CVD - PHD, IHD and acute coronary syndrome Flashcards
What is peripheral vascular disease?
- Atherosclerosis affecting peripheral vessels: lower limbs and abdominal artery
- can lead to death of tissue –> gangrene
What does PVD cause?
What symptoms does this cause?
Chronic ischaemia - atherosclerosis and narrowed artery
Symptoms:
- intermittent claudication - pain in calves when walking distance or up hills
- relieved by resting
- skin changes - ulcers, hair loss
- nail changes - brittle
What is acute ischaemia of the lower limb?
What are the symptoms?
Critical limb ischaemia - embolus or atherosclerotic plaque rupture
Symptoms:
- may have history of intermitent claudication
- severe constant pain in foot, calf or leg at rest
- pale, pulseless, perishing cold, paralysis, paraesthesia of limb
- gnagrene
- limb threatening
Call 999 and admit as emergency
How is PVD managed?
- risk factor modification
- exercise programme
- surgery: bypass grafts, stents, amputations
What is abdominal aortic aneurysm?
- damage to vessel wall from atherosclerosis –> dilated aorta
- risk of catastrophic rupture or tear
- UK screening programme for men over 65 (increased risk)
Symptoms:
- often asymptomatic
- sometimes vague abdominal pain
- often presents acutely with rupture: collapse, severe abdominal pain –> surgical emergency –> high mortality (50-90%)
What is the top cause of mortality in the western world?
How does it manifest?
How is this investigated?
Ischaemic Heart Disease
Manifests as:
- stable angina - exertional
- acute coronary syndrome: symptoms at rest
- unstable angina
- myocardial infarction
- heart failure
- arrhythmias
ECGs are used to investigate IHD
What causes stable angina?
Are there dental implications?
Due to narrowing of coronary arteries by atherosclerosis
Lack of blood (oxygen) to heart –> ischaemia –> visceral pain
- central chest pain radiating down right arm
- atypical - jaw pain, back pain, upper abdominal pain
- can be perceived as heaviness/breathlessness/heartburn
- sometimes associated with nausea
- often gets better with rest and nitrates if patient has GTN spray
Should not affect dental treatment if stable and GTN resolves symptoms promptly
How is stable angina managed?
- lifestyle modification
- manage underlying medical conditions e.g. diabetes, high BP, cholesterol
- medical management
- surgical management: percutaneous coronary intervention (stents) or coronary artery bypass grafting (open heart surgery)
What are some common ways of medical management of angina?
- antiplatelets - aspirin or clopidogrel
- cholesterol - statin
- symptom relief - vasodilators
e. g. beta blockers, calcium channel blockers, nitrates or nicorandil
What is acute coronary syndrome?
What is it due to?
Medical Emergency!
- unstable angina
- myocardial infarction
Often due to atherosclerotic plaque rupturing, a thrombus forms over the plaque, occluding the coronary artery. Both present with the same symptoms, and cannot distinguish between the two until an ECG
How does acute coronary syndrome present?
- usually more severe than angina but sometimes indistinguishable
- central crushing chest pain at rest or on minimal exertion
- pain may be felt as indigestion, radiation down left arm or to jaw
- often clammy, nauseated, dizzy, breathless
- feeling of imminent death, impending doom
- sometimes cardiac arrest
How do you manage a patient with acute coronary syndromes?
What are some other things to bear in mind?
- ABCDE assessment
- phone 999
- sit patient up
- give high flow oxygen
- give GTN spray - 2 puffs sublingually, upto 3 doses, 5 mins apart
- give aspirin 300mg
Send someone for AED
Stay with patient
Write a note to hospital of what you have given, especially is aspirin was administered
Do not give intramuscular injections
If they collapse, start BLS
