Common Cardiac Disorders Flashcards
What are the two types of disorders?
Mechanical: Reduced pumping effectiveness and efficiency of heart
Electrical: Conduction system impairment
What are the two main factors that cause ischemia?
When Metabolic demand does not equal oxygen demand
Cascade of heart failure
Untreated, chronic high BP ->
Coronary artery disease ->
Ischemic event ->
Myocardial infarction ->
Heart failure
What is the number one cause of mortality and morbidity in the US?
Coronary Artery Disease (CAD)
What is primary hypertension?
Accounts for 95% of cases in HTN
No universally established cause
Combination of:
Excess salt, Abnormal arteries, Increased blood volume, Genetic disorders, Stress
What is Secondary HTN?
Less than 5% of HTN
Caused by:
- Health conditions
- Certain medications
- Recreational drugs
- Pregnancy
- Hormonal therapy
AMA Guidelines for HTN
HTN to CHF Chain of Events
HTN ->
Left Ventricle Hypertrophy/ LV remodeling/ Acute MI ->
LV Dilatation/ Dysfunction ->
CHF ->
Signs & symptoms/ Arrhythmias/ Sudden Death
HTN: Medical Therapy
Diuretics, Beta Blockers, Calcium Channel Blockers, ACE Inhibitors
HTN Lifestyle Changes
Diet/weight changes
Exercise
Reducing/stopping smoking
Reduce salt intake
Stress reduction
Coronary Artery Disease (Acute Coronary Syndrome)
Plaque build up that ruptures and creates thrombus formation
End product of atherosclerosis
Oxygen loss effects both myocardium and electrical conduction very acutely and very quickly
CAD Clinical Presentation
Chest pain (angina pectoris)
Neck/arm pain or discomfort
Palpitation
Dyspnea
Syncope
Fatigue
Nausea (anginal equivalent)
Men and woman report differently
CAD Risk Factors (Modifiable)
Lipid metabolism related factors
Hypertension
Clotting factors
Smoking
Behavior
CAD Medications
Vasodilators
Beta blockers
Calcium channel blockers
Anti-vasospasmodics (Reduce coronary artery spasm)
CAD Invasive treatments
Percutaneous transluminal coronary artery angioplasty (PTCA)
Coronary artery stents (CAS)
Coronary artery bypass graft (CABG)
What is Angina Pectoris?
“Pain in chest”
An ischemic disorder with lactic acidosis characterized by gradual onset over time
First symptoms—substernal pain with episodes of exertion—radiates to left arm, jaw
Symptoms usually occur after more than 50% occlusion of a vessel
Symptoms of Angina?
Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest
Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. It may feel like indigestion
Symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur
Women are more likely to feel discomfort in their back, shoulders, and abdomen and report fatigue and nausea (“anginal equivalent”)
Stable Angina
Usually during physical exertion
Episodes of pain will be similar for each patient
Lasts a short time (<5 min)
Relieved by rest or medicine
Unstable Angina
Often occurs at rest, while sleeping at night, or with little physical exertion
More severe and lasts longer
Usually not relieved with rest or medicine
May get continually worse
May mean that a heart attack is imminent
Variant Angina
Prinzmetal angina
Due to coronary vasospasm in the absence of CAD
Tends to be severe
Is relieved by medicine
Myocardial Infarction
Sudden occlusion of coronary artery — heart attack
Approximately 1.5 million in U.S. per year
Approximately one in three fatal
80–90% from atherosclerosis with associated risk factors
Time = Muscle!
Can lead to heart failure
Myocardial Infarction Signs and Symptoms
Severe, crushing retrosternal pain without relief with usual medications and lasting > 30 min
Pain may radiate—left arm, jaw, even back
Pallor, cyanosis
Nausea and vomiting Differential Dx
Diaphoresis
Weak pulse
Apprehensive, sense of doom
Fever—due to inflammation with necrosis
MI Treatment
Medications
- Thrombolytics
- Pain relievers
- Vasodilators
- Anti-clotting agents
Percutaneous Transluminal Coronary Angioplasty
Coronary Artery Bypass Graft
Heart Failure
Inability of the heart to pump or receive
blood
Syndrome: Central and peripheral mechanisms compensate for decreased cardiac function
What are the two Heart Failure classifications?
Systolic dysfunction HFrEF (Ejection fraction less than 40% — Heart can’t pump, Walls are stretched and thin)
Diastolic dysfunction HFpEF (Made by exclusion in the presence of a preserved ejection fraction— Heart can’t fill, Walls are still and thick)
New York Heart Association Heart Failure Classification
