Cardiac Emergencies Flashcards
(25 cards)
Define ANGINA
It is an imbalance between the O2 demand and 02 supply of the myocardium.
Due to lack of 02, anaerobic respiration occurs which causes accumulation of lactic acid and C02 in myocardium, these metabolites irritate nerve endings and produce pain.
What’s the difference between stable and unstable angina?
Stable angina- •usually brought on by stress • lasts about 1-5min • attacks are similar • usually always relieved
UNSTABLE angina- • 'pre infarction' angina • random in nature • can occur at rest or exertion • pain lasts longer • hard to relieve
What can exacerbate ones angina?
When one is cold or when the stomach is full
What is Prinzmetals angina?
It is spasm of the arteries that causes pain, not linked to arteriosclerosis. Common in younger women.
Define an acute myocardial infarction
It is when there is total or near occlusion of blood flow to the heart through the coronary arteries
Ischemia and necrosis of myocardium occurs distal to occlusion
What determines the size of an infarction?
- The metabolic needs of the tissue being occluded
- Time until flow is re established
- Collateral damage
What is Clopidogrel or Plavix?
An oral anti-platelet agent
What occurs as a result of congestive cardiac failure?
LVF causes no forward pump, causing back flow into pulmonary circulation. Untreated LVF causes APO
RVF causes fluid accumulation in abdominal organs and peripheral oedema.
What is arteriosclerosis?
A general term for several diseases with cause the arterial wall to become thickened and loose its elasticity.
What is cardiogenic shock?
The most extreme form of pump failure, heart can not pump and meet metabolic demands. Result of infarction
What is Pericardial Effusion?
When blood or fluid leaks into the pericardial space, can lead to cardiac tamponade.
What are some s&s of pericardial effusion?
- Chest pain
- Dyspnoea
- Hypotension
- Distant heart sounds
What is the radiographic sign of pericardial effusion?
‘Water bottle heart’.
What is ‘Ewarts sign’?
Dullness on percussion due to fluid around the heart
What is Cardiac Tamponade?
When ventricular filling is mechanically limited due to the pressure around the heart.
Stroke volume is decreased as diastolic filling is impaired.
What is pericarditis?
Inflammation of the pericardium
What are some symptoms experienced with Pericarditis?
Chest pain described as sharp or stabbing (due to heart rubbing against the pericardium).
Pain increases when laying, deep breathing, coughing or swallowing.
What is aortic dissection?
Is when the intimal layer (one of 3 layers) of the aortic wall tears due to the blood entering under night pressure. Causes 2 pathways of blood heading up the aorta.
What is an Aortic Aneurysm?
It is the dilation of all 3 layers of the aorta.
Pain occurs when it ruptures or when actively bleeding- most are found accidentally.
What are the contraindications of Heparin?
Known allergy, hypersensitivy Oral anti-coags Bleeding disorders Actively bleeding Severe hepatic impairment Hx of heparin-induced thrombocytopenia (hit) Recent trauma or surgery
What is the dose of Heparin?
4000iU
Then 1000Iu for every hour following
What are the exclusions for tenecteplase?
Surgery Head trauma Ich, stroke or TIA Trauma (Major and last 3 months) GI bleed Anti coags or glycoproteins Bleeding disorders or active bleeding Allergy to tenecteplase or gentomycin
What are the cautions for tenecteplase?
Pericarditis Endocarditis (bacterial) Age >75 you halve it CPR prolonged for 10min Heart rate >120 Pregnancy or post partum 1 week Peptic ulcers Underweight Blood pressure >160sys or 110dial Liver disease Anaemia Vascular puncture (from recent central line or biopsy) non compressible
What are the inclusions criteria for Tenecteplase?
- SYMPTOMS FOR LESS THAN 12 hours AND
-monitor identified STEMI or 12 lead showing ST elevation in 2 or more contiguous leads
• >2.5mm for men under 40 in leads V2&3
• >2mm for men over 40 in leads V2&3
• >1.5mm for women in V2&3
• >1mm in all other leads
• New onset LBBB
