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Cardiac Emergency > Diseases > Flashcards

Diseases Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Angina Pectoris

A

Chest pain associated with ischemia

  • Increased oxygen demands but coronary vessels cannot deliver adequate amount of blood that is required (usually from atherosclerosis)
  • Progressive disease
  • Unstable occurs at rest and does not respond well to treatment
  • Stable occurs during activity or emotional stress and responds well to treatment
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2
Q

Myocardial Infarction

A

Myocardial tissue death/necrosis from prolonged decrease in oxygen blood supply

  • Most infarcts occur in left ventricle
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3
Q

Transmural infarct

A

Full thickness of myocardium death

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4
Q

Subendocardial infarct

A

Only deep levels of myocardium experience tissue death

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5
Q

Most common complication of MI

A

Dysrhythmias

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6
Q

Heart failure

A

Mechanical failure that results in cardiac output not being able to meet tissue oxygen demands

  • Most common complication is shortness of breath and pulmonary edema (rales/crackles on auscultation)
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7
Q

Left ventricular heart failure

A

Left ventricle cannot eject all the blood delivered from the right ventricle via the lungs; causes back pressuring into pulmonary circulation

Increased pressure to pulmonary veins/capillaries —> plasma forced into alveoli —> pulmonary edema and hypoxia

Starlings law allows for a short period of compensation

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8
Q

Right ventricular heart failure

A

Right ventricle fails causing pressure in the systemic venous circulation and pedal (pitting) edema

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9
Q

Causes of MI

A 
Atherosclerosis 
Thrombus/embolism
Vasospastic angina or unstable angina
Microemboli (cocaine)
Acute volume overload
Hypotension
Hypoxia
Trauma
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10
Q

Where to MI’s usually occur?

A

Left coronary artery occlusion- anterior, lateral, or septal infarct

Right coronary artery occlusion - inferior, posterior, or right ventricle

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11
Q

Causes of right ventricle heart failure

A 
Most common is left sided ventricle failure
Systemic hypertension
Pulmonary hypertension (COPD)
MI
Cor pulmonale
Pulmonary embolism
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12
Q

Cor pulmonale

A

Isolated right sided heart failure from pulmonary pathology, with no left sided heart involvement

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13
Q

Congestive heart failure

A

Heart’s reduced stroke volume causes an overload of fluid to the body (edema)

  • Edema can occur in pulmonary, peripheral sacral, or ascetic areas
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14
Q

Signs and symptoms of CHF

A

Acute - pulmonary edema, pulmonary hypertension, or MI

Chronic - heart enlargement (hypertrophy), left or right sided heart failure

Paroxysmal nocturnal dyspnea - sudden difficultly breathing that occurs after laying down

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15
Q

Cardiac tamponade

A

Fluid (blood, pus, air, serum) that accumulates between the visceral and parietal pericardium, in excess of the normal 25mL

Fluid increases intrapericardial pressure impairing diastolic filling, decreasing stroke volume that the ventricles can expel blood

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16
Q

Signs and symptoms of cardiac tamponade

A 
Chest pain (dull, sharp, severe)
Shortness of breath
JVD
Pulsus paradoxus (systolic BP drop of 10 mmHg or more on inspiration)
Muffled or faint heart sounds
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17
Q

Hypertensive emergencies

A

Life threatening evaluation of blood pressure and and a rapid increase in diastolic mmHg; rapid decrease needed to stop end organ failure

Class = >120-130 mmHg

AHS = >186/>110

Accompanied by restlessness, confusion, blurred vision, N/V

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18
Q

Hypertensive encephalopathy

A

Brain dysfunction due to significantly high blood pressure

Severe headache, N/V, visual disturbances (blindness), paralysis, seizures, stupor, coma

Could cause left ventricular failure, pulmonary edema, or stroke

19
Q

What BP is considered chronic hypertension?

A

Over 160/90

20
Q

Cardiogenic shock

A

Most severe form of pump failure; left ventricle is compromised to the point that the heart cannot meet the body’s demand and can no longer compensate

  • Usually occurs after an MI involving 40% of the left ventricle, or widespread ischemia
  • Remains after dysrhythmias and hypovolemia have been corrected
  • Body tries to compensate by increasing contractile force, improving preload or decreasing peripheral resistance
21
Q

Signs and symptoms of cardiogenic shock

A

Patient appears shocky in early strages

  • cold extremities
  • weak/absent pulses
  • low BP
22
Q

Causes of cardiogenic shock

A 
Tension pneumothorax/cardiac tamponade
MI
Pulmonary embolism
Valve malfunction
Recreational drug use
Trauma
Underlying disease (neurological, renal, GI, sepsis, metabolic)
23
Q

Aneurysm

A

Ballooning of an arterial wall, resulting from a defect or weakness in the wall; most occur from atherosclerosis and involve the aorta where pressure is the highest

