CV Disease I and II Flashcards
What could go wrong, relating to the CV system?
MI, angina = chest pain
Tachycardia = palpitations, breathlessness
Bradycardia = dizzy, blackout
Heart failure
Die = ventricular tachycardia, fibrillation
Endocarditis
What questions should you ask when faced with pts with definite or possible CV disease?
Will they tolerate treatment?
Will my treatment complicate their condition or treatment?
Will their condition or treatment complicate my treatment?
Should I tell anyone about them? - Yes if cardiac symptoms or signs
List the functions and consequences of malfunction of the myocardium, valves, conduction system and coronary blood supply
Myocardium = heart failure
Valves = heart failure, endocarditis
Conduction system = Arrhythmia (tachy, brady, sudden death)
Coronary blood supply = angina, myocardial infarction
List the common causes of heart failure
Previous MI, high BP, genetic causes, drugs (chemo), idiopathic
Name the standard assessment of pump function
Transthoracic endocardiography
Symptoms of heart failure?
Reduced CO = increase fluid pressure in lungs, reduces venous return to the heart via vena cava, fluid retention and vasoconstriction = Breathlessness (increased fluid pressure in lungs)
Swelling (increased fluid pressure in venous system)
Dizziness, tiredness, weight loss
Clinical signs of heart failure?
Low BP High pulse rate Crepitations in lungs Raised jugular venous pressure Pitting ankle oedema
What causes the same symptoms as heart failure?
Regurgitant or stenosed valves
What causes valve disease?
Degeneration Rheumatic fever Congenitally abnormal valve Endocarditis Papillary muscle rupture after MI
What is infective endocarditis?
Systemic infection, infected lumps in blood stream causing embolic complications and heart valves damage = valve regurgitation and heart failure
= night sweats, fever, rigors, weightloss
When is infective endocarditis more likely?
Artificial valves, abnormal valves, elderly, IV drug abusers, previous endocarditis
What organisms usually cause infective endocarditis?
Streptococcal, staphlococcal
What does infective endocarditis cause?
Valve damage and embolisation
Types of arrhythmia?
Tachycardia >100bpm
Bradycardia <60bpm
ECQ - What does P measure?
Atrial depolarisation
What does QRS measure?
Ventricular depolarisation
What does the T wave indicate?
Ventricular repolarisation
Closer QRS complexes indicate what?
Faster HR
Name the types and symptoms of Tachyarrhythmia
Atrial fibrillation - palpitations, dizziness
Atrial flutter - as above
Supraventricular tachycardia (SVT) - palpitations
Ventricular tachycardia - palpitations, sudden death
Ventricular fibrilation - sudden death
Ectopic beats - palpitations, skipped beats
Types and symptoms of bradyarrhythmia?
Sinus bradycardia - tiredness
Slow atrial fibrillation - tired/dizziness
2nd degree heart block - dizziness
Complete heart block - tired/dizziness/sudden death
Asystole - sudden death
Risk factors for coronary artery disease?
Smoking High cholesterol High BP Diabetes Overweight Poor diet Stroke, peripheral vascular disease Family history Genetics Male Age
What causes angina?
When coronary artery disease becomes obstructive
How does angina prevent thrombosis?
The plaque is stable = strong fibrous cap protects the blood from exposure to the liquid core of the lesion
What is angina?
Recurrent feeling of chest pressure/heaviness/pain/indigestion, sometimes radiating to arm, neck or back
What is unstable angina?
Increasing frequency of pain, duration or onset at rest = risky
When does a MI occur?
When an atherosclerotic plaque in a coronary artery ruptures = thrombus formation = permanent dead of some of the myocardium
When to know the difference between angina and an MI?
Angina rarely lasts more than 10 mins - MI pain is longer
How to tell if someone has coronary artery disease
Exercise ECG: inaccurate
Myocardial perfusion scan: more accurate
Angiography: by CT or invasive angiography
How to treat coronary artery disease?
Lifestyle modification: Stop smoking, exercise, healthy diet, weightloss Cholesterol lowering Antiplatelets Address risk factors
How to treat CAD if it’s causing angina?
CAD treatment plus
Medication to reduce anginal attacks - nitrates
If medication not working/side effects; stenting or coronary artery bypass grafting
How to investigate heart failure?
Transthoracic echocardiography to detect ventricular impairment
Tests for elevated serum B-type natriuretic peptide (BNP)
Cardiac MR
How to treat heart failure?
ACE inhibitors, betablockers, aldosterone antagonists, diuretics, ivabradine Correction of other causes (anaemia) Manage complications (arrhythmia) CRT (pacemaker type)
How to investigate valve disease?
Transthoracic echocardiography
Transoesophageal echocardiography = better image of mitral valve, unpleasant for pt
How to treat valve disease?
Symptomatic = valve surgery
- Metallic valves = requires lifelong warfarin, only stopped if bridged with heparin
Aortic stenosis = TAVI
How to investigate arrhythmia?
Diagnosis by ECG at time of symptoms
Look for causes - valve disease, family testing
What devices can be fitted to treat bradyarrhythmia?
Dual chamber pacemaker
What devices can be fitted to treat ventricular tachycardia or VF?
Implantable cardioverter/defibrillator
What device treats heart failure?
Cardiac resynchronisation Therapy (CRT)
When should you defer dental treatment?
Increasing pain with stable angina
Increasing breathlessness and oedema with stable heart failure
Recent MI (6 weeks) - defer until 3-6 months post MI
Frequent attacks of disabling tachycardia
Pt awaiting stents or bypass or valve surgery = if stable, can do treatment
How to investigate MIs?
Troponin count
ECG
Chest pain
What ECG and troponin features are present with different types of MI?
NSTEMI and STEMI = raised troponin
STEMI
- Elevated S-T
NSTEMI
- Normal ST or depressed ST or T wave inversion
How to manage MIs?
Both = Immediate dual anticoagulation therapy (aspirin and clopidogrel) and pain relief (aspirin and opiates)
- Avoid O2 and nitrates
Anticoagulation for 24-72hrs (heparin)
STEMI = Angiography and stenting (but thrombolyse preferred if available) immediately
NSTEMI = Angiography and PCI (stenting) within 72hrs or sooner if complications - takes longer to diagnose due to troponin non-sensitive test taking 6-12hrs)
Secondary prevention of MI?
Dual antiplatelet therapy for a yr, then aspirin alone, statin, beta blocker, ACE inhibitor
Clopidogrel 1 month after STEMI, 1 yr after NSTEMI
Cardiac rehab, exercise, education, smoking cessation, diet
