Exam Flashcards
What is the angina pectoris?
is a form of coronary artery disease, characterized by paroxysmal pain in the heart area caused by myocardial ischemia (without the development of necrosis).
Risk factors for angina pectoris?
- increase in blood pressure;
- violations of cholesterol metabolism;
- diabetes mellitus, poor control of blood glucose levels;
- smoking;
- male gender;
- sedentary lifestyle;
- the presence of IHD among blood relatives;
- the regular use of certain drugs (nicotine, caffeine, as well as cocaine, amphetamine,
inhaled beta-stimulants, or agonists, methylxanthines (theophylline)), emotional and physical stress.
atherosclerotic
تصلب الشرايين
Pathogenesis of the angina pectoris?
1.atherosclerotic (تصلب الشرايين ) coronary artery disease (stable angina)
2.transient vascular thrombus (جلطه ) formation (unstable angina)
3. decrease in coronary blood flow due to spasm or increased tone of the coronary artery
(dynamic obstruction).
The clinical picture of the angina pectoris?
*Angina pectoris of exertion and rest.
Pain in angina pectoris is provoked تستفز by physical exertion, most often localized behind the
sternum, sometimes slightly to the left, it has a pressing or compressive character of varying intensity
* most often the pains begin gradually, then intensify.
* At the time of an attack,
1) patients try to maintain a stationary position(في وضع ثابت )
2) they are afraid to take a deep breath
3) pallor of the skin due to vasospasm,
4) increased sweating
5) Sometimes there are burning pains, they resemble heartburn
6) symptoms of tightness in the chest
7) feeling of suffocation
8) Typical is the irradiation of pain to the hands, more often to the left along its inner surface to the little finger.
9) Often the pain radiates to the left shoulder blade, neck, and lower jaw.
10) Some patients have the urge to urinate and defecate. Sometimes nausea, vomiting, dizziness, trembling all over the body begin
What provokes the angina pectoris?
Pain in angina pectoris is provoked by physical exertion
What is the location of angina pectoris pain ?
most often localized behind the
sternum, sometimes slightly to the left
What is happening during the angina attack
During an attack, the pulse slows down or speeds up, and blood pressure rises. heart sounds are often muffled مكتوم .
concomitant diseases
الامراض المصاحبه لمرض ما
What is the Laboratory tests of angina pectoris ?
1) Clinical blood test: Changes in the results of a clinical blood test make it possible to identify concomitant diseases (anemia, erythremia, leukemia, etc.) that provoke myocardial ischemia.
2) Determination of biochemical markers of myocardial damage
What is the Instrumental methods angina pectoris ?
1) ECG at rest
2) Exercise ECG
3)Echocardiography at rest allows you to detect or exclude other disorders (for example, valvular heart disease or hypertrophic cardiomyopathy) as the cause of symptoms, as well as assess the function of the ventricles, the size of the heart cavities, etc
4) Stress echocardiography.
5) Coronary angiography in patients with cardiac arrest
For relief of an attack of the angina pectoris we need ?
Nitroglycerin
Nitroglycerin is a vasodilatory drug used primarily to provide relief from anginal chest pain.
Treatment of the angina pectoris ?
For relief of an attack, nitroglycerin (interval 5 min)
Basic therapy:
1) antiplatelet agents (aspirin)
2) statins (atorvostatin)
3) drugs to reduce myocardial oxygen demand (B-blockers or calcium channel blockers)
4) ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are medicines that help relax the veins and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from making angiotensin 2, a substance that narrows blood vessels.
5) metabolic therapy
hyperhidrosis
فرط التعرق
hiccups
زغطه
belching
تقريعه (تحدث بعد الاكل )
aneurysm
تمدد الاوعيه الدمويه
pericarditis
التهاب التامر المحاور للقلب
syncope
الاغماء
First medical aid.
الاسعافات الاوليه
hypovolemia
نقص حجم الدم
Arrhythmogenic
عدم انتظام ضربات القلب
hypotension
انخفاض ضغط الدم
hypoperfusion
نقص الامداد الدموي
Anaphylactic reactions
رد الفعل التحسسي
Dehydration
خفاف
Hypothermia
انخفاض في درجات الحراره
suffocation
اختناق
cyanosis
زرقه الاطراف
Oliguria
قلة البول هي انخفاض إنتاج البول. وتتراوح كمية البول المُنتجة خلال اليوم ما بين 100-400 مل.
anuria
توقف انتاج البول
CHF
Chronic heart failure
What is the IHD?
