symptoms may include blackouts due to pauses in the electrical rhythm of the heart, often referred to as heart block.
What is syncope?
Syncope is the experience of dizziness or blackouts due to irregular heart rhythms.
What type of pacemaker is used when the atria are beating irregularly and the ventricular rate is slow?
A single chamber pacemaker with just one electrode connected to the right ventricle is used.
What type of pacemaker is implanted when the sinoatrial node is not functioning properly?
A single chamber pacemaker with one electrode connected to the right atrium is implanted.
What is the function of a dual chamber pacemaker?
A dual chamber pacemaker is implanted when the sinoatrial node initiates an impulse normally, but the conduction pathways in the atria and ventricles are not functioning properly.
What is the minimum heart rate setting for most pacemakers?
Most pacemakers are set to a minimum rate of 60-70 beats per minute.
What is a biventricular pacemaker?
A biventricular pacemaker is used in patients with heart failure to ensure that the left and right ventricles contract simultaneously.
How does a biventricular pacemaker improve cardiac output?
It sends an impulse to the two ventricular leads at the right moment after full atrial contraction to ensure simultaneous contraction.
What is cardiac resynchronisation therapy (CRT-P)?
CRT-P is a type of biventricular pacemaker that paces the ventricles with every single beat and is rate responsive.
What is CRT-D?
CRT-D is a biventricular pacemaker that also functions as a defibrillator.
Do pacemakers affect or are they affected by household appliances?
Pacemakers do not affect and are not affected by normal household appliances.
What should be avoided near a pacemaker?
Mobile phones should be kept at least six inches from the pacemaker site and strong magnetic fields should be avoided.
What are the two main types of irregular heartbeat?
The two main types of irregular heartbeat are:
* atrial fibrillation
* ectopic beats
These conditions are commonly encountered in clinical settings.
What is atrial fibrillation?
Atrial fibrillation is the most common irregular heart rhythm, characterized by extremely rapid, erratic depolarisation throughout the atria, preventing synchronised atrial contraction.
What percentage of the UK population has atrial fibrillation?
Nearly 2.4%
What role does the atrioventricular node play in atrial fibrillation?
It conducts only some of the electrical impulses through to the ventricles, resulting in irregular ventricular contraction.
How does atrial fibrillation affect left ventricular filling?
It decreases left ventricular filling by 20%.
When can cardiac output be compromised in atrial fibrillation?
Cardiac output can be compromised except at very high heart rates.
What is the main long-term risk of atrial fibrillation?
An increased incidence of stroke.
What are the common causes of atrial fibrillation? (List them)
- Hypertension
- CAD
- Valvular heart disease
- Cardiac surgery
- Heart failure
What are the typical presentations of atrial fibrillation?
- Palpitations
- Irregularly irregular pulse
- Hypotension (if heart rate is very fast)
What happens to blood pressure in atrial fibrillation?
It can drop if cardiac output is compromised.
How does atrial fibrillation affect pulse monitors?
It interferes with monitors that rely on consecutive beats, potentially leading to no reading or inaccurate readings.
What investigations are used to diagnose atrial fibrillation?
- Resting electrocardiogram
- Blood tests for thyroid function
- Echocardiogram to detect underlying cardiac disease
- 24-hour electrocardiogram if intermittent
What are the common treatment methods for atrial fibrillation?
- Medication to control ventricular response rate (beta blockers, calcium channel blockers, amiodarone)
- Anticoagulation therapy (warfarin, rivaroxaban, dabigatran, apixaban)
- Direct current cardioversion or ablation therapy
What are ectopic beats?
Ectopic beats are beats that occur earlier than expected and are initiated by an impulse generated somewhere other than the sinoatrial node.
What can cause ectopic beats?
- Nicotine
- Excessive consumption of caffeine
- Excessive consumption of alcohol
What is the risk associated with three or more consecutive ventricular ectopics?
They can lead to life-threatening ventricular arrhythmias.
How do people often experience ectopic beats?
Some may feel their heart ‘missing’ a beat due to a compensatory pause after an early beat.
What investigations are used to diagnose ectopic beats?
- History
- Resting electrocardiogram
- Possibly 24-hour electrocardiogram if intermittent
- Blood tests to exclude electrolyte disturbances or thyroid disorder
What lifestyle changes are recommended for cardiovascular disease treatment?
Smoking cessation and reduction in caffeine and alcohol intake if excessive
What is a common prescription for patients with cardiovascular disease?
Beta blockers
What medication is most commonly prescribed to all patients diagnosed with cardiovascular disease?
