This document provides an outline of cardiovascular conditions and diseases. It begins with an overview of common conditions like hypertension, heart failure, and ischemic heart diseases. It then discusses general signs and symptoms, classifications, effects on body functions, and management of cardiac failure. Risk factors, types, signs, investigations, emergencies, and complications of hypertension are also summarized. The document aims to concisely cover a wide range of topics relating to cardiovascular diseases.

1. CARDIOVASCULAR CONDITIONS/DISEASES
COURSE OUTLINE
1. Hypertension
2. Heart failure/Congestive cardiac failure
3. Ischaemic heart diseases
4. Pericarditis Deep venous thrombosis (DVT)
5. Myocarditis Rheumatic heart disease
6. Endocarditis Alcoholic heart disease
7. Cardiomyopathies
8. Congenital abnormalities Aortic aneurysm
9. Pulmonary oedema Nutritional H Disease
10. Pulmonary embolism

2. General Signs and Symptoms of CVS D/Os
1. Dyspnoea-Its awareness of breathlessness on
exertion which is frequently the first symptom of HF.
It is hard to distinguish from dyspnoea due to lung
d’se.
• Patients with HF take rapid shallow breath,
wheezes but excessive use of muscles of
respiration is uncommon.
2. Cough-Repeatitive unproductive cough in the
presence of pulmonary oedema is an important
symptom in left sided heart failure.
3. Wheezing-when it becomes prominent its called
cardiac asthma.

3. General Signs and Symptoms cont’d
4. Orthopnoea-its dyspnoea that occurs when a
patient is lying down flat and improves upon sitting
up or breathlessness which prevents a patient from
lying flat.
• Lying down rises the right atrial pressure and the
right ventricular out put forcing more blood into
lungs. Breathlessness is due to stiffness of the
congested lungs & partly due to direct stimulation
of the fine nerve endings around the alveoli.
• Orthopnoea suggest left ventricular failure or
mitral valve stenosis but may also accompany
COPD

4. S/S CONT’D
5. Paroxysmal nocturnal dyspnoea-episodes of
sudden dyspnoea and orthopnoea that wakes up a
patient from sleep, usually 1-2 hours after going to
sleep. The patient has to sit up for relieve & may be
associated with wheezing and cough.
• It suggests Left ventricular HF or mitral valve
stenosis & may mimic nocturnal asthmatic attacks
6. Chynestokes respiration(periodic breathing)
• Common in severe HF but can also occur in elderly
patients without any evidence of HF particularly
during sleep.

5. S/S CONT’D
7. Peripheral Oedema (pedal/ankle/tibial oedema)
• Accumulation of fluids in tissues/interstsial spaces
• Occurs in HF due to excessive salts & water
retention. Found mainly in the feet & ankles in
ambulant patients as this site is largely determined
by gravity. Pressure with a thumb if sustained will
displace the fluid leaving a pit hence it is referred
as bilateral, non tender pitting pedal oedema
• In severe HF fluid may accumulate in pleural and
abdominal cavity causing pleural effusion and
ascites respectively

6. S/S CONT’D
8. Chest pain-cardinal symptom of Ischaemic heart
diseases e.g Angina pectoris& myocardial infarction
The stabbing squeezing tight chest pain felt
momentarily at cardiac apex is referred to as
Precordial catch. It is often indicated by a finger
pointing below the left apex beat.
Chest pain can also signify lung or muscular system
problem
9. Pleural pain- feature/symptom of pulmonary
infarction which often complicates HF

7. S/S CONT’D
11. Hepatic Pain- Felt in the right epigastrium and
some times a sign of acute or worsening HF. It is due
to hepatic distension from rise in central venous
pressure. It can be due to straining of the liver capsule
Coz of blood accumulation in liver RHF.
12. Palpitations-awareness of heart beat as a result of
exercise or anxiety. Occurs due to increased
catecholamine secretion (adrenaline and
noradrenaline) and sympathomimetic drugs.
13. Others s/s include; Easy fatigability, Exercise
intolerance

8. Classification of Heart conditions
1. Disorders of heart rate and rhythm e.g
Tachycardia and Bradycardia
2. Ischaemic heart diseases e.g angina pectoris & MI
3. Valvlar heart diseases e.g Rheumatic heart
disease, Infective endocarditis (sub acute bacterial
endocarditis)
4. Vascular heart diseases e.g HTN, peripheral
arterial diz like arteritis, aortic lessions,
thromboembolism etc
5. Diseases of the myocardium e.g myocarditis,
cardiomyopathies (dilated/restrictive), EMF

