Coronary Artery Disease, Angina pectoris, Myocardial Infarction

CORONARY ARTERY DISEASE ANGINA Pectoris MYOCARDIAL INFARCTION (MI) Presenter Dave Jay S. Manriquez RN. February 21, 2009

Objectives

Coronary Artery Diseases

Angina

Types

Mechanism

Causes

Clinical manifestation

Complication

Nursing care

06/08/09 www.health-nurses-doctors.blogspot.com

Coronary Artery Disease Definition: CAD is a term that refers to the effect of the accumulation of atherosclerosis plaque in the coronary arteries that obstructs blood flow to the myocardium 06/08/09 www.health-nurses-doctors.blogspot.com

Cont.

conditions result from CAD

1 . Angina Pectoris

2. Myocardial Infarction

Angina Pectoris

Definition:

Angina: Choking or suffocation.

Pectoris: Chest.

Angina pectoris, is the medical term used to describe acute chest pain or discomfort.

Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart.

It has 3 types

Stable Angina

Un stable angina &

Variant Angina (Prinzmetal’s or resting angina) :

Cont.

Types of Angina

Stable angina :

People with stable angina have episodes of chest discomfort that are usually predictable. That occur on exertion or under mental or emotional stress.

Normally the chest discomfort is relieved with rest,

nitroglycerin (GTN) or both.

It has a stable pattern of onset, duration and intensity of symptoms.

Cont.

Unstable angina:

It is triggered by an un predictable degree of exertion or emotion.

(progressive), more severe than stable. Characterized by increasing frequency & severity. Provoked by less than usual effort, occurring at rest &

interferes with pt lifestyle.

Cont.

Variant Angina (Prinzmetal’s or resting angina) :

occur spontaneously with no relationship to activity. Occurs at rest due to spasm. Pt discomfort that occurs rest usually of longer duration. Appears to by cyclic & often occurs at about the same time each day (usually at night). Thought to be caused by coronary artery spasm

Mechanism Of Angina

Causes

Coronary atherosclerosis (atheroma )

Factors increasing preload :

Hyperthyroidism

Exercise

Anemia

Factors increasing after load:

Hypertension

Aortic stenosis

Obstructive cardio myopathy

Coronary artery spasm

Clinical Manifestations

Characteristics: Squeezing, burning, pressing, choking, or bursting pressure.

Onset: Quickly or slowly

Location: Chest, right or left arms, shoulder, or neck, jaw.

Duration: Less then 5 minutes.

Associated: Dyspnea, Sweating, faintness, palpitation, dizziness ect.

Relieving: GTN and rest.

Aggravating: exertion, exercise, heavy meal, emotional upset, and anger.

Investigations

Electrocardiogram ( ECG)

Coronary angiography

Exercise Electrocardiogram (Stress test).

Complications:

Myocardial infarction

Cardiac Arrhythmias

Myocardium Infarction

Myo means muscle, “Cardiac” heart, infarction means “death of tissues due to lack of blood supply”.

It is also called heart attack. It occurs when coronary arteries become blocked and the part of myocardial muscles become dead due to prolonged lack of oxygen supply to the muscle cells.

PATHOPHYSIOLOGY

Coronary artery cannot supply enough blood to the heart in response to the demand due to CAD

Within 10 seconds myocardial cells experience ischemia

Ischemic cells cannot get enough oxygen or glucose

Ischemic myocardial cells may have decreased electrical & muscular function

Cells convert to anaerobic metabolism.

Cells produce lactic acid as waste

Pain develops from lactic acid accumulation

Pt feels anginal symptoms until receiving demand increase 02 requirements of myocardial cells

ECG changes in Angina & MI

Zone of Ischemia: T wave inversion

Zone of Injury: ST elevation

Zone of Necrosis: Abnormal Q wave

Sign and Symptom

Classic symptom of heart attack are chest pain radiating to neck, jaws, back of shoulder, or left arm

The pain can be felt like:

Squeezing or heavy pressure

A tight band on the chest

An elephant sitting on the chest

Cont

Other symptoms include:

Shortness of breath (SOB)

Weakness and tiredness

Anxiety

Lightheadedness

Dizziness

Nausea vomiting

Sweating, which may be profuse

Collaborative Management

Assessment:

History

Clinical manifestation

Cardiovascular assessment

Laboratory assessment

Troponin T & I

CK-MB

Radiographic Assessment

ECG

Stress Test

Myocardial perfusion imaging

MRI

Cardiac Catheterization

IMPORTANT INFORMATION TO REMEMBER Increase supply of Oxygen

Decreasing the demand of Oxygen:

Stop activity and lie down (CBR)

Take Tab. Angisid sublingually and wait till it dissolves.

If pain continues take up to 03 Tab. Angisid one every five minutes. If pain is not relieved yet take another tab. and rush to EMERGENCY services.

IMMEDIATE MANAGEMENT OF MI:

GOALS:

To prolong life.

Minimize infarct size.

Reverse ischemia.

Reduce cardiac work.

Prevent and treat complications.

A) INITIAL TREATMENT:

Rapid triage.

OMI (oxygen, monitor and I/V line).

Check vital signs and O2 saturation.

ECG within 10 minutes and repeat ECG.

Blood samples for enymes, CBC, lytes, and lipid profile.

Intervention

Medication:

Morphine Sulphate

Nitrates (GTN)

Beta blockers

Calcium Channel Blocker

Anti platelets / Anti coagulant

Thrombolytic therapy

Surgical management

PTCA (Percutaneous Transluminal Coronary Angioplasty

Coronary Artery Bypass Graft surgery (CABG) 06/08/09 www.health-nurses-doctors.blogspot.com

Nursing Diagnosis

Acute pain R/T imbalance between myocardial oxygen supply and demand

Ineffective tissue perfusion R/T interruption of arterial blood flow

Ineffective coping R/T effects of acute illness and major changes in life style

Impaired gas exchange related to ineffective breathing pattern and decreased systemic tissue perfusion.

Anxiety related to present status and unknown future, possible lifestyle changes, pain, and perceived threat of death.

Activity intolerance related to fatigue

Prevention

Recognize the symptoms

Reduce your risk factors:

Lose weight

Quit Smoking

Keep your cholesterol at a normal level.

Keep your blood pressure under control.

Use techniques to ease stress.

Control blood sugar level.

Eat Right

REGULER EXERCISE

COMPLICATIONS OF MI:

Arrhythmias

Atrial arrhythmias.

Ventricular arrhythmias.

Bradycardia and heart block.

Asystol.

Hypertension.

LV failure.

Cardiogenic shock.

CARDIAC REHABILITATION:

Cardiac rehabilitation provides a venue for continued education, re-enforcement of lifestyle modification, and adherence to a comprehensive prescription of therapies for recovery from MI, which includes exercise training