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Acute > W5 MC > Flashcards

W5 MC Flashcards

1
Q

Common patients admitted to ICU? Provide one exampe

A

Orthopaedic (eg MVA)
Neurological (eg Stroke/TBI)
Cardiac (eg CABG, MCI, heart failure)
Respiratory (COPD, bronchiectasis, CF)

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2
Q

The pumping action of the heart occurs via…

A

A very rapid process which requires synchronised movement of different structures of the heart (ie valves close, electrical conductivity)

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3
Q

Role of the heart

A

Pumping blood (oxygenated) throughout the body

Also…delivers waste products eg C02 back to the lungs to be removed

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4
Q

Electrical conductivity is governed by….

A

SA (sinus atrial) node and purkinje fibres (fire 60-100 times per minute ie number of times the heart beats)

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5
Q

The electrical conductivity of the heart ensures what in the heart contracts first? What does this allow?

A

The electrical conductivity of the heart ensures that the atria contract first, allowing blood flow into the ventricles, via the opening and closing of valves.

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6
Q

What are the two heart valves?

A

Tricuspid & bicuspid

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7
Q

The opening and closing of the valves is well timed to prevent….

A

Prevents early leaking of blood into the ventricles and prevent back flow of blood back into the atria.

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8
Q

What is the myocardium? What is it comprised of? Where is it thicker?

A

Muscular layer of the heart wall. Comprised of cardiac muscle and is much thicker in the ventricles

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9
Q

Contraction of what pushes blood throughout the body?

A

The myocardium

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10
Q

What is the heart also covered by?

A

A fluid-filled sac (pericardial sac)

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11
Q

Pericardial fluid is found between….

A

The two thin layers of pericardium

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12
Q

What is the two layers of the pericardium?

A

Inner layer that covers the heart (visceral pericardium/epicardium)

Another layer which attaches the heart to the chest wall (parietal pericardium)

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13
Q

What happens at the right atrium?

A

Receives deoxygenated blood from the body via SVC, IVC and coronary sinus

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14
Q

What happens at the right ventricle?

A

Receives deoxygenated blood from the right atrium via right atrioventricular orifice and sends it to lungs via pulmonary trunk

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15
Q

What happens at the left atrium?

A

Receives oxygenated blood from the lungs via pulmonary veins

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16
Q

What happens at the left ventricle?

A

Receives oxygenated blood from left atrium via left atrioventricular orifice and sends it to body via aorta

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17
Q

What are 5 ways of measuring cardiac function?

A

Heart rate
Stroke volume
Cardiac output
Mean arterial pressure
Systemic vascular resistance

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18
Q

What is normal Mean Arterial Pressure?

A

80-100mmHGg

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19
Q

What is normal cardiac output?

A

5-6L

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20
Q

What is normal stroke volume?

A

50-100mls

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21
Q

Heart rate what is it determined by?

A

Determined by signals from the sinoatrial node, which automatically depolarizes at an intrinsic rate of 60 to 100 times each minute.

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22
Q

What is stroke volume?

A

The volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction.

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23
Q

What is cardiac output?

A

The amount of blood pumped by the heart each minute and is the mechanism whereby blood flows around the body, blood flow to the brain and other vital organs

24
Q

What is mean arterial pressure? What is it influenced by?

A

The average arterial pressure throughout one cardiac cycle (systole, and diastole).

MAP is influenced by cardiac output and systemic vascular resistance.

25
Q

What is systemic vascular resistance?

A

Relates to diameter of blood vessels (small diameter = ↑ resistance) and viscosity of blood (increased viscosity (hematocrit) = ↑ resistance)

26
Q

What is myocarditis?

A

Acute cardiac presentation

Myocardium (heart muscle) becomes inflamed (can be focal or diffuse inflammation)

Commonly caused by viral infections but also can be due to autoimmune response

27
Q

What is pericarditis? How does it present?

A

Acute cardiac presentation

The pericardium (lining of the heart) becomes inflamed

Presents as chest pain due to rubbing of inflamed lining

28
Q

What is ischaemic heart disease also known as?

A

Coronary artery disease (CAD) or coronary heart disease (CHD).

29
Q

What is ischaemic heart disease/CAD/CHD?

A
  • Inadequate blood supply to the heart due to a blockage in the blood vessels which supply it.
  • Narrowing can be cause by a clot/embolism, however, is most frequently caused by atherosclerosis.
30
Q

Ischaemic heart disease: what is atherosclerosis?

A
  • Atherosclerosis is the build-up of plaque inside the blood vessels
31
Q

Ischaemic heart disease includes…

A
  • Includes Acute Myocardial Infarctions (AMI) (STEMI & NSTEMI) and angina (unstable & stable).
32
Q

CHD is the ….. cause of death in Australia (for both indigenous & non-Indigenous)

How many Australians does it impact?

A

Leading cause of death

Impacts 600,000 Australians

33
Q

CHD is implicated in how many deaths?

A

1 in 5

34
Q

ABTSI are …. more likely to experience a coronary event?

A
  • ABTSI people are 3x more likely to experience a major coronary event & with higher case fatality.
35
Q

Top 5 causes of death Male vs Female

A

Male
1. CHD
2. Dementia
3. Lung cancer
4. Cerebrovascular disease
5. COPD

Female
1. Dementia
2. CHD
3. Cerebrovascular
4. Lung cancer
5. COPD

36
Q

What is angina pectoris?

A
  • Form of ischaemic heart disease
  • Discomfort experienced when the heart muscle is deprived of 02

Note: patients can have silent ischemia ie experience episodes without pain

37
Q

How is stable angina relieved?

