Cardiovascular Disease Flashcards
Where has cardiovascular disease been the main killer since 1990?
Europe
What was the main reason for creating the paramedic profession?
To provide early, definitive treatments for patients with acute myocardial infarcation.
How many people die in England every year from coronary heart disease?
Over 110,000
Where is the anatomical location of the heart?
In the thoracic cavity in the mediastinum behind the left of the sternum. The apex of the heart is on the bottom and lies along the diagram.
What is the size of the heart
Approximately 12cm long and 9cm wide.
Weighing 250-390g in a man and 200-275g in a woman.
Describe the anatomy of the ascending aorta.
The ascending has the coronary arteries coming off it supplying the heart muscle with blood.
Describe the anatomy of the arch of the aorta
The arch has three branches off it. The brachiocephalic artery (which decided into the right common carotid artery and the right subclavian artery)
The left common carotid artery
The left subclavian artery.
Describe the anatomy of the descending aorta.
As it enters the abdomen the left and right renal arteries branch off The lumbar arteries branch out from behind. Then the left and and right gonadals then come out of the side. Ovarian and spermatic arteries) The superior (intestines) and inferior (large intestine) mesentric branch from the front. In the abdomen it branches into the two common iliac arteries
Use diagram to mark up inner anatomy of the heart.
Superior vena cava Pulmonary arteries Pulmonary veins Right atrium Pulmonary valve Tricuspid valve Right ventricle Inferior vena cava Left common carotid artery Left subclavian artery Aortic arch Ascending aorta Aortic valve Left pulmonary arteries Pulmonary veins Left atrium Mitral valve Chordae tendinae Papillary muscle Left ventricle Interventricular septum Endocardium Myocardium Epicardium
How does blood flow through the heart?
In through the superior vena cava. Into the right atrium Through the triscuspid valve Into the right at ventricle Through the pulmonary valve Through the pulmonary artery To the lungs Down the pulmonary vein Into the left atrium Through the mitral valve In to the left ventricle Through the aortic valve Into the aorta
What is the functions of the cardiovascular system and blood.
Carry oxygen and nutrients to the cells. Maintain body temperature Maintain the acid-base balance through excretion and absorption of hydrogen ions. Regulation of fluid balance Removal of waste products Blood clotting Defence action
How much blood does the heart pump each day
7000 to 9000 litres
Describe the outer layers of the heart.
Two tough sacs surrounding the heart. The serous pericardium and the fiborus pericardium
The fiborus a tough, inelastic layer made up of dense, irregular, connective tissue. Prevents over stretching if the heart, protection and holds heart in place.
The serous pericardium thinner more delicate inner layer of the pericardium, fused to the fibrous
In between the serous and epicardium is the pericardial cavity filled with fluid called the pericardial fluid. This reduces friction between the membranes as the heart moves.
Does not stretch readily
Cannot accommodate sudden accumulations of fluid
Describe the inner layers of the heart
The epicardium the layer outer layer.
The myocardium the muscular layer dealing the mechanical motion of the heart and initiating and and conducting of electrical pulses.
The endocardium the inner layer of the heart.
Use a diagram to label the outer anatomy of the heart.
Superior vena cava Aorta Right atrium right coronary artery Posterior descending artery Right marginal artery Right ventricle Left pulmonary artery Left pulmonary. Wins Left coronary artery Left circumflex artery Left marginal artery Left anterior descending artery Diagonal branch Left ventricle
Describe the anatomy of an artery on diagram
Tunia adventitia outer fiborus sheath
Tunica media middle layer of smooth muscle and elastic tissue
Tunica intima smooth outer lining of the endothelium
endothelium inner lining of artery
Lumen
What are arteries
Thick walled, muscular tubes that carry blood away from the heart and are usually oxygenated
Describe the atrial wall
Highly sensitive to stimulation from the autonomic nervous system.
Changes diameter as it contracts and relaxes
Regulates blood pressure generated by blood flowing through the body.
What are the capillaries
A network of microscopic vessels between the arterioles and venules.
Extremely thin walled to allow gas and nutrient exchange
Diameter is so small that blood must pass through in single file.
Describe the veins.
They operate on the low pressure side of the system and have thinner walls than arteries. They have less capacity to decrease their diameter than arteries.
They work through a system of calves and back pressure
The inferior vena cava carries blood from the lower part of the body
The superior carries blood from the upper part.
How does the heart vary blood flow.
Heart varies the degree of its contractions.
