Week 6: Cardiovascular Conditions Flashcards
What does the cardiovascular system consist of?
Heart, blood vessels and blood
What are the three main functions of the heart?
Transport, Protection, Regulation
Define myocardium
Muscle of the heart
Define ishaemia
Insufficent blood supply
Define infarction
Cell death due to ischaemia
Define atheroma
Fatty, calcified deposits
Define arteriosclerosis
Hardening of the arteries
Define atherosclerosis
Scaring and fatty, calcified deposits reduced blood flow and hardened arteries
What can ischaemia cause?
Angina
What is damage to the heart considered as ?
Myocardial Infarction
What is a STEMI?
An MI that shows elevation of the S-T segment on a heart trace
Define congestive heart disease
Due to disease the heart doesn’t pump properly, leads to mal-distribution of bodily fluids
Define cardiac arrest
Heart stopped
What are some non cardiac causes of chest pain
- musculoskeletal
- oesophageal reflux
- PE
- pneumothorax
- hiatus hernia
- referred pain
- pleurisy and other infections
- hyperventilation syndrome
What are common causes of left side chest pain that are linked to the heart and vascular issues?
- heart attacks
- coronary artery disease
- coronary artery dissection
- pericarditis
- hypertrophic cardiomyopathy
- aortic dissection
- aortic aneurysm
- mitral valve prolapse
What are the 4 types of atherosclerosis?
- atherosclerosis
- sclerosis
- atheroma
- ischeamia
What are the predisposing factors of atherosclerosis?
- increasing age
- gender
- hypertension
- diabetes mellitus
- obesity
- excessive alcohol
- stress
- smoking
- diet
What are acute coronary syndromes?
Sudden ischaemia disorders of the heart, represents a continuum of a similar disease process
What does active coronary syndromes include?
- unstable angina
- INSTEMI
- STEMI
What does unstable angina, STEMI and INSTEMI, all have?
A sudden ischamia, cannot be differentiated in the first hours as all have the same initiating events
What are the initiating events of unstable angina, INSTEMI and STEMI?
- plaque rupture
- thrombus formation
- vasoconstriction
Define ischaemi
A lack of oxygen with ST depression or T inversion
Define infarction
Death of tissue which may or may not show in the Q wave
Define injury
Prolonged ischaemia with ST elevation
What is angina pectoris
Insufficent blood flow to the heart muscle from narrowing of coronary artery may cause angina = ischaemia chest pain due to a build up of waste products (lactic acid and CO2) causing cramp
What is angina pectoris (chest pain) the most common symptom of?
Coronary artery disease
What are the three types of angina?
- stable angina
- unstable angina
- variant angina
What is stable angina?
Angina that occurs in a regular pattern that is provoked by exertion or emotional stress
What is the maximum duration of stable angina?
15 minutes
What causes stable angina?
A stable lesion in one of the coronary arteries
What is unstable angina?
A significant acute coronary syndrome that indicated an obstruction that is less stable and that a thrombus may e beginning to form
What may unstable angina proceed to?
Myocardial infarction
What are the symptoms of angina?
- pain behind the sternum, spreading across the chest
- pale and sweaty
- pain in neck, throat, jaw, armpit, down arms
- heaviness on chest or arms
- indigestion
What is the basic structure for management of cardiovascular conditions?
- full history
- obs
- cardio assessment
- O2 if required
- pain relief
- 12 lead ECG
- appropriate medicines
- IV access
- rapid transport
- JRCALC
What medication would you supply for angina?
- GTN (systole above 90mmHg) every 5-10 mins
- Morphine or IV paracetamol or entonox
- oxygen
- aspirin 300mg
What is a myocardial infarction?
“heart attack”, the process of causing death or damage to an area of the myocardium as a result coronary artery occlusion, generally due to a thrombus
What is a STEMI?
When in an MI the full thickness of the myocardium is involved and ST elevation will occur
What is a INSTEMI?
When in an MI only a partial thickness of the myocardium us involved, ST elevation will not generally occur
What is the cause of a MI?
The coronary artery becomes completely blocked either by a thrombus or coronary artery spasm, with increasing ischaemia leading to infarction (tissue can no longer conduct electricity or pump)
What are symptoms of a silent MI?
