L3 Cardiac Conditions PDF May 2022

Cardiovascular Conditions – Description and Management Component 2 + 5 © Department of Clinical Education & Standards  Cardiac Conditions - Part Component 2+5 Objective Describe the main conditions, signs,...

Cardiovascular Conditions – Description and Management Component 2 + 5 © Department of Clinical Education & Standards  Cardiac Conditions - Part Component 2+5 Objective Describe the main conditions, signs, symptoms and management of disorders of the Cardiovascular System ©Department of Clinical Education & Standards  Cardiac Conditions - Part Component 2+5 Covering Coronary Artery Disease Acute Coronary Syndromes Stable Angina Heart Failure Sickle cell ©Department of Clinical Education & Standards  Circulatory Disorders - Part Component 2+5 Heading Calibri (Headings) Font 40 Bullet Points/Detail Calibri (Body) Font 28 4 © Department of Clinical Education & Standards Circulatory Disorders - Part Component 2+5 ©Department of Clinical Education & Standards  Circulatory Disorders - Part Component 2+5 Risk factors for Coronary Artery Disease Heredity – family history Obesity Gender – Males more susceptible than females, until menopause, then female risk increases Diet – High in refined carbohydrates and/or saturated fats and cholesterol Increasing age Smoking Diabetes Mellitus Excess emotional stress Hypertension Sedentary Lifestyle High Cholesterol (LDL/Bad Cholesterol) Excess Alcohol consumption (Red – Modifiable factors) ©Department of Clinical Education & Standards  Circulatory Disorders - Part Component 2+5 Atherosclerosis Cholesterol gets lodged in the tunica media and accumulates White blood cells surround this and form a fibrous cap Build up of this cap leads to atherosclerosis If this plaque ruptures it can lodge elsewhere in the body ©Department of Clinical Education & Standards Plaque  Circulatory Disorders - Part Component 2+5 Atherosclerosis – Coronary Arteries This leads to a narrowing or blockage of the coronary artery Narrowing (Reduced blood flow) = Ischaemia Complete Obstruction (No flow) = Infarction ©Department of Clinical Education & Standards  Stable Angina - Part Component 2+5 Angina Pectoris – (Stable Angina) Ischaemic chest pain due to a reduction of the blood supply to the myocardium Caused by narrowing of the cardiac arteries due to CAD No pain at rest Pain caused during exertion / stress ©Department of Clinical Education & Standards  Stable Angina - Part Component 2+5 Angina Pectoris Signs and Symptoms Classic chest discomfort- pain, tightness, indigestion Can radiate to back, epigastrium, arms, neck, jaw Sometimes belching can occur Provoked by emotional stress / exertion Relieved by rest and /or medication, (nitrates) ©Department of Clinical Education & Standards  Stable Angina - Part Component 2+5 Management DR ABCDE Place patient at rest Help to reduce the workload of the heart – patient to avoid walking, moving excessively Analgesia as required (Entonox) ECG ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 Heart Failure An abnormality of Cardiac structure or function The heart cannot deliver oxygen at the rate the body needs Can be acute or chronic ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 Can be right sided, left sided or both Leads to a reduction in cardiac output (the amount of blood pushed around the body per minute) Cardiac output is Stroke Volume x Heart Rate Stroke volume is dependent on pre-load, contractility, and afterload ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 Preload Volume of blood stretching the resting heart muscle at the end of diastole Contractility Forcefulness of the muscle contraction Afterload The pressure needed to eject blood from the left ventricle around the body ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 Signs and Symptoms will vary depending on the extent of heart failure However 3 symptoms are common in all types: – Fatigue (including exercise intolerance) – Dyspnoea – Congestion – Breathless whilst lying down ©Department of Clinical Education & Standards  Heart Failure - Part Component 2+5 Management DR ABCDE Place patient at rest Full set of observations Oxygen – if required to maintain sats >94% ECG ©Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 ACS ACS covers a range of conditions including: Unstable angina Non-ST-segment-elevation myocardial infarction (NSTEMI) ST-segment-elevation myocardial infarction (STEMI) 19 © Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 20 © Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 Unstable Angina / NSTEMI A branch of a coronary artery becomes blocked, causing reduced blood flow to the tissue (ischaemia) leading to infarction (tissue death). Permanent damage is caused as cardiac muscle cannot regenerate. Effects and complications are greatest when the left ventricle is involved. 