9. Classification cont’d
6. Congenital heart defects e.g
• Patent ductus arteriosus (failure of ductus to close
at birth)= Ductus arteriosus shunt/communication
btn P.A & Aorta during foetal circulation/uterus
• Atrial septal defect=communication btn atria (R/L)
• Ventricular septal defect=communication btn
ventricles (R/L)
• Coarcitation of the aorta=narrowing of the aorta
usually just distal to the origin where D.A inserts.
7. Diseases of the blood vessels e.g atherosclerosis,
arteritis, phlebitis

10. Classification cont’d
8. Pericardial diseases e.g Pericarditis, Pericardial
effusion, constrictive pericarditis
9. Syphilitic heart diseases
10. Heart diseases secondary to lung disease e.g cor-
pulmonale
Cheynestoke respiration= Breathing commencing
with shallow & slow respn which decreases in rate &
depth & ceases for 10 seconds before commencing
(periodic breathing)

11. Effects of CVS Diz of body fxns
Diseases of the heart causes its inability to produce an
out put sufficient to meet patients’ needs. This affects
the body functions causing a number of
manifestations.
CVS e.g Pallor of mucus membranes, cyanosis,
tachycardia and chest pain
RS e.g cough, dyspnoea, pulmonary congestion,
haemoptysis

12. Effects of CVS CONT’D
NS e.g Insomnia, amnesia, mental changes &
delusions, delirium
GIT e.g Anorexia, dyspepsia, flatulence, constipation,
liver congestion
Urinary system e.g diminished urine output,
albuminuria
General e.g Oedema, Ascites and Pleural effusion

13. CARDIAC FAILURE/HEART FAILURE
By Frank.s
PRESENTATION OUTLINE
1. Definition
2. Risk factors
3. Types of HF
4. Sign and symptoms
5. Complications
6. Investigations
7. Differentials
8. Management

14. Definitions of HF
1. It’s a condition in which an abnormality of
myocardial fxn is responsible for the inability of the
ventricles to deliver adequate quantities of blood
to metabolizing tissues at rest or during normal
activity. It describes a state when the heart cant
maintain adequate cardiac out put and it does so
at high filling pressures.
2. CCF is a condition where the heart muscle
becomes weak and is unable to pump sufficient
oxygenated blood to meet the metabolic needs of
the tissues.

15. Definitions cont’d
3. Inadequate cardiac output for the body’s needs
despite adequate venous return-may be due to failure
of the left or right ventricles.
Types of HF
1. Right sided HF= results in a back flow of blood in
the venous circulation producing liver enlargement
and oedema in the extremities.
2. Left sided HF= results in a back flow of blood in the
pulmonary circulation, producing pulmonary
oedema
3. Biventricular HF/CCF= Affects both sides/long
term

16. Types of HF cont’d
• When RV fails to perform properly, the RA becomes
distended leading to stasis in the venous system.
• The pressure in the superior and inferior venacava
rises.
• The veins in the neck becomes distended (raised
jugular venous pressure-JVP)
• The liver becomes engorged and legs become
oedematous, this is known as CCF.

17. Causes of HF/CCF
• Coronary heart diseases
• Valvular heart diseases e.g rheumatic heart diz
• Cardiomyopathies
• Severe anaemia Myocardial infarction
• Systemic HTN Chronic respiratory diz
• Cardio toxicity arising from alcoholism
• Unknown/idiopathic Congenital heart defects
• Hyperthyroidism
• Aortic stenosis
• Post viral infections

18. Risk factors of HF/CCF
• Old age
• Family history/predisposition
• Lack of regular physical exercises
• Obesity/over weight
• High fat/high salt intake
• Sedentary life style
• Drugs like Aminophylline
• Liver failure and Kidney failure
• Pregnancy, Excessive Alcohol, Smoking
• Abnormal pulse rhythm (Arthymias)

19. Signs and symptoms of HF
• Palpitations, cough , weakness
• Rapid pulse, gallop rhythm
• Dependent oedema/swelling in the ankles
• Raised jugular venous pressure (JVP)
• Enlarged tender liver (right abdominal pain due to
stretching of liver capsule)
• Orthopnea, paroxysmal nocturnal DIB, tachycardia
• Exertional dyspnoea, fatigue, periodic breathing
• Basal crepitations
• Breathlessness & progressively decrease in effort
tolerance Cardiac cachexia-Excessive wasting

