IHD and heart failure Flashcards
cardiac causes of chest pain
Acute coronary syndrome (unstable angina and myocardial infarction).
Stable angina.
dissecting thoracic aneurysm, pericarditis, cardiac tamponade, myocarditis, acute congestive cardiac failure, or arrhythmias.
resp causes of chest pain
Pulmonary embolus, pneumothorax or tension pneumothorax, community-acquired pneumonia, asthma, or pleural effusion.
other causes of chest pain - non cardiac or resp
Gastroenterological causes, such as acute pancreatitis, oesophageal rupture, peptic ulcer disease, gastro-oesophageal reflux, oesophageal spasm, or oesophagitis.
Musculoskeletal causes, such as rib fracture, costochondritis, spinal disorders (disc prolapse, cervical spondylosis, facet joint dysfunction), rheumatoid or psoriatic arthritis, fibromyalgia, or osteoporotic fracture.
Cancer (for example, lung cancer); herpes zoster; Bornholm disease; precordial catch (Texidor twinge); or psychogenic or non-specific chest pain.
assessment referral
urgent same day - suspected ACS and pain free with chest pain in last 12 hours and normal ECG, no chest pain and no complications, or chest pain in last 12-72 hours
2 week - suspected ACS and pain free with chest pain >72 hours ago and no complications, suspected malignancy, lung collapse, or pleural effusion
routine - stable angina, chest pain of unknown cause
angina causes
coronary artery disease
valvular disease (aortic stenosis), hypertrophic obstructive cardiomyopathy, or hypertensive heart disease
define stable angina
physical exertion or emotional stress and relieved with mins of rest of GTN spray
define unstable angina
(usually within 24 hours) onset angina, or abrupt deterioration in previously stable angina, often occurring at rest. Unstable angina usually requires immediate admission, or referral to hospital.
stable angina management
smoking cessation
cardioprotective diet
increased physical activity
limit alcohol consumption
pharmacological management stable angina
GTN spray
beta blocker or CCB (second line - isosorbide mononitrate, ivabradine, nicorandil)
can be on 3rd drug while waiting for specialist assessment
secondary preventions of CVD events
for STEMI or NSTEMI
dual antiplatelet - low dose aspirin and…(ie rivaroxaban or clopidogrel)
ACEi (coexisting hypertension, heart failure, asymptomatic left ventricular dysfunction, chronic kidney disease, or previous myocardial infarction or DM)
statin
beta blocker
non drug treatments ACS
PCI - Primary PCI (if within 12 hours of symptom onset and within 120 minutes of the time when fibrinolysis could have been given) is the preferred strategy for most patients.
or CABG
initial treatment ACS
GTN
IV opioids - morphine
loading dose of aspirin
if low o2 sats - oxygen
monitor for hyperglycaemia
when in hospital - second antiplatelet (prasugrel) - unless high bleeding risk so aspirin alone
HF summary
https://www.nice.org.uk/guidance/ng106
define HF
progressive clinical syndrome caused by structural or functional abnormalities of the heart, resulting in reduced cardiac output. It is characterised by symptoms such as shortness of breath, persistent coughing or wheezing, ankle swelling, reduced exercise tolerance, and fatigue. These symptoms may be accompanied by signs such as elevated jugular venous pressure, pulmonary crackles, and pulmonary oedema.
risk factors for HF
men
smokers
diabetic
age
african or afro-caribbean
pre existing co-morbidites - hronic kidney disease, atrial fibrillation, hypertension, dyslipidaemia, obesity, diabetes mellitus, and chronic obstructive pulmonary disease