21 © Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 Common Symptoms Chest pain: heavy, squeezing, crushing, tight Pain may radiate: , L or R arm, chest, jaw, neck, upper back Nausea & Vomiting Marked sweating 22 © Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 Common Symptoms Shortness of breath Pallor Feelings of impending doom Skin clammy and cold to touch NB These may not always be present 23 © Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 Atypical presentations of ACS are not uncommon! Up to a third of patients having an MI will have atypical presentations such as shortness of breath or collapse , without chest pain. Often observed in: Younger (25-40yrs) Older (>75yrs) Unwell diabetics Unwell female patients. 24 © Department of Clinical Education & Standards  Acute Coronary Syndrome - Part Component 2+5 Management 12 lead ECG as soon as possible Correction of major ABC problems Administration of medications as per local practice guidelines (AAP’s can administer oxygen & Entonox only) Oxygen if sats under 94% on air Rapid transport to the appropriate hospital Reassurance 25 © Department of Clinical Education & Standards  Sickle Cell Sickle cell is a hereditary condition affecting the haemoglobin contained within red blood cells. When the haemoglobin is deoxygenated under certain conditions it becomes misshapen – ‘sickle’ shaped This prevents the cells moving through smaller blood vessels and they can become blocked leading to ischemia ©Department of Clinical Education & Standards  Sickle Cell The lifespan of the cells is reduced by early haemolysis leading to anaemia Normal RBC – Breakdown after 120 Days Sickle Cell – Breakdown after 19 Days 28 © Department of Clinical Education & Standards  Sickle Cell Sickle Cell Trait vs Disease The disease is hereditary Children receive one gene from each parent The combination of these genes determines whether the patient has sickle cell trait or sickle cell disease ©Department of Clinical Education & Standards  Sickle Cell Early breakdown of RBCs leads to an Sickle Cell Anaemia insufficient amount of haemoglobin available to carry oxygen to cells Only one sickle cell gene is present and Sickle Cell Trait does not normally cause the patient a problem The presence of both sickle cell genes Sickle Cell Disease leading to a hereditary disorder that causes sickle shaped RBC’s and early haemolysis When sickle shaped RBCs clump Sickle Cell Crisis together to occlude microvasculature causing ischemia and pain ©Department of Clinical Education & Standards  Sickle Cell Sickle Clumping of Sickle cells Cell Crisis leading to crisis ©Department of Clinical Education & Standards  Sickle Cell Signs and Symptoms of Sickle Cell Crisis Severe Pain Especially at the Joints Difficulty in Breathing May show signs of jaundice May Be Pyrexic May Be Aggressive/frustrated due to Pain Dehydrated- excessive thirst; frequent urination Hypotension Tachycardia Altered LOC ©Department of Clinical Education & Standards  Sickle Cell Assessment & Management of Sickle Cell Crisis Assessment – ABCD Ask if patient has an individualised treatment plan. If ‘Yes’ – follow it. If time critical - Correct A&Bs Go to nearest A&E. Consider need for Paramedic assistance. ©Department of Clinical Education & Standards  Sickle Cell Assessment & Management of Sickle Cell Crisis Oxygen Pain relief (Entonox) - assess mild/moderate/severe ECG Fluid Treatment plan Take to patient’s own specialist unit ©Department of Clinical Education & Standards  Cardiac Conditions - Part Component 2+5 Any Questions? 35 © Department of Clinical Education & Standards