20. Complications of HF
• Cerebral symptoms e.g confusion, difficult in
concentration, impaired memory and headache
• Oliguria i.e diminished urine out put due to renal
failure
• GIT symptoms e.g dyspepsia, nausea, heart burn,
vomiting, anorexia due to congestion of the
stomach and intestines
• Respiratory failure with marked haemoptysis due
to pulmonary infarcts in the lungs as a result of
pulmonary congestion
• Ascites and pleural effusion

21. Differential diagnosis
• Severe anaemia
• Protein energy malnutrition (PEM)
• Nephrotic syndrome
• Asthma Renal failure, Liver failure/cirrhosis
• Severe pneumonia/Pulmonary diseases
Investigations
• Chest x-ray to rule out cardiomegaly/P.Oedema/LVF
• Blood for CBC/FBC, TPHA/RPR for syphilis
• Echocardiogram and ECG
• Lipid profile (LDL/HDL/Triglycerides)
• RFTs (Urea/creatinine/electrolytes), LFTs

22. Management of HF/CCF
Aims of mgt/Principles of mgt
1. To relieve symptoms
2. To improve exercise tolerance
3. To reduce incidences of acute exacerbations
4. To reduce hospitalization and mortality
5. To eradicate risk/precipitating factors e.g anaemia
6. Reduction of the work load imposed on the heart
by reducing obesity and having bed rest
7. Reduce salt intake and water retention

23. Supportive Mgt
• Bed rest with the head of the bed elevated when
symptoms are severe
• Prop up patient in sitting up position/cardiac bed
• Reduce weight in obese patients
• Limit salt/sodium intake
• Stop smoking
• Moderate physical exercises when s/s are mild-
moderate
• Avoid alcohol intake and other relaxation drugs
• Monitor fluid in put and out put chart

24. Drug Mgt of HF/CCF
• Diuretics=effective symptomatic relief in patients
with peripheral oedema or pulmonary oedema and
rapidly relieve dyspnoea.
• Frusemide/Lasix oral/IV/IM 20mg-80mg daily in
morning can be increased to 160mg in divided
doses prn (1mg/kg)
• Plus sprinolactone (Aldactone A) 25mg-50mg bd
(1.5mg-3mg/kg) if oedema persists
• Others include; Bendrofluazide/Aprinox 5mg-10mg
od in mild to moderate cases, Metolazone
combined with frusemide to enhance diuresis

25. Drug mgt HF/CCF cont’d
• Diuretics RX is not sufficient on its own as clinical
stability tends to deteriorate over time
• Beta blockers; reduce hospitalization, sudden death
and overall mortality in CHF and recommended in
RX of severe CHF.
• Tab carvedilol 3.125mg bd increased gradually
depending on response. Metoprolol
• Digoxin-Increases the strength of the heart’s
pumping action and is good patients with severe HF
esp due to certain disturbance of the heart rhythm
• It decreases relapses of HF& re-admissions

26. Drug Mgt of HF/CCF cont’d
• In urgent situations; digoxin injection loading dose
250mcg (0.25mg) IV 3-4times in the first 24 hours.
• Maintenance dose 250mcg (0.25mg) daily
• In non urgent situations; Tab loading dose 0.5mg-
1mg orally daily in 2-3 divided doses for 2-3days
• Maintenance dose 250mcg orally daily and elderly
patients 125mcg daily (15mcg/kg) daily for 5 days
• NOTE: Ensure patient has not been taking digoxin in
the past 14 days before digitalizing because of risk
of toxicity due to accumulation in the tissues.
• ACE inhibitors e.g Captopril, Enalapril, Lisinopril

27. Mgt of HF/CCF
• Tab Captopril 6.25mg tds, starting dose then
Maintenance dose of 50mg tds
• For acute pulmonary oedema (severe chest pain)
e.g Morphine 5-15mg (0.1mg/kg) repeated every 4-
6 hours until there is improvement.

28. HYPERTENSION=C.O X P.R
PRESENTATION OUTLINE
1. Definition
2. Risk factors/Causes
3. Classification of HTN
4. Types of HTN
5. Signs and symptoms
6. Investigations
7. Hypertensive emergency
8. Hypertensive crisis
9. Management
10.Complications

29. Definition
HTN is persistent elevation of blood pressure higher
than normal for a patient's age.
 The elevation may occur during systolic phase
(when the heart is in contractile phase) or during
the diastolic phase (when the heart is in relaxation
phase).
Generally a sustained BP of 140/90mmHg and
above indicate HTN.
HTN can also be defined as persistent high resting
blood pressure.