The tighter it squeezes the more ventricular blood is ejected into the heart.
Nervous controls regulate the contractibility of the heart.
It can be altered with drugs.
What is special about the heart.
It generates its own electrical impulses
It has specialised conductive tissue and its own pacemaker the Sinoatrial node.
What factors affect heart rate?
Circulating chemicals Activity and exercise as we exercise more oxygen is needed and the heart rate increases to meet this need Emotional states Gender Age Body temperature
Describe a cardiac cycle
P atrial depolarisation. The time taken for an electrical impulse to spread throughout the atrial musculature
P-R the time taken to travel through the av node to the bundle of his
QRS represents ventricular depolarisation
ST period between ventricular depolarisation and repolarisation
T repolarization of the ventricles
R-R the time between two depolarisations
Name the parts of the impulse anatomy of the heart using the diagram.
SA node Internodal pathways Av node Bungle of his Right bundle branch Purkinje fibers Left anterior fascicle Left posterior fascicle Left bundle branch
What is coronary heart disease?
Disease of the blood vessels which supply the heart.
What coronary heart disease cause.
Ischemia insufficient blood supply
Infarcation death of a area.
What is atherosclerosis
A condition where arteries become clogged with fatty substances called plaques or atheroma.
Affects the inner lining of the aorta, cerebral and coronary blood vessels.
Provides a focus for the formation of a fixed clot.
What is arteriosclerosis.
Thickening, hardening and loss of elasticity of the walls of an artery.
Caused by calcium precipitate from the blood stream into the arterial walls
This greatly reduces the elasticity of the arteries.
What are the risk factors for atherosclerosis?
Hypertension Cigarette smoking Diabetes High serum cholesterol levels Lack of exercise Obesity Family history of heart disease or stroke Male sex
What is acute coronary syndrome.
A term used to refer to a range of ACUTE myocardial ischaemic states.
What device do we use to diagnose acute coronary syndromes.
12 lead ECG
What is the pathophisology of angina
Inner wall of the artery known as the intima over time get small asymptomatic amounts of plaque build on it.
Over time a large but stable lump may form making blood flow to the coronary arteries harder and blood pressure higher.
Heart become ischeamic and starts to go into an anaerobic state causing pain in the chest.
Symptoms usually happen after exertion or stress. This is stable angina.
The plaque can develop tears and become unstable. The body try’s to repair this developing a thrombus over the area. Which leads to unstable angina or even MIs.
How would you recognise stable angina.
Follows a pattern
Pain after exertion
Predictable location, intensity and duration
GTN is usually taken which provides relief
How would unstable angina be recognised.
Noticeable changes in frequency, severity, and duration of angina pain.
Often occurs without stress or exertion
GTN not always as effective.
Indicates a greater degree of obstruction and may be a precursor to an MI.
Describe acute myocardial infarction.
How is it caused
What affects the location and size
Also known as a heart attack
A portion of the cardiac muscle is deprived of coronary blood blood flow long enough that portions of the muscle die.
Could be caused by either occlusion by a blood clot
Spasm of a coronary artery
Or reduction of the overall blood flow
The coronary artery that is blocked
Where along the artery it’s blocked
What are the common signs of an acute myocardial infarcation
What other associated signs may there be
Central chest pain which builds up over time.
Often described as heavy, squeezing, crushing or tight
Pain can ‘radiate’ up into the neck and jaw down both arms
No position eases the pain
Patients can present with associated symptoms but minus the pain.
Ashen grey pallor, diaphoresis (sweating) clamminess
Acute dyspnoea
Nausea and vomiting
Dizziness, lightheadedness or profound weakness
Apprehensive, looks scared, with a sense of impending doom.
Many woman present differently and can ignore their symptoms.
How do you manage a AMI
Use the systematic approach (a,b,c)
Gain a history of the presenting complaint
Commence assessment and treatment accordingly
Aim to be en route to hospital in 10mins
Gain sufficient evidence (baseline observations, 12 lead ecg)
Goals of treatment
Limit size of mi
Decrease the patients fear and pain
Prevent development of serious cardiac arrhythmias
What pain relief can be given to a patient in the correct order
Oxygen
Aspirin
GTN-ask for paramedic
Morphine- ask for paramedic
Where should the ecg electors be placed
V1 4th intercostal space to right of the sturnum
V2 4th intercostal space to the right of the sturnum
V4 5th intercostal space, mid-clavicular, to the left of the sturnum
V6 5th intercostal space, mid-axila to the left of the sturnum
V3 between 2 and 4
V5 between 4 and 6
Red right arm r
Yellow left arm l
Green left leg f
Black right leg n
How would you transport a MI patient
Minimise effort by patient
Get to vehicle in wheel chair or carry chair
Place in semi recumbent position on stretcher
Continue to monitor, assess and treat patient accordingly
Safe and appropriate transport with ASHICE call preferably to PPCI
(Primary percutaneous coronary intervention)
Time is muscle
Be prepared for cardiac arrest
What is ASHICE
Age Sex History Injuries/illness Condition- obs ETA
What happens in chronic heart failure?
