Ischaemic heart disease and acute coronary syndromes Flashcards
Describe the sequence of changes seen on ECG during evolution of STEMI
Normal Peaked T wave Degrees of ST elevation Q wave formation and loss of R wave- caused by fibrosis T wave inversion
How does a heart attack happen?
Heart disease develops over time as fatty deposits narrow coronary arteries, restricting blood flow to the heart
Coronary artery blocks
Blood flow is restricted and a heart attack begins
If blockage continues, parts of the heart muscle start to die
Heart may stop beating, leading to cardiac arrest
What stops a heart attack?
Quick action and medical treatment restores blood flow and saves heart muscle
Time is muscle
Describe the rapid treatment of STEMI
Antiplatelet agents (aspirin + clopidogrel) AND “Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow ‘Primary’ angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow
State and describe some revascularization therapies used in STEMI
Primary PCI
The NIAP* suggests that PPCI is most effective if delivered within 150mins of the patient’s call for help (‘call-to-balloon’ time)
Thrombolysis:
Treatment of choice in STEMI when primary PCI cannot be performed
Aim to initiate within 90mins of patient calling for help (‘call-to-needle’) or within 30mins of arrival at hospital (‘door-to-needle’)
List some limitations of thrombolysis
Only 50% restore normal coronary flow after 90 minutes
Increased bleeding risks with thrombolysis (haemorrhagic stroke)
Lack of reliable non-invasive methods for assessing patency of infarct related artery
Describe the warning symptoms of an MI
Chest discomfort—pressure, squeezing, fullness or pain in center of chest
Discomfort in arm(s), back, neck, jaw or stomach
Shortness of breath
Breaking out in a cold sweat
Nausea
Light-headedness
List some groups of people where the presentation of an MI is considered atypical
Women- present later with atypical symptoms of nausea, breathlessness, shortness of breath, back ache
Elderly - Confusion, Collapse, pneumonia
In context of pneumonia etc.
Diabetics - ‘silent’, DKA, SOB
What are the advantages of calling 999?
Brings emergency personnel who can:
Arrive fast and commence medical care
Send information to hospital ED before the patient’s arrival
Defibrillation if patient goes into cardiac arrest
List the complications of coronary angioplasty
Myocardial infarction Stroke Arrhythmias Renal failure- large volume of contrast or if the patient already has renal problems Vascular injury Contrast reactions Coronary artery dissection- from insertion of the balloon Emergency surgery Death
What is monitored during a coronary angioplasty?
Blood pressure
Oxygen saturations
ECG – ST segments
Arrhythmias - Bradycardia or Tachycardias
Define cardiac rehabilitation
“The coordinated sum of activities* required to influence favorably the underlying cause of cardiovascular disease as well as to provide the best possible physical, mental and social conditions, so that patients may by their own efforts, preserve or resume optimal functioning in their community and through improved health behavior, slow or reverse progression of disease’’.
List some goals for cardiac rehabilitation
Recovery
Secondary Prevention
Adoption & Maintenance of Healthy Lifestyle
Preservation of Mobility and Self-Sufficiency
Return to Work
Cost-Effectiveness for the Health Service
List some components of cardiac rehabilitation
Exercise Education Psychological support Risk factor modification Medical Risk Management
How is cardiac rehabilitation delivered?
Multidisciplinary team approach Cardiac rehabilitation specialist nurses Physiotherapists Dietician Administrator Clinical lead Psychologist/Psychology practitioners Pharmacist Occupational therapist
What are the key priorities for MI patients following the event?
Cardiac rehabilitation to begin as soon as possible after admission
Lifestyle changes to include information on diet,activity,smoking
Drug therapy treatment and offer an assessment of left ventricular function to all patients who have had an M.I.
Communication of diagnosis and advice on secondary prevention, including future management plan
Describe the psychological impact of a cardiac event
Anxiety and depression, if not treated or managed can lead to poor cardiac rehabilitation outcomes.
All patients should undergo a valid assessment including anxiety and depression ,assessment of other relevant psychological factors
Agreed referral pathway to appropriately trained professionals for individuals with clinical levels of anxiety or depression and for those demonstrating signs of psychological illness.
List some of the physiological challenges for patients who have CHD
Frightening, life-threatening event
Medication side effects
Fears for family and partner being left alone
Threat to employment and financial status
Being treated differently by other people
Neurological impairment
Making lifestyle changes
Why are distressed CHD patients a problem?
Distressed CHD patients have:
Significantly higher rates of hospitalisation
Significantly higher rates of cardiac events
Therefore most cost to the health service
List some contraindications to exercise following a cardiac event
Fever and acute systemic illness Unresolved unstable angina Resting BP: Systolic > 200 mmHg, Diastolic > 110 mmHg Critical aortic stenosis Uncontrolled arrhythmias Acute pericarditis or myocarditis Acute or unstable heart failure Breathlessness or palpitations Dizziness or lethargy Uncontrolled diabetes Recently altered ECG response especially ST segment depression Severe pulmonary, orthopaedic, or metabolic condition that would hinder exercise capacity
Education should be culturally sensitive and achieve two main aims…
To increase knowledge and understanding of risk factor reduction
To utilise evidence-based health behaviour change theory in its delivery. Incorporation of both aspects of education increases the probability of successful long- term maintenance of change
