Cardiovascular Conditions

Question 1

Name 7 indicators of cardiac involvement

Answer 1

1. chest pain
2. dyspnoea
3. nausea
4. dizziness
5. TLoC
6. palpitations
7. Oedema

Question 2

ACS is compiled of which 3 conditions?

Answer 2

1. ST segment elevation MI (STEMI)
2. non ST segment elevation MI (NSTEMI)
3. unstable angina

Question 3

Acute Coronary Syndrome happens when…

Answer 3

There is a sudden reduction of blood flow to the heart

Question 4

What causes the reduction of blood flow?

Answer 4

Build up of arethoma (atherosclerosis) in vessel walls reduces flow. Due to reduced space, blood cells and platelets will accumulate and clot, this will create a thrombus which will reduce blood flow

Question 5

Which type of ACS wil show ST elevation on a 12 lead ECG?

Answer 5

STEMI

Question 6

Which type of ACS will show ischemia/ T wave changes and rasied troponin levels in a blood result?

Answer 6

NSTEMI

Question 7

What causes angina?

Answer 7

Atherosclerosis

Question 8

Describe the difference between ischaemia and infarction

Answer 8

Ischaemia - redcution of blood supply causing O2 shortage
Infarction - Tissue death caused by complete lack of blood

Infarction is due to blockage causing reduced blood supply causing lack

Question 9

Descibe some risk factors of ACS

Answer 9

• smoking
• obesity
• hypertension
• diabetes
• age
• male
• hyperlipidaemia
• diet
• genetics

Question 10

Why is time so important with STEMI diagnosis?

Answer 10

1/2 of salvageable myocardium is lost within 1 hour of blockage

Question 11

What is the pre-hospital treatment for ACS?

Answer 11

• Analgesia - IV access , Morphine mg, administered slowly, Paracetemol, 1000mg
• Oxygen only if needed(<94%/88% in COPD)
• Aspirin - anti-platelet, 300mg tablte chewed, adminsiter even if pt takes daily
  *Anti-emetics - range of options, check whats available in local trusts (oadansetron, cyclizine, metoclopropramide)
• Nitrates - GTN spray (sublingual), 400-800mcg, repeat 5-10mins

Also continuous monitoring, repeat ECG’s

Question 12

What is Pathway 1?

Answer 12

• ST segment elevation/depression with or without pain
• New LBBB
• Left coronary main stem (depression

Question 13

What is Pathway 2?

Answer 13

• No ST segment elevation but has ST segment or T wave changes and chest pain and/or history of AMI

Question 14

Where do you transport these pt’s with STEM criteria?

Answer 14

To the coronary care unit, where they will receive a primary percutaneous coronary intervention(PPCI) treats narrowed arteries

Question 15

What is Heart Failure?

Answer 15

A clinical syndrome of the heart where the heart is failing due to structural/functional abnormalities that raise intracardiac pressure or fail to meet adequate cardaic ouput. Most commonly caused by Coronary artery diease.

Question 16

Name and describe the differrences between the 3 types of heart failure

Answer 16

1. Chronic; long term diagnosis, high prevalence, community treatments
2. Acute following chronic; sudden worsening sysmptoms, decompensated
3. Acute HF; first presentation, Think ACS!

Question 17

What are the causes and signs/symptoms of LVF?

Answer 17

• HTN
• CAD
• Valvular disease
  1. SOB on exertion
  2. signs of pulmonary oedema (fluid on lung,) bi-basal creps)

Question 18

What are the causes and signs/symptoms of RVF?

Answer 18

• LVF
• Pulmonary HTN (COPD)
• Right MI
  1. Peripheral oedema (swelling in peripheral tissues)
  2. Ascites (fluid in abdomen)
  3. JVD (jugular vein distention)

Question 19

Name clinical indicators for HF

Answer 19

1. Dyspnoea
2. Worseing cough
3. Hypoxia/cyanosis
4. Orthopnea (SoB, relieved by sitting)
5. Pulmonary oedema
6. Raised JVP
7. Pink frothy sputum
8. Swelling in legs/ankles
9. Pleural effusion

Question 20

Describe some risk factors associated with HF

Answer 20

1. Smoking
2. Obesity
3. HTN
4. CAD
5. Arrythmias
6. Drugs
7. COPD
8. Cardiomyopathies
9. Congenital heart disease
10. Genetics
11. Valvular disease (aortic stenosis)
12. Pericaridal dieases (constructive pericardities)

Question 21

A embolus can be made up of what?

Answer 21

• fat
• air
• tumour
• foreign object
• blood

Question 22

Describe the pathophysiology of a DVT

Answer 22

Damaged valves allow blood to flow in both directions, which leads to accumulation. The blood moves slowly, allowing a thrombus to from. Parts of this can break of and travel in the bloodstream

Question 23

What are these symptoms of?
* pain/ tenderness
* reddening/discolouration
* swelling (typically unilateral)
* leg tiredness
* discomfort on flexion of foot

Answer 23

DVT

Question 24

The Well’s scoring system is used for what?

Answer 24

DVT/PE

Question 25

When is a DVT patient referred toa suitable sevice within 4 hours?

Answer 25

When they are high risk

Question 26

Describe how pulmonary embolisms occur

Answer 26

When a blood clot breaks free and begins travelling through the body, it can get lodged in a vessel in the lung, partial occlusion/complete will deprive the lung tissue of blood and becomes ischaemic

Question 27

Symptoms of... * dyspnoea * pleuritic chest pain, localised, worsens on inhalation) * substernal chest pain * apprehension * cough * haemoptysis (coughing blood) * syncope

Answer 27

PE

Question 28

Signs of... * resp rate 20 pm * pulse rate >100 bpm * SpO2 <92% * signs of DVT * low grade fever

Answer 28

PE

Question 29

What is the difference between ACS and MI?

Answer 29

Decreased blood flow to an area of the myocardium, usually a blockage in the coronary arteries leading to tissue death in the affected portion. ACS is the build up of atherosclerosis