- pulmonary oedema
- confusion
- hypotension
- dyspnoea
- palpitations
- syncope or pre-syncope
- general weakness
- diabetic keto- acidosis
What are the symptoms of an atypical MI?
- musculoskeletal, positional or pleuritic features
- often unilateral
- may be described as sharp or stabbing
- included epigastric discomfort
Who is more likely to experience a atypical MI?
Females, diabetics, elderly
What are the main symptoms for an MI?
- severe central chest pain which can radiate to other body parts
- crushing/heavy pain across chest
- cool, grey, clammy to touch
- coughing, wheezing, SoB
- sense of impending doom
- Levines sign
- nausea/vomiting
What is the medication for an MI?
- aspirin 300mg
- GTN 400mcg (systolic above 90mmHg) 5-10 mins
- morphine, IV paracetamol or entonox
- oxygen
What is heart failure?
A condition resulting from the heart becoming an incompetent pump
Why may a heart have an incompetent pump?
- MI
- myocardial disease
- chronic hypertension
- cardiac valvular disease
- cardiomyopathy
What is congestive heart failure?
The inability of the heart to supply adequate blood flow and oxygen to peripheral tissues and organs
When does CHF occur?
When cardiac output decreases or/and the fluid backs up behind the failing ventricle
What are the two components of CHF?
- primary problem
- compensatory mechanisms
What are the primary causes of CHF?
Heart muscle damage, valve disease, abnormal rhythm
What does heart failure result in?
- heart ineffectively pumps blood through the circulatory system
- excessive fluid accumulation in tissues and peripheries
What occurs in heart failure LVF:
LV cannot pump out enough blood, pressure builds behind the left side of the heart, vessels are engorged with blood. serum is forced into alveolar spaces, fluid collects in lungs
What is the cause of heart failure RHF?
- primary disease of the right heart?
- secondary to left heart failure
- blood backs up behind RV, RA and systemic veins
- cor pulmonale
What are symptoms of LVF?
- dyspnoea
- tachypnoea
- tachycardia
- possible cyanosis
- foamy blood-tinged sputum
- noisy laboured breathing
- rated or wheezes
What are heart failure symptoms RHF?
- listened neck veins
- tachycardia
- systemic oedema
- swollen abdomen
- liver discomfort
- fatigue
- weight gain
What is shock?
Defined as inadequate tissue perfusion due to a real or apparent lack or lowering of circulatory bodily fluids
What is the progression of shock?
- compensated shock
- decompensated shock
- irreversible shock
What are the causes of shock?
- pump failure
- no nervous control
- fluid loss
- no sympathetic tone
- leaky blood vessels
What are the 4 types of shock?
- hypovolaemic
- obstructive
- disruptive
- cardiogenic
Define hypovolaemic
No enough blood in vessels to distribute O2
Define obstructive
Blood physically cannot reach target area
Define disruptive
Tone of vessels affected and become floppy or leaky
Dfine cardiogenic
SV X BPM = CO
What is the physiological response to shock?
Release of chemical and vascular reaction:
- local vasoconstriction
- formation of a platelet plug
- coagulation
- growth of fibrous tissue into the blood clot that permanently closes and seals the vessel
How would you calculate cardiac output?
Stroke vol x beats per min = cardiac output
What is an aortic aneurysm?
The weakening of the artery wall
What are some signs of an aortic aneurysm?
- stomach/back pain
- pulsating in the stomach
- taring chest pain
- cold/clammy/sweating/faint
- unequal BP in arms
- loss of consciousness
- features of dissection
Why are some causes/risks of aneurysms?
- male and above 65
- smoke
- high blood pressure
- high cholesterol
- close relative who’s had aneurysm
- atherosclerosis
- COPD
- marfan syndrome
What is pericarditis?
The inflammation of the lining around your heart causing chest pain
What are the symptoms of pericarditis?
- sharp/stabbing chest pain
- rub on auscultation
- global elevation on ECG with PR segment depression
- increased pain with coughing, inspiration, swallowing
- worse when lying supine
- relived by sitting forward
- long duration
What are common causes of pericarditis?
- trauma
- uraemia
- myocardial infarction
- other infections
- rheumatoid, autoimmune etc
What is the most common cause of pericarditis?
A viral infection such as the cold or flu