Anti-platelet medication, most commonly aspirin
Name alternative anti-platelet medications to aspirin.
- Clopidogrel
- Ticagrelor
- Prasugrel
What is the primary purpose of anti-platelet drugs?
Reduce the risk of thrombi forming and occlusion of arteries
What type of medication do nearly all patients with cardiovascular disease take?
Cholesterol-lowering drugs (statins)
What condition does hypertension refer to?
Elevated blood pressure above normal healthy levels
What physiological effect does high blood pressure have on the heart?
Causes the heart to work harder due to greater back pressure
What are potential long-term consequences of untreated hypertension?
- Enlarged heart
- Atherosclerosis
- Myocardial infarction
- Stroke
- Kidney failure
What percentage of hypertension cases are considered primary or essential?
About 90%
What is secondary hypertension?
Hypertension resulting from another condition, such as pregnancy or renal disease
What common lifestyle changes can help manage hypertension?
- Increasing physical activity
- Smoking cessation
- Weight loss
- Dietary modification (reduction in alcohol and salt intake)
What is the goal of medication in treating hypertension?
Reduce blood pressure via reduction in circulating fluid volume and vasodilation
What is the ‘rule of halves’ in relation to hypertension?
Only 50% of those with hypertension are diagnosed; of those, only 50% are treated, and of these, only 50% are treated effectively
What does the acronym ABCD represent in hypertension medication?
- ACE inhibitors
- Angiotensin Receptor Blockers
- Beta blockers
- Calcium channel blockers
- Diuretics
What is a stroke?
Occurs when cerebral tissue is deprived of oxygen and dies
What is the most common cause of a stroke?
Cerebral infarction due to thrombus formation from atheromatous plaque
What distinguishes ischaemic stroke from haemorrhagic stroke?
Ischaemic stroke is due to occlusion, while haemorrhagic stroke is due to a bleed
What is a transient ischaemic attack (TIA)?
Reversible neurological deficits from temporary diminished blood flow to the brain
What are common clinical manifestations of a TIA?
- Giddiness
- Nausea
- Jerky movements
- Muscle weakness
- Sudden loss of postural control
What should individuals presenting with a TIA do?
Be urgently referred to a TIA clinic for assessment
True or False: Transient ischaemic attacks can last longer than 24 hours.
False
What is the significance of calling 999 in the context of stroke?
It is crucial to get help immediately if a person fails any of the stroke tests, as a delay can lead to death or long-term disabilities.
The tests include facial weakness, arm weakness, and speech problems.
What is the primary treatment for ischaemic stroke in the acute stage?
Early thrombolytic treatment to dissolve the thrombus, reducing injury to the brain.
This treatment is crucial for improving outcomes in ischaemic stroke.
What long-term treatments are recommended for preventing further strokes?
- Anticoagulants or antiplatelets to prevent further clots
- Antihypertensive therapy to control blood pressure
These treatments help manage the risk of future strokes.
What is carotid endarterectomy?
A surgical procedure to remove blockage from the carotid artery, the main artery to the brain.
This procedure is important in preventing strokes.
What treatments are recommended for haemorrhagic stroke?
- Antihypertensive therapy to control blood pressure
- Surgical intervention to address bleeding
Anticoagulants are not appropriate due to the risk of further bleeding.
List some risk factors for stroke that should be modified.
- Hypertension
- Diabetes
- Coronary artery disease
- Blood diseases related to clotting
- Smoking
- Elevated cholesterol
- Obesity
- Physical inactivity
- Medications (e.g., birth control pill, steroids)
- High alcohol intake
- Cocaine and other recreational drugs
Modifying these risk factors is essential for stroke management.
What does Peripheral Arterial Disease (PAD) refer to?
Diseases affecting systemic blood vessels, including peripheral arterial disease and peripheral venous disease (e.g., varicose veins).
PAD can lead to serious complications such as aneurysms and limb ischaemia.
What is the most common symptom of Peripheral Arterial Disease?
Intermittent claudication.
This symptom occurs due to narrowed arteries, leading to pain during physical activity.
What causes intermittent claudication?
Narrowing of the arteries within the peripheral circulation due to atheromatous plaques.
This condition restricts blood supply to the legs during exercise.
What is the American College of Sports Medicine’s grading for claudication pain?
- Grade 1: Definite discomfort, minimal
- Grade 2: Moderate discomfort, attention can be diverted
- Grade 3: Intense pain, attention cannot be diverted
- Grade 4: Excruciating, unbearable pain
This grading helps assess the severity of claudication pain.