30. Causes
• Un known/idiopathic (majority of cases)-essential
HTN
Secondary causes
Chronic glomerulonephritis, Pyelonephritis
Eclampsia and preclampsia (pregnancy)
Renal failure Drugse.g oral
contraceptives&steroids
Cushing’s syndrome Coarctation of the aorta
Phaeochromocytoma Alcohol intoxication
Primary aldosteronism
Renal vascular diseases

31. Risk factors of HTN
Old age(>60 years)
DM
Hyperlipidemia
Obesity/over weight, High sodium intake
Smoking
Stress
Family history of CVS diz
Sedentary life style/lack of exercises
Execessive alcohol intake
See HF/CCF for more

32. Classification of BP/HTN
Systolic (mmHg) Diastolic (mmHg) Category
<130 <80 Normal
<90 <60 Hypotension
130-139 81-89 High normal (pre HTN)
140-159 90-99 Mild HTN (stage 1)
160-179 100-109 Moderate HTN (stage 2)
180-209 >110 Severe HTN (stage 3)
>209 Very severe HTN (stage 4)

33. Types of HTN
1. Essential HTN (primary HTN)
Most common and cause not known
Contributes to 90-95% of the cases of HTN in medical
practice.
2. Secondary HTN
Elevation of BP due to an identifiable cause e.g see
above. There is poor response to RX (resistant HTN),
worsening control in previously stable patients,
systolic BP of >180mmHg, or diastolic of >110mmHg,
no family H/O HTN, onset of HTN < 20 years,
significant hypertensive target organ damage.

34. Types of HTN cont’d
• Secondary HTN accounts for 5-10%
• Primary HTN affects both sexes equally ratio 1:1
• Primary HTN often seen in later years of life and
usually has familial history.
• If both parents were/are suffering from HTN, there
is 45% chances of their children suffering from HTN
• Severity of HTN increases gradually but can be
acute or progressive with a poor prognosis known
as malignant HTN

35. Signs and Symptoms of HTN
• There is no s/s specific to HTN instead it is
diagnosed by chance during routine medical
examinations. S/S include
• Headache Anxiety
• Palpitations Nervousness
• Breathlessness/DIB
• Dizziness Weight loss
• Chest pain Insomnia
• Epistaxis Irritability
• Wheezing

36. Complications of HTN
• Some patients may present with symptoms
associated with complications
The include;
Stroke (Brain)
Renal failure (Kidney)=oliguria
Impaired vision/blurred vision (Eyes)
Heart failure (Heart)=oedema, DIB, Orthpnoea
Heart attack
Hypertensive encephalopathy=fits/convulsions,
vertigo, impaired memory and concentration

37. Investigations
FBC/CBC
Chest X-ray
Fasting blood sugar (FBS)
Urinalysis
ECG/ECHO
RFTs
Serum uric acid
Total, high and low density lipoprotein cholesterol

38. Management of HTN
Aim of Rx
To normalize BP to less than 140/90mmHg
To avoid hypotension and to improve survival
To avoid adverse drug effects
To prevent or retard end-organ damage
Supportive Mgt
Sodium restriction (reduce salt intake)
Weight reduction if patient is obese
Regular aerobic exercises (little jogging)
Behavioral modification to reduce stress

39. Supportive MGT cont’d
Restriction of alcohol
Avoidance of smoking
Increased consumption of fruits and vegetables
Re-evaluate patients after4-6weeks and if still
hypertensive, then drug RX is recommended
Patient education is important as non compliance is
a major cause of poor response to RX
Appropriate counseling and patient follow up is
needed to understand the risk of untreated HTN.
This mgt is for mild HTN

40. Drug mgt=moderate-severe HTN
• Drug combination is important in mgt of HTN
1. Angiotensin enzyme converting inhibitors (ACEI)
e.g captopril 25-50mgtds, Lisinopril 5mg, Enalapril
2. Beta blockers e.g Carvedilol, Atenolol, propranolol
3. Calcium channel blockers e.g Nifedipine,
Amlodipine, Felodipine
4. Diuretics e.g Bendrofluazide, Furosemide,
Sprinolactone
5. Angiotensin-II antagonist e.g Losartan and
Valsartan
6. Centrally-acting anti-HTN e.g Methylodopa

