Coronary

Question 1

What is heart (cardiac) failure?

Answer 1

Cardiac output is unable to maintain the circulation of sufficient blood to meet the needs of the body.

Question 2

What are the modifiable risk factors for heart disease?

Answer 2

Elevated serum lipid levels Hypertension Cigarette smoking Diabetes mellitus Sedentary lifestyle Stress Obesity Excessive intake of saturated fats, carbohydrates and salt. (Scott,2012)

Question 3

What are the non-modifiable risk factors for heart disease?

Answer 3

Age Male gender Family history Race Scott, 2012

Question 4

What effect does oestrogen have on heart disease?

Answer 4

Women are less susceptible than men to heart disease possibly due to protective effect of oestrogen.

Question 5

How is does race affect occurrence of heart disease?

Answer 5

African and Asian more susceptible.

Question 6

What is cardiac tamponade?

Answer 6

Rise in intrapericardial pressure restricts the diastolic filling of the heart. Rise in pressure due to blood or fluid build up in pericardial sac. As little as 200ml can induce an emergency if the build up is rapid. Cardiogenic shock and death can occur if untreated. If the pressure build up is slow (pericardial effusion due to cancer) the sac stretch to hold 2000ml of fluid! (Scott, 2012)

Question 7

What can cause cardiac tamponade?

Answer 7

Trauma, infections, myocardial rupture, uremia, hypothyroidism, drug reactions (Scott, 2012).

Question 8

What is the treatment for cardiac tamponade?

Answer 8

Initially relieve the pressure by: Pericardiocentesis. Insertion of a drain into pericardial sac to drain effusion. Surgical creation of pericardial window. Further treatment may include: Hypotensive patients - IV administered saline solution, inotropic drug such as dopamine, vasopressor drugs such phenylephrine. surgery to repair traumatic damage. Heparin induced tamponade - heparin antagonist protamine. Warfarin induced tamponade - vitamin k and infusion of fresh- frozen plasma if necessary.

Question 9

What is Beck’s triad?

Answer 9

Indicative of Cardiac Tamponade - increased jugular vein pressue/muffle heart sounds/decreased blood pressure.

Question 10

What is coronary artery disease?

Answer 10

A disease where narrowing of the coronary arteries leads to insufficient nutrients and oxygen getting to the myocardial muscles. Most prevalent in middle aged man and the elderly. 60,000 deaths occurred in UK from CAD without being hospitalised. Total number of deaths around 120,000. 50% of men 60 or over show signs of CAD during postmortem (Scott, 2012).

Question 11

What is the most common form of coronary artery disease?

Answer 11

Atherosclerosis is the most common form of CAD.

Question 12

What is atherosclerosis?

Answer 12

Build up of fatty fibrous plaques, possibly containing calcium deposits, reduced the size of the coronary artery lumens.this reduces the blood flow leading to myocardial ischaemia and ultimately to necrosis. (Scott, 2012).

Question 13

What are the risk factors for atherosclerosis?

Answer 13

Non-modifiable: Over 40 Male White Family history Modifiable: Low levels of high-density lipoproteins High levels of low density lipoproteins Systolic >140 mm Hg Diastolic >95 mm Hg Stress Inactivity Smoking Obesity Diabetes mellitus esp in women elevated levels of homocysteine

Question 14

What are the signs of atherosclerosis?

Answer 14

Angina is the classic sign of CAD (Scott, 2012).

Question 15

What is angina?

Answer 15

-

Question 16

What is the treatment for coronary heart disease?

Answer 16

-

Question 17

What is a myocardial infarction?

Answer 17

Reduced blood flow to cardiac muscle due to partial or total blockage of a coronary artery. Leading to ischemia, injury and or necrosis.

Question 18

What are the signs of a myocardial infarction?

Answer 18

Chest pain: -sub-sternal. -radiating to throat, jaw, arm, back, across chest. -Pain described as crushing/heavy/squeezing. -Persistent. Nausea/vomiting Dizziness Shortness of breath Diaphoresis Anxiety -sense of impending doom Restlessness Cool extremities pale Other things to look out for: unexplained fainting Indigestion symptoms Confusion

Question 19

What is pericarditis?