What lifestyle changes are recommended for treating intermittent claudication?
- Smoking cessation
- Physical activity that induces ischaemic pain
These changes contribute to improved symptoms and overall health.
What treatments are available for severe cases of intermittent claudication?
- Angioplasty
- Bypass surgery
- Amputation in extreme cases
These interventions may be necessary when conservative measures fail.
What is an aneurysm?
An aneurysm is a condition where the walls of the main arteries become weakened and stretch, making them prone to rupture.
Where do aneurysms most commonly occur?
Aneurysms most commonly occur in the abdominal part of the aorta and behind the knee in the popliteal artery.
What is the second most common complication of peripheral arterial disease?
The second most common complication of peripheral arterial disease is aneurysm.
What is the risk factor for abdominal aortic aneurysm (AAA) in men?
Men aged over 65 are more likely to have an abdominal aortic aneurysm (AAA).
What is the purpose of the NHS AAA Screening Programme?
The NHS AAA Screening Programme invites men for screening to identify those at increased risk of an abdominal aortic aneurysm.
What happens during the annual monitoring of diagnosed aneurysms?
Patients will have their blood pressure controlled and monitored annually using ultrasound to determine the need for surgical intervention.
Which heart valves are most commonly affected by valvular heart disease?
The mitral and aortic valves are the most commonly affected by valvular heart disease.
Define stenosis in the context of heart valves.
Stenosis is the narrowing of a valve that obstructs normal blood flow, requiring extra work from the heart.
What is the consequence of aortic valve stenosis on the left ventricle?
Aortic valve stenosis causes the left ventricle to increase its mass (hypertrophy) but lose its contractile force.
List some symptoms of aortic stenosis.
- Shortness of breath
- Dizziness
- Chest pain
What causes pulmonary edema in the case of a stenosed mitral valve?
Blood backs up due to the stenosed mitral valve, causing fluid accumulation in the lungs.
What happens in the heart with regurgitant valves?
The heart has to cope with an extra volume load due to backward flow, leading to progressive volume overload.
What is a heart murmur?
A heart murmur is an abnormal sound heard with a stethoscope, indicating turbulent blood flow through a valve.
What may cause defects in heart valves?
Defects may be congenital or due to infection, such as endocarditis or rheumatic fever.
How is valve disease generally managed?
Patients are often managed medically for many years, with surgical intervention needed only if symptoms become unmanageable.
What medications may be prescribed for valve disease?
- Antihypertensives
- Heart failure medications
- Anticoagulation therapy if atrial fibrillation is present
- Anti-arrhythmic therapy if in atrial fibrillation
What are the two types of valves used in valve replacement surgery?
- Mechanical valve
- Tissue valve
What is a key advantage of mechanical valves?
Mechanical valves can last for life but require long-term anticoagulation therapy.
What is a disadvantage of tissue valves?
Tissue valves usually last for only 10 to 15 years.
What factors influence the choice of valve replacement?
The choice depends on the age and lifestyle of the patient.
What is endocarditis?
An infection of the valve and surrounding endocardium, potentially life-threatening.
What symptoms may suggest endocarditis in patients with replacement valves?
Flu-like symptoms, unexplained malaise, or fever for longer than 48 hours.
What is a complication of valve surgery that may increase the risk for stroke?
Atrial fibrillation.
What does TAVI stand for?
Transcatheter aortic valve implantation.
Describe the procedure of TAVI.
Inserting a new artificial heart valve inside the old tight valve using a balloon catheter.
What materials make up the TAVI valve?
A metal frame (stent) and the outer lining (pericardium) of a cow’s heart.
What are the two common routes for transcatheter aortic valve insertion?
- Transfemoral: through the femoral artery
- Transapical: through a small cut on the left side of the chest
What are the expected benefits of treatment with the new valve in TAVI?
Improved symptoms of aortic stenosis, increased life expectancy, and quality of life.
When is TAVI recommended over conventional open heart aortic valve replacement surgery?
When the risks of TAVI surgery are less than those of conventional surgery.
What types of drugs are commonly used in the management of heart disease?
Drugs affecting heart rate, blood pressure, and exercise capacity.
Why might patients be unclear about their cardiac medications?
Many cardiac medications can treat multiple problems, not always obvious.
What is a common use for beta blockers?
Management of angina, hypertension, arrhythmias, or heart failure.
What is a standard therapy post-myocardial infarction?
