PVD, IHD and acute coronary syndrome Flashcards
what is pvd?
peripheral vascular disease- atherosclerosis affecting peripheral vessels. E.g limbs/aorta (abdomen)
what are the symptoms of chronic ischemia in limbs?
- intermittent claudication in calves when walking
-skin/nail changes
how would you assess the severity of chronic ischemia of lower limbs?
ask how far they can walk before pain begins i.e short distance and pain= greater severity of disease
what causes acute ischemia of limbs?
embolus/plaque rupture = emergency
what are the symptoms of acute ischemia of limbs?
-pale
-pulseless
-cold
-constant severe pain
-paralysed
how is pvd of lower limbs managed?
-risk factor modification
-exercise
-surgery (stent, bypass graft, amputation)
what does atherosclerosis of the aorta cause?
abdominal aortic aneurysm due to swelling of the aorta
what does swelling of the aorta lead to?
swelling-weakens walls-risk of rupture-bleed out/death
who is most at risk of abdominal aortic aneurysm?
men over the age of 65- they must undergo screenings.
what are the symptoms of abdominal aortic anuerysm?
-often asymptomatic
-vague abdominal pain
if acute/rupture- severe pain- requires surgery and has a 50-90% mortality rate.
what is the top cause of mortality in the western world?
ischemic heart disease
does stable angina cause pain on exertion or rest?
exertion
is stable angina acute or chronic?
chronic
what investigation would be use to assess angina/ischemic heart disease?
Echocardiogram- dye placed in catheter outlines sclerosis (narrowing) of the arteries.
what causes stable angina?
narrowing of the coronary arteries by atherosclerosis
what are the symptoms of stable angina?
-chest pain on exertion
-breathlessness
-nausea
what relieves chronic angina symptoms?
rest and nitrates i.e GTN spray
how do you management stable angina?
-modification of risk factors
-management of underlying contributory conditions
-surgery- stents and bypass graft
-drugs including antiplatelet (clopidegrel and aspirin), statins to lower cholesterol, vasodilators such as gtn spray, calcium channel blockers and beta blockers.
what does unstable angina cause?
acute coronary syndrome in the form of myocardial ischemia or myocardial infarction
does unstable angina cause chest pain at rest?
yes
what should you NEVER give someone with acute coronary syndrome?
IM injection- this will cause excessive bleeding
what causes unstable angina?
plaque rupture- where a thrombus forms over the plaque which partially blocks the coronary arteries (myocardial ischemia) or completely occludes the coronary arteries (myocardial infarction).
do myocardial ischemia and myocardial infarction have the same symptoms?
yes
what are the symptoms of unstable angina?
-chest pain at rest or min exertion
-pain radiating down left arm
-severe pain
-clammy/dizzy
-fear of impending doom
-cardiac arrest (heart stops pumping-pt not breathing)
is unstable angina a medical emergency?
YES
how would you manage someone with unstable angina?
abcde assessment and 999
-999 and send someone for AED- stay with patient
-sit pt up/comfortable position
-abcde assessment
-high flow o2
-gtn spray
-aspirin
-if collapse start BLS
-handover notes
what is considered a high flow of oxygen?
15 litres/min
what is the correct gtn dose?
800mg- 2x400mg
2 sprays under the tongue
3 times- 5 mins apart
what is the correct dose of aspirin?
300mg