Heart is unable to pump blood fast enough to empty its chambers
Blood backs up into the systemic circuit, the pulmonary or both.
What are the two types of interlinked heart failures
Left sided failure (left ventricular failure (LFV))
Right sided failure (right ventricular failure (RVF))
What are the consequences of LVF?
Back flow in the system
Increased pressure in the lungs
Pulmonary oedema
What are the signs and symptoms of LVF
Sever dyspnoea Tachyponea Tachycardia Elevated blood pressure Extream restlessness and agitation Confusion Crackles and possibly wheezes Frothy, sputum in late stages could be 'pink' in colour.
Explain RVF
Often causes as a result of left sided heart failure, as the right side is unable to keep up with the workload
Other causes could be pulmonary embolism or COPD
Blood backs up behind the right ventricle
Backs up into systemic circulation
What are the symptoms of right sided heart failure
Shortness of breath Swelling of feet and ankles (peripheral oedema Distended neck veins Increased urination Palpitations Irregular fast heart beat Fatigue Weakness Fainting
What is the management of heart failure
Aim
Improve oxygenation and decrease the hearts workload
Reduce the volume of venous blood
Management includes Give oxygen via sp02 reading Sit patient up, with feet dangling Attach monitoring electrodes Administer GTN Furosemide Salbutamol Transport in sitting position
What is cardiac tamponade
Build up of blood or fluid in the serous cavity putting pressure on the heart.
What are the signs and symptoms of cardiac tamponade
Classic symptom of narrowing pulse pressure
Initial drop in blood pressure is usually followed by an increase in heart rate leading to tachycardia
Heart sounds may be muffled or quieter than usual
Jugular vein distension
Becks triad (low systolic/muffled heart sounds/vein distension)
ECG of limited value
What is the management of cardiac tamponade?
The ultimate treatment is pericardiocentesis/thoracotomy
So rapid transport is imperative
Support airway, breathing and oxygenation
What is cardiogenic shock
Cardiogenic shock is when the heart has been so damaged that it is unable to supply enough blood to the organs of the body.
What are the symptoms of cardiogenic shock
Confused or comatose due to reduced cerebral perfusion
If conscious likely to be restless and anxious
Pale, cold skin
Rapid, shallow respirations
Pulse is racing and thready
As compensatory mechanisms begin to fail, blood pressure will fall.
What is the management of cardiogenic shock
Improve oxygenation and peripheral perfusion
Advanced airway may be necessary if the patient is comatose
Place the patient in a supine position unless pulmonary oedema present then use semi-recumbent position
Transport expeditiously
Apply monitoring electrodes
Call for paramedic support
What is an aneurysm?
Dialation or outpouring of a blood vessel
Aneurysms are of greatest concern in pre-hospital care
Swelling of the aorta greater than 1.5 times normal usually representing weakness in the wall of the aorta at that location
Generally caused by degenerative changes in the wall of the aorta
Pronounced with advancing age and people with chronic hyper-tension
What is a dissecting aneurism
Separation of the arterial wall, begins when the intima is torn and crates a false channel between the intima and Musial layers of the wall.
What are the signs and symptoms of a dissecting acute aortic aneurism
Most common complaint is sudden ripping, tearing or sharp pain in the chest that radiates into the back.
Symptoms depend on the site of and size of the tear
Likely to cause a difference in blood pressure
Disruption of blood flow into the left common carotid artery may produce signs of a stroke
Death is almost always as a result of aortic rupture into the pericardium and caused by cardiac tamponade
A puss tile mass palpable in the abdomen
Management of an acute dissecting aneurysm
Adequate pain relief Oxygen if low sats Calm and reassure patient Apply monitoring electrodes and obtain ECG Paramedic interventions required Transport without delay
Who shouldn’t you give morphine or nitrates to
Hypotension patients