Beta blockers, even in the absence of specific conditions.
What are the main drug groups students are expected to know?
The main cardiac conditions treated by medication.
Name a proprietary name for the beta blocker Atenolol.
Tenormin.
What cardiac conditions are treated by medication?
- Myocardial infarction
- Hypertension
- Heart failure
- Arrhythmias
- Hyperlipidaemia
- Poor left ventricular function.
True or False: Proprietary names of drugs remain constant over time.
False, different brands come onto the market all the time.
What is an arrhythmia?
A defect in the initiation or conduction of electrical impulses in the heart
Arrhythmias result in abnormal heart rhythms.
What defines a heart rhythm as not being sinus rhythm?
It is outside the resting range of 60-100 beats per minute
Sinus rhythm is the normal heartbeat initiated by the sinoatrial node.
What is tachycardia?
A heart rate greater than 100 beats per minute
Tachycardia can be caused by stress, exercise, or medical conditions.
What is bradycardia?
A heart rate less than 60 beats per minute
Bradycardia can indicate underlying health issues or be normal in well-trained athletes.
What are the three main groups of arrhythmias?
Tachycardia, Bradycardia, Irregular
Each group signifies a different type of heart rhythm abnormality.
Fill in the blank: An arrhythmia is characterized by a heart rate that is _______ the normal range.
outside
The normal resting heart rate is between 60 and 100 beats per minute.
True or False: All arrhythmias are a result of sinus rhythm disturbances.
True
Arrhythmias occur when the heart’s electrical impulses are not functioning normally.
What is the heart rate threshold for tachycardia?
Heart rates > 100 beats per min
What common factors can cause elevated heart rates?
- Exercise
- Caffeine
- Alcohol
- Asthma inhalers
What is considered an abnormal resting heart rate?
Persistent resting HR > 100 for more than 15 min of seated rest
True or False: A heart rate above 100 beats per minute is always considered abnormal.
False
Fill in the blank: A persistent resting heart rate greater than 100 beats per minute for more than 15 minutes of seated rest is considered _______.
abnormal
What is the worst cardiac arrhythmia?
Ventricular Tachycardia and Ventricular Fibrillation
These conditions are considered life-threatening emergencies.
What is the size of an implantable cardioverter defibrillator?
Matchbox sized!
What does ICD stand for?
Implantable cardioverter defibrillator
What is the purpose of a dual-chamber ICO device?
Inserted for pacing, cardioversion or defibrillation
When is an ICD used prophylactically?
At risk of a serious arrhythmia
When is an ICD used preventatively?
Already had life threatening arrhythmia
What happens when the heart rate exceeds the set threshold of an ICD?
Device will kick in
What is an example of a threshold setting for an ICD?
180 beats per minute
What is bradycardia?
Heart rate <60 beats per minute
Bradycardia may be considered ‘normal’ in endurance athletes.
List three causes of bradycardia.
- Myocardial Infarction
- Valve disease or surgery
- Abnormalities of the conduction system
- Medications (B-blockers, calcium channel blockers, ivabradine)
What are common symptoms of bradycardia?
Dizzy, fainting
What are two diagnostic methods for bradycardia?
- Resting ECG
- 24-hour electrocardiogram
What do pacemakers deliver to promote the contraction of the heart muscle?
Short pulses of electricity
What condition is treated with pacemakers that involves a slow heart rate?
Bradycardia
What condition is treated with pacemakers that involves a fast heart rate?
Tachycardia
What type of pacemakers are used for heart failure?
Biventricular (CRT) pacemakers
Fill in the blank: Pacemakers are used to treat _______ by delivering electrical pulses.
[bradycardia, tachycardia, heart failure]
What is Atrial Fibrillation (AF)?
A condition characterized by irregular pulse and multiple atrial foci
Atrial Fibrillation is less serious than Ventricular Fibrillation (VF) if it is only 20%
What happens to the ‘atrial kick’ in Atrial Fibrillation?
It is lost
The ‘atrial kick’ refers to the additional blood volume that the atria contribute to ventricular filling.
How does the AV node function in Atrial Fibrillation?
It only conducts some of the impulses
This partial conduction can lead to an irregular heart rhythm.
By what percentage is left ventricular filling decreased in Atrial Fibrillation?
20%
This reduction can impact overall cardiac output.
What is the increased risk associated with Atrial Fibrillation?
Increased risk of stroke
Patients with AF are more likely to develop blood clots.
Fill in the blank: Atrial Fibrillation is more likely to lead to a _______.
clot
This is due to the irregular blood flow associated with AF.
