cardiovascular pathology part 2 Flashcards
Ischemic heart disease results from…
Myocardial ischemia
cause of ischemic heart disease
coronary Atherosclerosis, reduction of blood flow to coronary arteries
4 clinical syndromes of IHD
Angina pectoris
* Myocardial infarct
* Chronic IHD with Heart Failure
* Sudden cardiac death (SCD)
Chronic IHD with Heart Failure
progressive congestive heart failure as a
consequence of accumulated ischemic myocardial damage
mechanisms seen in IHD
pump failure - myocardium contraction is weakened, or relaxation is insufficient
flow obstruction - vessel obstruction, valve failure
regurgitation - backflow of blood causing volume overload
shunted flow- blood is diverted through acuired defecrt
failure of cardiac conduction
- arrhythmias cause inefficient myocardial contraction
rupture of heart/blood vessel - trauma or dissection
transmural infarction
involves the full thickness of the ventricular wall
Subendocardial infarction
involves the inner third of the ventricular wall
multifocal infarction
involves only small vessels in the myocardium
angina pectoris
Recurrent attacks of substernal chest discomfort caused by transient myocardial ischemia
(stable/unstable)
myocardial infarct
Death of cardiac muscle due to prolonged severe ischemia (Heart Attack)
Sudden cardiac death
unexpected death from cardiac causes either without symptoms or within 12-24 hours of symptom onset
initial assessments for admissions to A&E
Clinical History (previous Hx)
Physical examination (vital sign monitoring)
Resting 12-lead ECG (unstable patterns)
Blood Test (cardiac enzymes)
Chest x-ray
NICE guidelines (NG185) 2020: Acute coronary syndromes
covers the early and longer-term (rehabilitation) management of acute coronary syndromes. including (STEMI), (NSTEMI) and unstable angina
NICE guidelines (NG185) 2020: Acute coronary syndromes - reperfusion therapy (Angiography with follow-on PCI)
- Offer if pt presentation is within 12 hours of onset symptoms
- consider coronary angiography for those with acute STEMI presenting for 12hrs +, after onset symptoms
- Consider radial (in preference to femoral) arterial access
NICE guidelines (NG185) 2020: Acute coronary syndromes - reperfusion therapy (Fibrinolysis)
offer to those with acute STEMI within 12 hours of onset of symptoms if pci cannot be delivered within 120mins
- When treating people with fibrinolysis, give an antithrombin at the same time.
-Offer an electrocardiogram (ECG) to people with acute STEMI treated with fibrinolysis, 60 to 90 minutes after administration
Fibrinolysis drugs function
dissolve blood clots
Congestive heart failure (CHF)
Heart is unable to pump blood at a rate sufficient enough to meet metabolic demands
Congestive heart failure (CHF) etiology
CAD, Cardiomyopathy, Post MI, obesity, kidney failure
Congestive heart failure (CHF) physiological effects
dilation of heart, contractility and stroke volume increases
mechanical work causes damages - increased myocytes causing hypertrophy. muscle stiffness and loss of elasticity
volumes activates neuro systems, release of chemicals to adjust filling volumes and pressures which increases heart rate
congestive heart failure Left sided: characterised by:
- passive congestion
- Blood pooling in pulmonary circulation
- Stasis (inactivity) of blood in left heart chambers
- Inadequate perfusion of tissues
congestive heart failure 2 types
systolic - pump failure - ejection failure
diastolic - LV cannot relax, filling failure
congestive heart failure Right-sided: characterised by:
caused by left-sided CHF
venous congestion
left sided heart failure symptoms
- fatigue
- tachycardia
- tachypnea (rapid breathing)
- pulmonary congestion
- cough and wheezing
- cyanosis
right-sided CHF
- Blood pooled in the lungs from LCHF causes blood travelling from PA from RV to be backed up in RV
- Pressure in RV is raised-Increased workload
- Muscle of RV becomes damaged over time unable to force blood into PA
- Blood pools in RV, forced back eventually to RA and SVC/IVC
-Eventual organ failure due to lack of oxygen being transported to organs
radiographic appearances
cardiomegaly
congestion
pulmonary oedema
radiographic appearances
cardiomegaly
congestion
pulmonary oedema
stage 1 of CHD redistribution
Pulmonary capillary wedge pressure (13-18mmHg)
redistribution pulmonary vessels
cardiomegaly
broad vascular pedicle
stage 2 of CHD interstial oedema
PCWP 18-25mmHg
Kerley lines
peribronchial cuffing
Hazy contour of vessels
thickened interlobar fissure
stage 3 of CHD Alveolar odema
PCWP > 25mmHg
Consolidation
air bronchogram
Cottonwool appearance
pleural effusion
CHF referred imaging test
Echocardiography
Echocardiography procedure
…..
Echocardiography pt prep
Echocardiography pt consideration
Echocardiography pt instructions
transthoracic echocardiography (TTE) consists of
five standardised windows which are obtained in a standardised sequence
transthoracic echocardiography obtains views from
left parasternal, apical, subcostal, and suprasternal notch windows and The right parasternal window
transthoracic echocardiography evaluates
Heart chambers
* Heart valves
* Papillary muscles
* Blood vessels
* Blood flow
* Blood volume overload
alternative imaging techniques for further imaging (nice guidelines - CHF in adults ng106)
cardiac MRI, radionuclide angiography if a poor image is produced by transthoracic echocardiography
what is cardiac MRI
cardiac MRI is a non-invasive test used to image the heart and diagnose conditions
cardiac mri function
produces detailed images and helps to study the structure and function of the heart muscle. it also helps to find causes of pt heart failure or identify tissue damage
Radionulide Angiography
specialises in showing the functionality of the hearts chambers, with the use of a radioactive tracer
transoesophageal echocardiogram
ultrasound test for your heart. shows heart structure and function
provides detailed imaging
checks problems with valves, clots, aorta problems or heart infection
