Medical Overview of CVD Flashcards
Coronary artery disease clinical presentation
Chest pain: classically ischaemic chest pain- pressure or heaviness in central chest, nausea/ diaphoresis, radiation to jaw/ arm
ECG changes
Troponin Rise: marker of myocardial injury
Pt instability: may be hypotensive, bradycardiac, dangerous arrhythmias
Coronary artery supplies oxygen rich blood to muscles of the heart. If plaque forms, it attract platelets leading to a blood clot. This damages the ability of the heart to effectively pump blood.
Coronary artery disease risk factors
Smoking Hypertension Dyslipidaemia Diabetes Family Hx Prior IHD Obesity and metabolic syndrome
STEMI ST elevation myocardial infarction
Most serious form of acute coronary syndrome
Complete occlusion of a coronary artery
Has the worst short and long term prognosis
Associated with arrhythmia (early), mechanical Cx and heart failure in the long term (ischaemic cardiomyopathy)
Coronary Angiography
Our aim is door to balloon time less than 90 mins
In a country hospital the key isntheombolysis with a door to needle time less than 60mins.
If there is a multivessel disease- the patient will have stenting of the blocked artery with referral for coronary artery bypass surgery as an inpatient
Medical management of STEMI
Diet
Exercise
Cardiac rehab- education, weight management, smoking cessation
SAAB- statin, ACE-I, two antiplatelet agents, beta blocker, long term treatment
Manage risk factors
Long term cardiology follow up
Statin therapy
Block are in liver responsible for producing cholesterol
How long can you go- max tolerated dose
All ACS patients started on a high intensity astrovastatin 40/80 or Crestor 20/40 in the first 24-48 hours of event
Good data to show this improves mortality regardless of what LDL level is
Is an adjunct to non- pharmacological treatment
STEMI mimics
Variant angina (prinzmetal angina) - have chest pain that is often confused with myocardial infarction
Coronary artery vasospasm
Not related to atherosclerosis but can be related to cold weather, smoking and cocaine use
Seen on angiography with improvement in artery diameter with GTN. Appears to look like ischaemia or infarction on ECG.
Treated with GTN (glyceryl trinitrate, sprayed under tongue widens blood vessels in heart and body) and CCBS (calcium channel blockers )
SCAD - spontaneous coronary artery dissection
In young, fit females
Not well understood but may relate to hormonal effects weakening arterial wall component.
Not related to atherosclerosis but we treat it similarly with use of statins in patients with dyslipidaemia
Takotsubos cardiomyopathy
Form of stress related cardiomyopathy classically following strong emotion
More common in middle aged females
Referred to in the media as “broken heart syndrome”
No atherosclerotic disease seen on angiography
Thought to relate to sympathetic overdrive and potentially small vessel construction
Treated with ACEI and BB but not statins
Heart failure with reduced ejection fraction
Reduced ejection fraction
EF- <40%
Heart is unable to eject enough blood out with each contraction
Traditional form of heart failure
Many causes- myocardial infarction, valvular disease, infective, alcohol/ drugs, stress, infiltration, genetic
Good medical management available
Symptoms are dyspnoea, oedema, light headedness and chest pain
Management of heart failure
Graded exercise Diet- salt restriction, fluid restriction, weight loss, smoking and drug/ alcohol cessation Pharmacological- improve mortality ACE-I, BB, spironolactone Diuretics Devices
Heart failure with preserved ejection failure
EF >50%
The heart can’t relax to actually fill with enough blood
A different beast
Generally old pts, more likely to be female, more likely to have metabolic diseases, more comorbidities, OSA, AF
Heterogenous population
Not very good at treating these patients
Management of risk factors, contributing conditions such as arrhythmias, sleep, apnoea. Medications don’t have proven mortality benefit. For both types- education and lifestyle modifications are key
Eg. Alcohol and drug related cariomyopathies can improve significantly with cessation
Tachy arrhythmia
Heart rate >100
Chaotic activity in atria
Atrial fibrillation
Patient presents with palpitations, dyspnoea, chest pain, dizziness
Associated with ischaemia, metabolic conditions (thyroid), excess alcohol, heart failure, electrolyte problems and infection
Main risk with AF is stroke
Management- slowing down heart rate or reverting PT to normal rhythm, thinning the blood
Reducing alcohol intake, weight loss, treating sleep apnoea are all important in reducing recurrent AF
Ventricular tachycardia/ fibrillation
Medical emergency Often related to myocardial infarction Electrical reversion is lifesaving Can be genetic or related to scar ICD in case it happens again (implantable cardioverter defibrillator), pulse generator
Heart block Brady- arrhythmia
Main concerning symptom is loss of consciousness without warning. Other symptoms can be presyncope, palpitations, breathlessness or reduced exercise tolerance
Pacemaker can be inserted to prevent people losing consciousness or dying - battery needs to be charged every 10 years approx
Ventricular assist device
LVAD connected to heart. A cable connects the external control unit and internal LVAD through small hole in the abdomen