What are the causes of Atrial Fibrillation?
Hypertension, cardiac surgery, valvular heart disease, heart failure
These are common medical conditions that can lead to the development of Atrial Fibrillation.
List the symptoms associated with Atrial Fibrillation.
- Palpitations
- Irregular pulse
- Hypotension
These symptoms can vary in intensity and may require medical evaluation.
What is a consideration regarding exercise for patients with Atrial Fibrillation?
AF may interfere with automated blood pressure monitors
This can affect the accuracy of blood pressure readings during physical activity.
What diagnostic tools are used for Atrial Fibrillation?
Resting/24-hour ECG, echocardiogram
These tools help monitor heart activity and identify irregularities.
What types of medications are used for rate and rhythm control in Atrial Fibrillation?
- B-Blockers
- Calcium channel blockers
- Amiodarone
- Digoxin
These medications help manage heart rate and rhythm.
What is the purpose of anticoagulation in Atrial Fibrillation?
To prevent stroke
Anticoagulation helps reduce the risk of blood clots forming.
Name four anticoagulants used in Atrial Fibrillation treatment.
- Apixaban
- Dabigatran
- Edoxaban
- Rivaroxaban
These medications help thin the blood and prevent clot formation.
What is cardioversion in the context of Atrial Fibrillation?
Synchronized DC shock
This procedure is used to restore a normal heart rhythm.
What is ablation therapy?
Procedure using radio frequency energy to destroy initiating pathway
This therapy aims to prevent the heart from going into arrhythmias.
What is the definition of Hypertension?
A condition where the blood pressure in the arteries is persistently elevated.
Hypertension is a major risk factor for cardiovascular disease.
What is a Stroke?
A medical condition where poor blood flow to the brain results in cell death.
Strokes can be ischemic or hemorrhagic.
What is Peripheral Arterial Disease?
A common circulatory problem in which narrowed arteries reduce blood flow to the limbs.
It often leads to leg pain when walking.
What is Intermittent Claudication?
Pain or cramping in the legs or buttocks during physical activities, caused by inadequate blood flow.
It is a symptom of Peripheral Arterial Disease.
What is an Aneurysm?
An abnormal bulge or ballooning in the wall of a blood vessel.
Aneurysms can occur in various parts of the body, including the aorta.
What is Valve disease?
A condition where one or more of the heart’s valves do not function properly.
This can lead to problems such as stenosis or regurgitation.
What is the term for diseases related to the heart and blood vessels?
Cardiovascular Disease
What does a 24 hr ECG measure?
Continuous monitoring of heart activity over 24 hours
What is an atheroma?
A buildup of fatty deposits in the arteries
What condition is characterized by chest pain due to reduced blood flow to the heart?
Stable Angina
What does ECG stand for?
Electrocardiogram
What are the investigations used for diagnosing cardiovascular conditions?
ECG, CT scan, MRI, Nuclear Imaging, Angiogram, Echo & Stress echo
What is the typical presentation of acute coronary syndrome (ACS)?
Chest pain, shortness of breath, and other symptoms
What imaging technique uses radioactive substances to visualize heart function?
Nuclear Imaging
What is a CT scan primarily used for in cardiovascular assessments?
Detailed imaging of the heart and blood vessels
What does ACS stand for?
Acute Coronary Syndrome
What is the purpose of MRI in cardiovascular diagnostics?
To obtain detailed images of the heart and surrounding structures
What condition is often confused with stable angina but presents with more severe symptoms?
Unstable Angina
What is NSTEMI an abbreviation for?
Non-ST-Elevation Myocardial Infarction
What does STEMI stand for?
ST-Elevation Myocardial Infarction
What are Echo & Stress echo used for?
Assessing heart function and blood flow during stress
What is PPCI with stents and antiplatelet therapy?
Primary Percutaneous Coronary Intervention with stenting and medication to prevent clotting
What is the general treatment approach for cardiovascular diseases?
Medication, lifestyle changes, procedures like PCI or CABG
What type of surgery is performed to repair or replace heart valves?
Valve surgery
What is an angiogram used for?
To visualize the blood vessels in the heart
What does PCI stand for?
Percutaneous Coronary Intervention
What does CABG stand for?
Coronary Artery Bypass Grafting
What is heart failure?
A condition where the heart cannot pump effectively
What are common complications of cardiovascular diseases?
Arrhythmias, heart failure, myocardial infarction
What device is used to manage arrhythmias?
Pacemaker/ICD