Fusiform -symmetrical bulge around the circumference of the aorta (most common)

Saccular - asymmetrical bulge on one side

24
Q

Thoracic aortic aneurysm

A

Can be located in the upper aspect of the aorta above the diaphragm; involves the ascending aorta, aortic arch, or descending aorta

Can by asymptomatic or:

  • hoarse voice
  • trouble swallowing
  • stridor
  • neck swelling
  • tearing sharp pain between shoulder blades
  • chest pain
25
Q

Abdominal aortic aneurysm (AAA)

A

Can be located in aorta, below renal arteries, and/or above the bifurcation of the common iliac arteries

Signs/symptoms:

  • abdominal pain (pulsating masses)
  • sudden lower back, flank, or should blade pain
  • ripping sensation
  • urge to defecate
  • difference in BP between left and right arms (30mmH)
26
Q

Dissecting aneurysm

A

A tear or degenerative changes in smooth muscle and elastic tissue where blood gets between the layers of the aortic wall

Causes a sudden, sharp or stabbing chest or back pain

Careful movement of patient as they are at high risk of rupture; need to be moved without compressing the abdomen

27
Q

Pericarditis

A

Inflammation or irritation of the pericardium sac around the heart

Can occur as a result of an infection, MI, neoplasm (tumour), high dose radiation to the chest, uraemia, trauma

Chest pain as a result of layers of pericardium rubbing together; patient feels relief when they lean forward, and worsens when laying down

28
Q

Signs and symptoms of pericarditis

A

Pain that radiates to trapezius ridge or scapula
Sharp sudden pain that starts over the sternum, radiating to the neck, shoulders, back, and arms
Pain increases with deep inspiration

29
Q

Deep vein thrombosis (DVT)

A

Blood clot in vein, commonly in the large veins of the thigh and calf

Often caused by immobilization for long periods of time (e.g., flying), post-surgery inactivity, pregnancy, trauma

30
Q

Signs and symptoms of deep veins thrombosis

A

Gradually increasing pain and calf tenderness
Leg swelling from occluded venous drainage
Warm, red skin

Homan’s sign - hyperextension of the foot at the ankle towards the nose causes pain in the calf and/or posterior knee

Risk of pulmonary embolism, stroke, or MI if clot travels

31
Q

Prinzmetal’s angina

A

Coronary artery vasospasm; a temporary increase in coronary vascular tone causing a reduction in luminal diameter

  • More common in women
  • Occurs at rest with most patients not experiencing exertional symptoms
32
Q

Acute coronary syndrome (ACS)

A

Sudden reduction of coronary blood flow

33
Q

Arteriosclerosis

A

Chronic disease of the arterial system causing abnormal thickening and hardening of the vessel walls, losing it’s elasticity

Change of metabolism of lipids and cholesterol within tunica intima

34
Q

Atherosclerosis

A

Form of arteriosclerosis caused by soft deposits of intra-arterial fat and fibrin (plaque) which narrow arterial lumen

Leading cause of coronary/cerebrovascular disease

Usually occurs at points of high pressure, high flow, and high points of turbulence

35
Q

Peripheral arterial disease

A

Reduced blood flow to the lower limbs due to atherosclerosis of the femoral and peripheral arteries

36
Q

Raynaud’s disease

A

Small peripheral artery spasms

Reduced circulation to fingers, toes, skin precipitated by cold environments/stress

37
Q

Marfan syndrom

A

Inherited disease of connective tissue causing cardiovascular, skeletal, and ocular anomalies

Progressive dilation or mitral valve prolapse

38
Q

Ischemia

A

Immediately during arterial occlusion, subendocardial ischemia occurs

ST segment depression, and inverted t-waves

39
Q

Infarction

A

Myocardial cells die and there is a release of cardiac markers (within 20-30 minutes)
- Troponin

Pathological q-waves (<1mm or 25% of R-wave)

40
Q

Injury

A

Prolonged ischemia (>20-40 minutes) that causes injury to follow the endocardial surface

ST segment elevation

41
Q

Stable angina

A

“Choking of the chest” - supply of oxygen to the myocardium cannot meet the demand and cardiac muscle becomes Ischemic

Principle symptom of Coronary artery disease (CAD)

42
Q

What is primary hypertension?

A

Chronic hypertension

Causes the heart to work harder, leading to hypertrophy of cardiac muscle, and left ventricular failure

Progresses at same rate as atherosclerosis

1 in 5 Canadians have HTN, and half don’t know (asymptomatic)

43
Q

What BP defines hypertension?

A

140/90

Headache is the most common symptom

44
Q

What is secondary hypertension?

A

Caused by structural or hormonal issues (e.g., pregnancy, tumours)
- Exogenous causes: oral contraceptives (increased renin-angiotensin system), sympathomimetic drugs, cocaine, ETOH

  • Renal causes: damaged nephrons, renal artery stenosis

Cardiac Emergency (1 decks)

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