ISchemic heart disease
What is the definition of ISchemic heart disease?
IHD is an acute or chronic heart disease, caused by a decrease of blood supply to the myocardium (عضله القلب ) due to atherosclerotic (تصلب الشراين ) lesions of the coronary arteries, and disrupts the balance between coronary blood flow and myocardial oxygen demand.
What is the Acute myocardial infarction (AMI)?
is a clinical syndrome that occurs as a result of damage to the heart muscle when there is a unbalance between myocardial oxygen demand and the possibility of its delivery
Pathogenesis of myocardial infarction ?
rupture of atherosclerotic plaques;هو الدهون والكولسترول المسبب لتكوين عائق
- coronary artery thrombosis;
- coronary spasm.
Clinic feature of ISchemic heart disease?
1) Painful variant : pain, independent of position of the body The pain is pressing, choking, burning, tearing, localization behind the sternum, in the entire anterior chest wall with possible irradiation to the shoulders, neck, arms, back, epigastric region, combination with hyperhidrosis (فرط التعرق ) severe general weakness, pallor of the skin
2)Abdominal option - a combination of epigastric pain (الم المعده )with dyspeptic symptoms عسر الهضم
- nausea(غثيان ), which does not bring relief from vomiting, hiccups, (زغطه), abdominal distension, (انتفاخ البطن )constipation,( امساك)irradiation of back pain, tension of the abdominal wall and pain on palpation in the epigastrium
3) Asthmatic ازمه ربو- an attack of shortness of breath due to acute congestive heart failure (pulmonary edema)
4) Arrhythmic عدم انتظام ضربات القلب
Diagnostics ISchemic heart disease?
1) Clinic
2) ECG changes
When Early complications in acute myocardial infarction ?
Early complications - occur in the first hours or in the most acute period (3-4 days)
1)rhythm and conduction disturbances, cardiogenic shock, pulmonary edema, cardiac asthma, acute mitral regurgitation, acute rupture of the IVS and LV outer wall, LV aneurysm, early pericarditis (episthenocarditis), parietal LV thrombosis
2) from other organs and systems: gastrointestinal tract paresis, bleeding,central nervous system, mental disorders
Prehospital treatment of myocardial infarction?
-Nitroglycerin 0.4 mg under the tongue
-Acetylsalicylic acid 250mg + clopidogrel 300 mg
What is the Nitroglycerin?
Nitroglycerin is a vasodilation
What is the Acute vascular insufficiency ?
Acute vascular insufficiency is a pathophysiological condition characterized by a drop in vascular tone or a violation of the adequate ratio between the capacity of the vascular system and the volume of circulating blood (hypovolemia), leading to impaired blood supply to organs and tissues
syncope
الاغماء
What is the syncope or fainting ?
Fainting is a sudden short-term loss of consciousness resulting from acute brain hypoxia;
Classification of Fainting /syncope?
I. Fainting in organic heart disease:
II.Vascular syncope
III.Fainting with obstruction of cerebral arteries
Fainting in organic heart disease
1) Arrhythmogenic:
A) Ectopic tachycardia
B) AV blockade 2-3 degrees
C) Sick sinus syndrome
D) Frequent blocked extrasystoles
2) With mechanical blockade of cardiac output:
A) Aortic stenosis
B) Stenosis of the pulmonary artery
C) TELA
D) Myxoma or thrombus in the atrial cavity
II.Vascular syncope:
1) Associated with a drop in arterial tone:
A) Vasopressor (vasovagal)
B) Increasing the sensitivity of the carotid tone
C) Reflex (diseases of the pharynx, larynx, esophagus, irritation of the pleura, peritoneum,
pericardium)
2) Associated with a drop in venous tone:
A) Orthostatic (constitutional, decreased blood volume, taking or overdose of drugs:
nitroglycerin, ganglion locators) B) VNS diseases
III.Fainting with obstruction of cerebral arteries
1) Spasm or transient thrombosis
2) Compression of the vertebral arteries (spondylosis)
3) Hyperventilation syndrome
Pathogenesis of Acute vascular insufficiency ?
