cardio pt 3

EKG and Heart Attacks

  • Purpose of EKG
      - Used to classify heart attack types based on changes in the EKG.

Symptoms of Heart Attack

  • Common Misconceptions
      - Symptoms not limited to classic signs such as chest clutching.
      - Symptoms may include:
        - Heaviness
        - Pressure
        - Dullness
        - Aching
        - Radiation of pain to arms, shoulders, or neck
        - Sweating
        - Dyspnea (shortness of breath)

  • Distinguishing Angina from Myocardial Infarction (MI)
      - Symptoms overlap significantly between angina and MI.
      - Key difference:
        - Symptoms of MI persist because heart cells are damaged and dead.
        - Unstable angina can also lead to continued symptoms.

  • Personal Anecdote
      - The instructor’s mother had a heart attack with atypical symptoms:
        - No chest pain, only abdominal pain, nausea, and a sense of impending doom.

  • Gender Differences in Symptoms
      - Women often present with more unusual symptoms during a heart attack.
      - Symptoms such as impending doom can be misdiagnosed as anxiety or gastrointestinal issues.

Importance of Risk Factors

  • Recognizing risk factors is crucial for assessment:
      - Risk factors for heart attack include:
        - Diabetes
        - Hypertension
        - Obesity
        - Sedentary lifestyle
        - Older age
        - Post-menopausal status in women

  • Example from the instructor’s mother highlights these risk factors in practice.

Diagnosis and Testing

  • Troponins and CKMB
      - Troponin and CKMB levels are checked when heart attack is suspected.
      - Troponin lab tests may take time to show elevated levels due to time it takes for the heart cells to die and release these enzymes into the bloodstream.
      - EKG changes are permanent indicators of MI type.

  • Lab Work
      - Process for a patient presenting with chest pain includes:
        - Conducting chest pain workup.
      - If a patient presents without chest pain but has risk factors, important to test for potential MI (e.g., if having abdominal pain).

Treatment Options

  • Immediate treatment is essential during a heart attack, options include:
      - Medications
        - Blood thinners to address clotting.
      - Intervention
        - Percutaneous Coronary Intervention (PCI)
          - A catheter is used to locate and open blockages in the heart.
          - Preferred over CABG for non-complex cases, leads to quicker recovery.
        - Coronary Artery Bypass Graft (CABG)
          - Performed if multiple blockages are present and too complex for PCI.
          - Longer recovery due to need for surgical incision in the chest.

Valvular Heart Diseases

  • Regurgitation: Failure of a valve to close, causing backward blood flow.

  • Types of Valvular Diseases
      - Stenosis: Narrowing of a valve preventing it from opening properly.

  • Murmurs: Abnormal flow of blood due to valvular issues can be auscultated using a stethoscope.
      - Aortic Stenosis and Regurgitation are notable types.

Aortic Stenosis

  • Occurs when the aortic valve narrows and does not open adequately.
      - Causes increased strain on the left ventricle, leading to hypertrophy.
      - Patients often do not show symptoms until the condition worsens.

Aortic Regurgitation

  • Occurs when the aortic valve fails to close during diastole, causing backflow into the left ventricle.
      - Leads to increased workload on the left ventricle and potential heart failure symptoms.
      - Unique symptom is a wide pulse pressure.

Heart Sounds

  • Systolic Murmurs: Typically caused by aortic stenosis, characterized by a crescendo-decrescendo pattern.

  • Diastolic Murmurs: Associated with aortic regurgitation, characterized by a decrescendo pattern.

Heart Failure

  • Classification based on which side of the heart is affected:
      - Left-Sided Heart Failure
        - Left ventricle fails to pump effectively, leading to fluid accumulation in lungs, causing pulmonary symptoms.
        - Symptoms include: shortness of breath, cough (may be frothy).
      - Right-Sided Heart Failure
        - Often caused by left-sided failure.
        - Results in systemic fluid overload, causing edema and ascites.

Congestive Heart Failure (CHF)

  • Both left and right side failures lead to congestive symptoms due to fluid accumulation

Pericarditis and Cardiac Tamponade

  • Pericarditis: Inflammation of the pericardial sac leading to severe chest pain.

  • Cardiac Tamponade: Fluid accumulation in pericardial sac that compresses the heart, leading to failure. Symptoms include hypotension and faint heart sounds.

Pediatric Cardiology

  • Fetal Circulation: Unique circulatory adaptations before birth, involving structures like the foramen ovale and ductus arteriosus.

  • Congenital Heart Defects
      - Patent Ductus Arteriosus (PDA): Failure of ductus arteriosus to close after birth leading to compromised systemic circulation. Hallmark murmur described as machinery-like.
      - Tetralogy of Fallot: Comprises four defects including:
        - Ventricular septal defect (VSD)
        - Pulmonary stenosis
        - Overriding aorta
        - Right ventricular hypertrophy
      - Symptoms include cyanosis, especially during exertion (e.g., crying).

Coarctation of the Aorta

  • Characterized by a narrowing in the aorta, leading to differing blood pressures in upper and lower parts of the body, typically lower in the legs than in the arms.