41. Drug mgt cont’d
• Tab Atenolol 50-100mg od/bd prn
• Tab Propranolol 40mg-120mg bd/tds
• Tab Carvedilol 3.125mg-6.25mg od/bd
• Tab Furosemide 40mg-80mg od in morning
(1mg/kg)
• Tab Sprinolactone (Aldactone A) 25mg-50mg od/bd
• Tab Bendrofluazide 2.5mg-5mg od morning
• Tab Nifedipine 20mg-40 bd/tds
• Tab Amlodipine 5mg-10mg bd
• Tab Losartan 50mg od/bd
• Methylodopa 250mg bd/tds

42. Drug mgt cont’d
• AB/CD/BC/ABC/BCD can be used
• Propranolol, atenolol should not use in heart failure
and asthma
• Diuretics should not use in pregnancy or breast
feeding except in case of pulmonary oedema or pre-
eclampsia.
• Make notes about suitability safety of ant
hypertensive in different conditions like
DM,CCF,COPD/Asthma, Ischaemic heart diseases,
Chronic renal failure etc

43. Hypertensive crisis
• This is a group of acute hypertensive disorders
characterized by end organ damage
(180/120mmHg).
• In hypertensive crisis, arterial BP rises rapidly and
severely, threatening the patient's life and can
quickly comprises the patient's cerebral,
cardiovascular and renal function.
• Non compliance and rebound HTN following
withdrawal of RX should always be considered as an
etiological factor.
Classification of Hypertensive crisis
• Hypertensive urgency and emergency

44. Hypertensive urgency
• This is a clinical situation in which there is an
elevation of blood pressure but end organ damage
is less acutely progressive (gradual).
• Hypertensive urgency is less life threatening.
Signs and symptoms
• Severe headache
• Nausea and vomiting
• Dyspnoea
• Blurred vision
• Chest pain, leg & arm numbness &tingling
• Progressive impairment of consciousness

45. Mgt of hypertensive urgency
• Nifedipine, Captopril and Prazosin
Hypertensive emergency
This is a clinical situation in which there is an
elevation of BP complicated by life threatening end
organ damage (acute).
Situations in which HTN is considered an emergency
are;
Hypertensive encephalopathy
Acute aortic dissection Stroke
Pulmonary oedema Acute MI, unstable angina
Pre-eclampsia and Eclampsia

46. Mgt of hypertensive emergency
• It requires rapid (within one hour) lowering of BP to
prevent any organ damage.
• Admit a patient
• IV furosemide 40-80mg stat
• Iv hydralazine 20mg slowly in D5% over 20minutes
• Check BP regulary at least 3 hourly
• Rapidly acting antihypertensive e.g sodium
nitroprusside, hyralazine (Apresoline) and Labetalol
are normally used.

47. ISCHEAMIC HEART DISEASES (IHD)
1. Angina pectoris
2. Acute myocardial infarction
NOTE: IHD can also be called Coronary heart disease
(CHD)

48. ANGINA PECTORIS
This is a syndrome characterized by discomfort that
occurs when the myocardial oxygen demand
exceeds supply.
A clinical syndrome as result of coronary blood flow
being less than required hence lack of 02 in heart
muscle. Transient myocardial ischemia
Signs and symptoms
Chest pain Dizziness
Nausea Shortness of breath
Left arm discomfort Sweating

49. S/S cont’d
Chest tightness in the middle of the chest like a
band around chest. Sense of oppression worsening
on exertion, relieved by rest and lasting for a few
minutes.
Pain radiates to left hand and neck& is more
induced after meals and cold weather.
Pain is also induced by exercise and relieved by rest
Pain is likely to be worse when walking against wind
or uphill/cold weather/after meals
Some patients are wakened up by pain(nocturnal
angina) with alarming dreams

50. S/S cont’d
Some patients experience pain when lying flat
(angina decubitus)
Pulse is weak and irregular, lasts for several hours
Patient may go into shock, Dyspnoea
Anxiety sweating, vomiting
Low BP
Arrhythmias

51. Differential diagnosis
Indigestion
Peptic ulcer disease
Pleurisy
Pericarditis
Severe anaemia
Dissecting aneurysm (Separation of layers of
aorta plus dilatation)

