Heart Conditions Flashcards
What is coronary artery disease?
Narrowing of the coronary arteries, usually by atheroma
What is atheroma?
Degeneration of walls of arteries caused by build up of fat and scar tissue, leading to restricting of the circulation and risk of thrombosis (blood clot)
What is acute coronary syndrome?
Damage or death of heart muscle usually following blockage of one or more of the coronary arteries
What is heart failure?
Abnormal back pressure due to inability of the heart to maintain normal circulation
What is cardiac arrest?
Where the heart stops and here is lack of circulating blood to the brain and vital organs
What is hypercholesterolaemia?
Cholesterol is an important substance used in the structure of cell membranes and steroid hormones
Elevated cholesterol as a result of foods high in LDL and HDL
What should normal cholesterol levels for healthy adults be?
5mml/l
What is atherosclerosis? And what does it do?
Increased deposition of cholesterol into arteries leads to formation of ‘atherosclerotic plaques’.
It is these plaques which narrow lumen of arteries and increase mean arterial pressure (BP)
These atherosclerotic plaques reduce the amount of blood travelling to coronary arteries and thus with significant deposition, chest pain can occur as a result of myocardial ischaemia. If these plaques rupture, arteries can become totally occluded.
What is hypertension?
High blood pressure = >140/90
Why does hypertension occur?
Damaged vasculature which is closely linked to atherosclerotic processes including lipid deposition and plaque formation caused by smoking etc
What are hypertensive patients at risk of?
Myocardial Infarction, angina, cerebrovascular events (strokes and TIAs), subarachnoid haemorrhages and kidney failure
What does TIA stand for?
Transient Ischaemic Attack
What increases the probability of a person having a TIA?
Temporary blood clots
What is arteriosclerosis?
A degenerative process in which the vessels of the circulatory system become damaged over time
What is arteriosclerosis often due to?
It is often due to advancing age as collagen and elastin fibres are degraded but it’s onset can be accelerated through smoking and excessive alcohol consumption
Alongside arteriosclerosis, what other conditions can increase the risk of an individual having angina or an MI?
Hypertension, hypercholestrolaemia, atherosclerosis
What are some risk factors for cardiac disease?
Hypercholestrolemia
Hypertension
Diabetes
Family history of coronary artery disease at an early age
Smoking
Obesity
Alcohol
Physical inactivity
What is angina pectoris?
Temporary lack of oxygen in the myocardial tissue and the accumulation of carbon dioxide and lactic acid
Related to exertion
What is stable angina?
It follows a recurrent pattern
Exertion or emotion precipitates pain of similar intensity, duration and location
Most attacks are relieved by rest in 2-3 minutes
What are some clinical features of angina?
Pain behind breast bone, running the length of the bone and spreading across chest
Pain radiates to throat, jaw and teeth and also into the armpits and arms
Described as heaviness in the arms or chest
Pallor
What are some treatments for angina?
Rest
Oxygen if required
Administration aspirin
Administration of Glyceryl Trinitrate (GNT)
Pain relief
Hospital
What is aspirin?
Acetylsalicylic Acid
What form is aspirin in and how much does it contain?
In tablet form containing 300 mg
When would you give aspirin?
Clinical ECG evidence of an MI or ischaemia
What are the three key actions that aspirin takes?
Anti-platelet
Anti-pyretic
Anti-inflammatory
What are some contra-indications of aspirin?
Known aspirin allergy or sensitivity
Children under 16 years
Severe hepatic disease
Haemophilia
Active GI bleeding (gastrointestinal bleeding from mouth to rectum
What are some cautions that need to be taken before using aspirin?
Asthma Pregnancy Kidney and liver failure Gastric and duodenal ulcers Current treatments with anti-coagulants (blood thinners)
What are some side effects of aspirin?
Wheezing in asthmatics
Gastric bleeding
What is GTN?
Glyceryl Trinitrate
Metered dose spray containing 400mcg GTN per dose
Tablets containing GTN 2, 3 or 5mg for buccal administration
What are some indications for the use of GTN?
Cardiac chest pain due to angina or MI
Acute cardiogenic pulmonary oedema
What does GTN do?
Vasodilator
Dilation of coronary arteries/relief of coronary spasm
Dilation of systemic veins resulting in lower preload
Reduced BP
What are some contra-indication of GTN?
Hypotension (systolic >90mmHg)
Hypovolaemia (low blood plasma)
Head trauma
Cerebral haemorrhage
Sildenafil within 24 hours (AKA viagra used to treat erectile dysfunction and pulmonary arterial hypertension)
Unconscious patients
What is needed for GTN to be given for it to work?
The oral mucosa must be moist for GTN absorption
How would you use the Sub-lingual spray of GTN?
400-800mcg every 5 mins if required (no Max dose)
How would you give buccal tablets of GTN?
2,3 or 5mg tablets - 1 tablet
Remove tablet if side effects occur
What is Entonox?
Also known as gas and air
Combination of 50% nitrous oxide and 50% oxygen
It is a pain relieving gas
It is stored in medical cylinders that have a blue body with white quartered shoulders
What are some indications for the use of Entonox?