-Acute decrease in cerebral circulation (narrowing of cerebral vessels) and / or systemic blood flow (hypotension) leads to a narrowing with disorders of cardiovascular and respiratory activity
-Loss of consciousness, developing for 5-10 s, with hypoperfusion of the brain, is accompanied by the activation of autonomous centers that regulate blood circulation and the restoration of adequate cerebral circulation and consciousness
Clinic (diagnostic algorithm) of Acute vascular insufficiency or syncope
1) Sudden loss of consciousness
2) The patient is pale, Coldness of the limbs, Skeletal muscles are relaxed, There may be
clonic twitching (رعشه )of the face and trunk
3) Pulse is weak, difficult to palpate (may be arrhythmicعدم انتظام في ضربات القلب ), decreased blood pressure, shallow breathing, may be cold sweat
4) Consciousness is restored quickly and completely after 10-30 seconds remember what preceded the fainting;
First aid Acute vascular insufficiency or syncope?
1) Lay the patient down with his head lowered, legs raised (60-70 degrees) or, if conditions do not allow, sit down and lower his head below the knees
2) Unbutton the collar or relax tight clothing
3) If the patient is in a horizontal position, turn his head to one side so that the tongue does not burn
4) Sprinkle cold water on face and neck
5) Give an inhalation of ammonia vapors (from a moistened cotton wool or bandage) 6) Warm the patient
7) Reflex effects: massage of the fingers of the hands, pressure at the base of the nail,
squeezing the earlobes several times
Medication therapy of Acute vascular insufficiency - syncope?
1) Cordiamine - subcutaneously 1-2 ml
2) Caffeine Na benzoate - 10% solution 1-2 ml subcutaneously
3)Mezaton - 1% solution 1 ml subcutaneously
4) With bradyarrhythmia - ephedrine hydrochloride - 5% solution - 1 ml subcutaneously
5) Atropine sulfate - 0.1% solution - 1 ml subcutaneously
What is the bradyarrhythmia
Bradyarrhythmia is an abnormally slow resting heart rate, typically below 60 beats per minute.
What is the Acute vascular insufficiency ?
Acute vascular insufficiency is a pathophysiological condition characterized by a drop in vascular tone or a violation of the adequate ratio between the capacity of the vascular system and the volume of circulating blood (hypovolemia), leading to impaired blood supply to organs and tissues
What is Collapse ?
Collapse is an acutely developing vascular insufficiency, characterized by a drop in vascular tone or a rapid decrease in circulating blood volume (BCC), characterized by a sharp but reversible drop in blood pressure. Unlike fainting, loss of consciousness is optional;
Pathogenesis Acute vascular insufficiency - collapse.
an acute drop in vascular tone and (or) a rapid decrease in the mass of circulating blood, leading to a decrease in venous flow to the heart, a drop in arterial and venous pressure, brain hypoxia and suppression of vital body functions.
Etiology of Acute vascular insufficiency - collapse ?
Infection
- Intoxication
-Anaphylactic reactions
-Blood redistribution (orthostasis, acute diseases of the abdominal cavity) -Dehydration (diarrhea, vomiting)
- Hypothermia, overheating
-Oppression of the vasomotor center (sharp pain syndrome, etc.)
Collapse diagnostic algorithm of the Acute vascular insufficiency - collapse.?
1) Sudden onset of severe weakness
2) Dizziness
3) The patient is conscious
4) Sluggish
5) indifferent
6) Has difficulty answering questions
7) The facial features are pointed
8) The skin and mucous membranes are pale
9) Cold clammy sweat
10) The limbs are cold
11) Breathing is shallow, the patient has no feeling of suffocation
12) The pulse is slightly palpable
13) Veins are collapsed, empty, the boundaries of the heart are not changed 14) Acute drop in blood pressure below 80 mm Hg
First aid of Acute vascular insufficiency?
1) Horizontal position with raised legs
2) Warm the patient (hot strong tea)
3) oxygen therapy
drug therapy of Acute vascular insufficiency?
-Noradrenaline 0.2% -1ml
-Prednisolone-60mg (2ml) intravenous stream
abdominal distension
انتفاخ البطن
constipation
امساك