52. Risk factors of Angina
Advanced age
DM
Oral contraceptives
Gender (males are more prone)
HTN (especially when systolic BP>180mmHg)
Calcium channel blockers e.g amlodipine
Obesity
Smoking
Hyperlipidemia
Hypothyroidism

53. Classification of Angina
Stable angina
Unstable angina
Prinzmetal’s angina
Stable angina (Chronic stable angina)
Usually precipitated by exertion and relieved by rest
Frequency, intensity & duration of attack are stable
Usually followed by precipitating factors e.g
Climbing stairs A heavy meal
Sexual intercourse Cold weather
Emotional stress

54. • Caused by a fixed coronary obstruction secondary
to atherosclerosis.
Unstable angina (coronary syndrome)
Unstable angina is a clinical syndrome intermediate
between stable angina and acute myocardial
infarction. Characterized by
Recent onset
Increasing severity, duration or frequency of attacks
It occurs at rest or with minimal exertion
It may be due to plaque rupture

55. Prinzmetal’s angina
Occurs spontaneously when the patient is at rest
with greater frequency during the night or early
hours in the morning.
It carries considerable risk of progression to
myocardial infarction.
It is caused by coronary artery spasm with or
without significant coronary artery disease.
Patients are also more likely to develop ventricular
arrhythmias.
It is common in women over 30 years .

56. Supportive mgt
Weight reduction in obese patients
Regular aerobic exercises
Correction of folate deficiency
Low cholesterol/low fat and low sodium intake
Advise the patient to stop smoking
Correction of possible aggravating factors e.g
anemia, HTN, DM, hyperlipideamia etc
Monitor closely pulse rate and circulatory status
Effective control of HTN and DM

57. Drug mgt
Nitrates e.g Sublingual nitroglycerine and isosorbide
dinitrate
Glyceryl trinitrate 500mcg sublingually, repeat after
5min if no response
Beta blockers e.g atenolol, propranolol 10-40mg prn
Avoid it patinets with shock or hypotension
Calcium channel blockers e.g nifedipine, amlodipine
Acetylsalicyclic acid 150mg single dose 2 be chewed

58. MYOCARDIAL INFARCTION (MI)
1. Definition
2. Cause
3. Risk factors
4. Signs and symptoms
5. Investigations
6. Management

59. Definition
This is necrosis of heart muscles resulting from an
insufficient supply of oxygenated blood to an area
of the heart.
It results from occlusion of a coronary artery by a
thrombus supplying that area.
OR it is a condition in which part of myocardium is
damaged due to a major obstruction in the
coronary artery that part of the heart gets
insufficient blood supply and dies off.
The infarct may affect full thickness of the
myocardium or it may be confined to sub
endocardial region.

60. Aetiology/cause
Coronary thrombosis is the main cause due to
arteriosclerosis.
It always due to formation of an occlusive thrombus
at any site in the coronary artery.
 The thrombus often undergoes spontaneous lysis
over the next 2days although at this time
myocardial damage has already occurred.

61. Risk factors of MI
Cigarette smoking
Obesity
DM
Family history of heart disease
HTN
Excessive alcohol intake
Previous cardiovascular disease e.g angina pectoris
Plasma lipid abnormalities/high cholesterol levels
Old age

62. Signs and symptoms of MI
Weakness/fainting/extreme fatigue
Bradycardia
Sweating
Severe tight chest pain lasting more than 20minutes
Patient usually restless and in severe pain
Low BP (hypotension)
Bilateral crackle in the chest
Shortness of breath/dyspnoea
Feeling of indigestion
Nausea and vomiting

63. S/S cont’d
Pain is more described as tightness or heaviness or
constriction in the chest
At its worst, pain is one of the most severe pain to
be experienced by a patient in which pallor may
convey the seriousness of the situation.
Cyanosis may occur
Vomiting and sinus Bradycardia may be due to
vagus nerve stimulation but vomiting can also be
aggravated by opiate analgesics.
Patient may have fever and die off in a few days.