Moderate to severe pain
Labour pains
What actions does Entonox have?
Inhaled analgesic agent (diminishes sensation to pain without loss of consciousness)
What are some contra-indications for the use of Entonox?
Severe head injuries with impaired consciousness
Decompression sickness or anyone who has been diving within the last 24 hours
Violently disturbed psychiatric patients
Intraocular injections of gas within the last 4 weeks
Abdominal pain where intestinal obstruction is suspected
What are the three main cautions needed to be taken before administering Entonox?
Pneumothorax - abnormal collection of air in pleural space between lung and chest wall
Pneumomedastinum - pressure rises in lungs and causes alveoli to rupture
Pneumoperitoneum - abnormal presence of air or other gas in peritoneal cavity, a potential space within the abdominal cavity
How is Entonox administered?
Self administered via face mask or mouth piece. Takes 3-5 minutes to become effective and 5-10 minutes for maximum effect
Can be used in children who are capable of following administration instructions and can activate the demand valve
What is important when using Entonox in colder temps?
Must invest several times because gases separate and need to remix
What is acute coronary syndromes?
More serious and indicates increasing obstructions of coronary arteries
Unpredictable with changes in frequency, intensity or duration of pain
May occur at rest
Unstable angina may precede an Acute Myocardial Infarction (AMI) by a few hours a day
What is Acute Myocardial Infarction (AMI)?
Process of death or damage to an area of heart muscle
Coronary artery becomes blocked or significantly narrowed
Due to blood clot or embolism
What is the problem with an acute myocardial infarction (AMI)?
Prevents oxygen from reaching the muscle beyond the blockage
May result in heart failure or death
May cause heart arrhythmias
What is the different between a STEMI and a NonSTEMI AMI?
STEMI is a full thickness damage of heart muscle
NonSTEMI is a partial thickness damage of heart muscle
What is the most common cause heart sudden death form heart disease?
AMI
80% arrest into VF
What are the clinical features of AMI?
Severe central chest pain which may radiate to one or both sides of the chest and into the neck, jaw, arms or back and is often described as crushing in nature
Heavy feeling in arms or paraesthesia
Sweating, fainting, giddiness, nausea and vomiting
Sense of impending doom
Grey or cyanosed
Changes in vital signs
What is some treatment options for ATM?
Rest - do not allow to walk
Oxygen if SPO2 is less than 94% (88% in COPD)
Aspirin
GTN
Analgesia
Monitor
Place defib pads on
Rapid transport - into a Primary Percutaneous Coronary Intervention (PPCI) centre if STEMI
what is heart failure?
The inability of the heart to pump adequately
What is heart failure caused by?
MI
Myocarditis
Hypertension
Valvular heart disease
What is left sided heart failure known as?
LVF
Usually more acute and may accompany an AMI
What is a symptom of heart failure and why does this happen?
Present as short of breath by fluids retained in lungs
When does right sided heart failure usually occur?
It’s usually secondary to LVF (left sided failure) and occurs over time
RVF
What is some clinical signs of RVF?
Increased to need to urinate at night
Oedema in the body (often pitting)
Swelling of the abdomen
Very rapid weight gain form fluid retention
What are some clinical signs of LVF? (Left sided heart failure)
Shortness of breath
Reduced ability to exercise
Fatigue and weakness
Rapid or irregular heartbeat
Persistent cough or wheezing with white or pink blood-tinged phlegm
Difficulty concentrating or decreased alertness
Sudden, severe shortness of breath and coughing up pink, foamy mucus
Chest pain if heart failure is caused by heart attack
What are some treatment options for LVF?
Rest
Oxygen if SPO2 is less than 94% (88% in COPD)
GTN
Furosemide
Salbutamol
Prealert
What are furosemide contained in and how much is stored?
Ampoules containing furosemide 40mg in 2ml
What is an indication for the use of furosemide?
Pulmonary oedema secondary to LVF
How does furosemide work?
Potent diuretic with rapid onset (30 minutes) and short duration
What are some contraindications for the use of furosemide?
Pre-comatose state secondary to liver cirrhosis
Severe renal failure with anuria (can’t produce urine)
Children under 18 years old
What dosage of furosemide appropriate?
40mg IV slowly over 2 minutes
What are some cautions needed to be taken for use of furosemide?
Hypokalaemia (low potassium levels)
Pregnancy
Hypotension
What are some possible side effects of furosemide?
Hypotension
Gastrointestinal disturbances
What does DVT stand for?
Deep Vein Thrombosis
What is DVT?
A blood clot that usually occurs in a deep leg vein, such as the calf or the thigh
What are some causes of DVT?
Previous history of DVT or pulmonary embolism
Family history of blood clots
Inactivity for long periods
Blood vessel damage
Certain conditions or treatments that cause blood to clot more easily than normal - such as cancer
Being pregnant
Being overweight or obese
The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen which causes blood to clot more easily
What are some symptoms of DVT?
Unilateral - swelling in one or both legs
Pain or aching in affected area
Warm skin
Red skin or discoloured
Sharp chest pain
Shortness of breath
Haemoptysis
Blood clot breaks free becomes a pulmonary embolism in the lungs