A
  • Stable angina is relieved promptly with rest or by taking nitroglycerin

Note: unstable angina is not relieved with rest

38
Q

Where is discomfort present in angina pectoris & what can aggravate it?

A
  • Discomfort above the waist & may be experienced in the chest, jaw, shoulder, back, or arms (can replicate heart attack symptoms)
  • Typically aggravated by exertion or emotional stress
39
Q

Acute myocardial infarction is a form of…. also known as?

A

Ischaemic heart disease
A heart attack

40
Q

What happens in an acute myocardial infarction?

A
  • Caused by decreased or complete cessation of blood flow to a portion of the myocardium (heart muscle)
41
Q

Symptoms of AMI?

A
  • Chest pain- retrosternal and may be described as pressure of heaviness. Usually > 20 mins, not affected by positional changes or movement
  • Referred pain down arm, mandibular pain or epigastric discomfort.
  • Can present as dyspnea or fatigue and be accompanied by sweating, nausea, abdominal pain and syncope (also reflux, epigastric pain?)
  • Presentations are considered a medical emergency.
  • Can vary in presentation- can be mild and present as palpitations or be quite dramatic and cause cardiac arrest.
42
Q

What symptom do women commonly experience in an AMI that men do not?

A
  • Nausea, feeling light-headed or unusually tired
43
Q

How can infarcts be classsified?

A

Can be classified according to:
* Anatomical location of the left ventricle involved: eg: anterior, posterior, circumferential
* Degree of thickness of the ventricular wall involved:
- Transmural (full thickness)
- Subendendocardial (only part of the myocardial wall)

44
Q

What does transmural mean in regards to an AMI?

A

Full thickness (in related to the degree of the ventricular wall present in AMI)

45
Q

What does subendendocardial mean in regards to an AMI?

A

Only part of the myocardial wall

46
Q

Criteria for acute, evolving or recent MI

A
  • Typical rise &/or fall of biochemical markers of myocardial necrosis (troponin) with at least one of the following:
  • Ischemic symptoms
  • ECG changes indicative of new ischemia (new ST elevation or new/presumed to be new LBBB)
  • Development of pathological Q waves in the ECG
  • Imaging of new loss of viable myocardium or new Reginal Wall Motion Abnormality
47
Q

Common ECG finding for cardiac patients?

A

ST segment can either elevate or depress in MCI patients. ECG will demonstrate that there is a complete loss of sinus rhythm during a myocardial infarction. There is still activity from the SA node which causes electrical impulses to be recorded but there is absolutely no structure to these.

48
Q

Complications of MI

A
  • Sudden death - Usually within hours; from ventricular tachycardia (VT)
  • Arrhythmias - First few days; due to changed blood flow and conduction
  • Persistent pain - 12 hours to a few days; from extension of infarct
  • Heart Failure - variable time frame; from ventricular dysfunction.
  • Cardiomyopathy.
  • Mitral valve incompetence – first few days; from papillary muscle dysfunction
  • Ventricular aneurysm - 4 weeks or more; stretching of new scar tissue
  • Pericarditis - 2 to 4 days
  • Transmural infarct with inflammation of the pericardium

DAP HMM VPT

49
Q

What causes sudden death after an AMI?

A

Ventricular tachycardia

50
Q

How is ischaemic heart disease diagnosed?

A

Cardia* Cardiac stress test (community outpatient – if someone is stable enough to do. Progressively increases in intensity eg incline). Monitoring blood pressure, ECG, etc
* Coronary angiogram to assess for any blockages in the main vessels

51
Q

What is percutaneous coronary intervention?

A
  • A group of minimally invasive procedures used to unclog blocked coronary arteries & restore blood flow to ischemic areas

More info:
* Is the treatment choice for acute presentations
* Performed at cardiological centres of excellence -? Accessibility
* Catheter inserted through femoral or radial arteries
* Very few contraindications
* Can be done even if cardiogenic shock up to 12–36 h after infarction
* Not ideal for multiple vessel disease or in patients with diabetes - CABG has better outcomes

52
Q

In a percutaneous coronary intervention where is the catheter inserted?

A

Femoral or radial arteries

53
Q

What are the two main types of percutaneous coronary interventions?

A

-Coronary angioplasty balloon: using a catheter a balloon is expanded in the artery which compresses the plaque to the wall (balloon is then removed?)

  • Coronary angioplasty with drug eluting or bare-metal stent: stent widened artery to maintain artery width and plaque compressed against wall (stays in?)
54
Q

What is the risk of recurrence (plaque) after coronary angioplasty balloon & angioplasty with stent?

A
  • 30% risk of recurrence after coronary angioplasty balloon
  • 15% restenosis rate for coronary angioplasty with stent (drops to 10% when stent is combined with medication)
55
Q

Common arteries requiring angiogram balloon/stent?

A

Circumflex artery
Anterior descending artery (left)

56
Q

Immediate hospital care for cardiac conditions?

A
  • Cardiac monitoring/Coronary Care Unit- 12 lead ECG
  • Oxygen (6-8L via facemask)- indicated for hypoxemia
  • Pain relief e.g. morphine
  • Nitrates- Sublingual glyceryl trinitrate (GTN)
  • Administer antiplatelet agents (clopidogrel or ticagrelor)
  • Venous access
  • Straight to the lab for angio+/- stent
  • Beta-blockers
  • Treatment of acute pulmonary oedema (if present)

Acute (14 decks)

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