Answer 19

-

Question 20

What are the signs of pericarditis?

Answer 20

-

Question 21

In 2010 how many people died in Scotland from coronary heart disease?

Answer 21

8000. More than any other disease. BHF

Question 22

How many MI’s in Scotland in 2010?

Answer 22

7000 men, 5000 women. BHF

Question 23

How many calls did SAS receive in 11/12 for chest pains?

Answer 23

32224 SAS Annual report 11/12

Question 24

What is a non STEMI?

Answer 24

Blockage of small vessel, inner layer muscle damaged. Does not show on ECG.

Question 25

What is a STEMI?

Answer 25

Block of large vessel. All muscle layers damaged. Shows on ECG.

Question 26

List some acute coronary syndromes.

Answer 26

Unstable angina, Non-STEMI, STEMI

Question 27

What is ischaemia?

Answer 27

Lack of oxygen

Question 28

What is unstable angina?

Answer 28

Partial blockage worsening. A change in the patients normal symptom pattern.

Question 29

Who might present differently with an MI?

Answer 29

Elderly, Diabetics, Females

Question 30

What problems may exist after an MI?

Answer 30

Muscle necrosis and scar tissue (this forms at the necrotic area as cardiac muscle will not regenerate) will impair effectiveness of heart as a pump thus leading to chronic heart failure.

Question 31

How is an MI diagnosed?

Answer 31

Baseline obs History of complaint Pain descriptors Past medical history 12 lead ECG - not all MIs will show. Telemetry and advice from PPCI centre Blood test cardiac markers e.g. TroponinT

Question 32

What does PPCI stand for?

Answer 32

Primary Percutaneous Coronary Intervention

Question 33

What is the treatment for an MI?

Answer 33

Pain relief - Entonox/morphine (morphine - drug of choice but paramedic drug as given IV) Oxygen - if indicated Anti-platelet therapy Aspirin/Clopidogrel Nitrates - GTN Anticoagulants - Heparin Thrombolytics - Tenecteplase Angioplasty - PPCI

Question 34

What is angioplasty?

Answer 34

Repair or reconstruction of a narrowed or blocked blood vessel.

Question 35

Why is pain relief important for treatment of MI?

Answer 35

Pain increases stress and can therefore increase workload and oxygen demand on the heart. Pain relief calms the patient and has tangible effect which will reduce the stress on the myocardium.

Question 36

Would you give oxygen to all people suffering from an MI?

Answer 36

No - must be based on the patient’s SpO2 - over-oxygenation may cause further damage (Cabello et all 2010). Follow JRCALC 2013 guidelines.

Question 37

Where would people with a STEMI go to ideally?

Answer 37

Straight to PPCI bypassing A&E.

Question 38

What is GTN and why is it used with MIs?

Answer 38

Glyceryl Trinitrate - dilates coronary arteries and relieves spasms - dilation of systemic vessels = lower pre-load. - Reduce blood pressure.

Question 39

What is heparin?

Answer 39

An anti-coagulant.

Question 40

What are thrombolytic agents?

Answer 40

Drugs used to break up clots.

Question 41

How big is the heart and how many litres can it pump in a day?

Answer 41

Size of a man’s fist, weighs 250 to 300 grammes and is capable of pumping 7000-9000 litres of blood a day.

Question 42

What are the three layers of the wall of the heart?

Answer 42

Epicardium - thin membrane outermost layer. Myocardium - muscular middle layer. Endocardium - thin membrane that lines inside of heart cavities and forms valves. Smooth surface to reduce turbulence as blood flows through heart.

Question 43

What surrounds the heart?

Answer 43

Pericardium - fibrous sac protects the heart and provides lubrication between heart and surrounding structures. Superficial layer is parietal pericardium and anchors heart within mediastinum and surrounding structures. The deep layer is the visceral pericardium and is fused to the epicardium. A potential space exists between the two layers. Infection, cancer or trauma can lead to abnormal accumulation of fluid. Pericardial effusion - small accumulation. Pericardial tamponade - large accumulation leading to decrease in cardiac output and cardiovascular collapse.