64. Investigations
ECG/ECHO
Fasting blood sugar
FBC/CBC
Serum lipid profile
Cardiac enzymes
Blood urea and creatinine (RFTs)
DDX
Angina pectoris
Pericarditis
Mitral valve stenosis

65. Complications of MI
Heart failure due of impaired contraction of the
myocardium
Rupture of the heart
Severe arrhythmias
Pulmonary embolism
Pulmonary infarction
Pericarditis

66. Management of MI
Aims of mgt
To abort infarction
To increase myocardial oxygen delivery
To provide symptomatic relief of pain and reduce
anxiety
To prevent complications and recurrences
To reduce mortality and improve the quality of life
To rehabilitate the patient and also prevent
arrhythmias

67. Mgt of acute attack of MI
Morphine IV 5mg-10mg to relieve pain and anxiety
Oxygen therapy to all patients except those with
COPD
Nitrates e.g Glyceryl trinitrate 500mcg sublingually,
repeated after 5min if no response to relieve
Ischaemic pain
Aspirin 75mg-150mg (cardiac aspirin/Ecorin 75mg)
to dissolve the clots or other antiplatelets
Metoclopramide 5-10mg IV/IM may be added to
prevent nausea and vomiting associated with
morphine
Always remember MONA in AMI

68. Long term mgt of MI
Supportive mgt
Control of HTN
Rest and reassurance
Avoid smoking
Exercises regularly should be mild during the period
when infarct is replaced by a fibrous tissue 4-6wks
Reduce weight for obese patients
Proper control of DM
Avoid sedentary lifestyles
Eating vegetables and fruits
Avoid fatty diet

69. Long term drug mgt of MI
Aspirin 75mg-150mg daily (prolonged use) by
mouth to reduce the rate of reinfarction
Beta blockers e.g atenolol 5mg-10mg or
propranolol should be continued for at least one
year (for arrhythmias)
Nitrates may be required for patients with angina
Statins e.g simvastatin may be used in patients with
high risk of reoccurrence
Thrombolytic drugs e.g IV streptokinase 1.5mu in
100mls of N/S as an infusion over 1 hour is useful in
acute attacks.

70. STROKE (CVA)
PRESENTATION OUTLINE
1. Definition
2. Classification
3. Causes
4. Risk factors
5. Symptoms and signs
6. Investigations
7. Management

71. Definition and classification of stroke
This is acute brain injury caused by decreased blood
supply or heamorrhage.
Stroke is a medical emergency and can cause
permanent neurological damage, complications and
death if not promptly DX and RX.
Classification of stroke
1. Ischaemic stroke (lack of blood supply caused by
thrombosis or embolism)
2. Haemorrhagic stroke

72. Causes of stroke
Blood clot (embolism from distant site)
Cardio-embolic stroke accounting for 20-25% of all
stroke
Cerebral heamorrhage (secondary to HTN)
Clotting with in the artery (Thrombosis)

73. Risk factors of stroke
Hypertension
Cigarette smoking
Excessive alcohol intake
Undesirable blood cholesterol (LDL/HDL)
DM
Obesity
Old age

74. Signs and symptoms of stroke
Sudden onset of weakness or numbness of the face,
arm or leg
Sudden lack of coordination of the limbs
Sudden vision loss or double vision
Sudden difficult in speaking
Severe dizziness
Loss of balance
Severe headache
Paraplegia/hemiplegia/monoplegia
Coma
Muscle weakness/paresis

75. Investigations
Fasting blood sugar
Urinalysis
FBC/CBC
Serum triglycerides and cholesterol (lipid profile)
Chest/skull x-ray
ECG and ECHO
CT scaninng

76. Management of stroke
Supportive mgt
Admit the patient if unable to walk
Ensure adequate oxygenation
Ensure adequate fluid and electrolyte balance
Prevent pressure sores by regular turning of the
patient, Pass Nasogastric tube for feeding
Pass urethral catheter to keep patient clean
Physiotherapy should be started as soon as BP
stabilizes
Prophylactic anticoagulants to prevent
thromboembolism

77. Drug mgt
Acute stroke (Ischaemic/haemorrhagic)
Antiplatelet Rx e.g Aspirin 150mg-300mg started
with in 48hours of the onset of Ischaemic stroke
IV Clexane 40iu od/bd
Anticoagulants e.g Heparin
Anticoagulants and antiplatelets drugs are not used
in the mgt of hemorrhagic stroke as they may
exacerbate bleeding
The main treatment in this type of stroke is to
normalize HTN

78. Long term mgt of stroke
Adequate control of HTN, DM,
Hyperlipidemia e.g artovastastin tab 10mg increase
after 4weeks max 40mg/day, simvastatin
Reduction of alcohol consumption
Advise the patient to stop smoking
Tab Aspirin 75mg-150mg daily prn
Tab Dipyridamole 300mg-600mg in 3-4 divided
doses OR
Tab Clopidogrel initially 300mg then 75mg od