nursing students can refer as their is responsibility of a nurse or anyother care taker of an ihd or cad patient

1. By – Pravisha Bhabal
S.Y Basic B.sc Nursing

2.  Students will
 Conceptualize ischemic heart disease with its etiology
and pathogenesis
 Explain syndrome of CAD
 Discuss the risk factors and relate sign and symptoms,
investigations to pathophysiology of IHD
 Discuss about treatment and prognosis
 Discuss about the nursing management of patient
with IHD

4. IHD – A group of closely related syndromes caused by an
imbalance between the myocardial oxygen demand and blood
supply.
Usually caused by decreased coronary artery flow
Four syndromes :
 Angina pectoris ( chest pain )
 Acute myocardial infarction
 Chronic ischemic heart disease and congestive heart failure
 Sudden cardiac death
 The most common cause of IHD is coronary atherosclerosis
 Less commonly it is due to vasospasm and vasculitis

6.  Age – risk increases with age
 Sex – males are more prone and females are prone after 10 yrs as
postmenopausal decrease in cardiac protective estrogen
 Race – non whites increased risk
Modifiable risk factors
 Elevated lipid levels
 Hypertension
 Obesity
 Tobacco use
 Diabetes mellitus
 Sedentary lifestyle and stress

8.  Role of clinical stenosis and obstruction
 Role of acute plaque change
 Role of coronary thrombus
 Role of vasoconstriction
 Role of inflammation

14.  Angina Pectoris
 Acute MI
 Chronic IHD with Congestive Heart Failure
 Sudden cardiac deadth.

15. ANGINA PECTORIS

16.  STABLE ANGINA PECTORIS
It is relieved by rest or nitroglycerine
> Character - substernal chest pain,pressure,heaviness
including squezing,burning,choking
- may produce in numbness or weakness in arms, wrists or
hands
- associated symptoms include diaphoresis, nausea,
dypsnea,tachycardia,increased BP
- women may experience chest pain,jawpain,shortness of
breath
 Location – behind middle or upper third of sternum
 Radiation – radiates to neck , jaw , shoulder , arms ,hands and
posterior intrascapular area
 Duration – lasts 2 to 15 min after stopping activity

18.  Chest pain occuring at rest
 No increase on oxygen demand
 Lack of blood flow to heart due to plaque
 Lasts longer than 10 min
 Unrelieved by rest or sublingual nitroglycerine
SILENT ISCHEMIA
 Absence of ischemia with imbalance between myocardial
oxygen demand and bkood supply
 ST elevation in ECG
 Increase heart rate , blood pressure and blood viscosity.

19.  ANTIANGINAL
i. Nitrates : vasodilation of arteries
ii. Cardioselective Beta Adrenergic Blockers : inhibit sympathetic stimulation
iii. Calcium channel blockers : inhibit movement of calcium with heart muscle
and coronary vessel
 ACE INHIBITORS - Remodelling the vacular endothelium
 ANTILIPID AGENTS – Reduce total cholesterol and triglyceride level
 ANTIPLATELET AGENTS – Decrease platelet aggregation
 FOLIC ACID AND B COMPLEX VIT – Treat increased homocystiene levels

20.  Characteristic chest pain and clinical history
 Nitroglycerin test : relief of pain with nitroglycerine
 Blood tests : cardiac markers , creatine kinase and its
isoenzyme CK- MB , homocycteine and lipoprotien
,hemoglobin to rule out anemia
 12 lead ECG which may show LVH , ST elevation, arrythmias
 ECG stress testing

21.  Treadmill test ( TMT ) : changes in ST elevation
 Cardiac cathetorization : determines the presence ,
location and extent of coronary lesions.
 Position emission tomography ( PET Scan ) : detect very
small perfusion differences caused by arteries.
 Computed tomography ( CT Scan ) : detects coronary
calcium
 Radionuclide imaging : indicates regions of ischemia
induced by exercise

23.  Participate in normal daily program of activities that
do not produce chest discomfort and shortness of
breath
 Avoid activities like walking against the wind,
extremes of temperature , emotionally stressful
situations
 Rest after each meal
 Do not carry heavy objects

24.  Carry nitroglycerine at all time
 Place nitroglycerine under the tongue at first sign of chest
discomfort
 Stop all efforts or activity, sit and take nitroglycerine tablet
 Repeat dosage in 5 min for total of 3 tablets if relief is not
obtained
 Keep a record of the number of tablets taken to evaluate
change in anginal pattern
 Take nitroglycerine prophylactically to avoid pain known to
occur with certain activities

25.  Instruct patient on administration of transdermal
nitroglycerine patches
a) Remove previous patch ; fold in half so that the medication
does not touch your fingertips and will not be accessible in
trash
b) Wipe area with tissue to remove any residual medication
c) Apply patch to a clean ,dry and non hairy area of body
d) Rotate administrationn sites
e) Instruct patient not to remove patch for swimming or
bathing
 Teach patient about potential adverse effects of medications
a) Constipation
b) Ankle edema
c) Dizziness

26. PATCH
SITES OF
ANMINISTRATION

27.  Inform patient the methods of stress reduction
 Review low fat and low cholesterol diet
a. Omega 3 improve arterial health and decrease BP,
triglycerides and the growth of atherosclerosis
plaque.
b. Omega 3 oils can be found in fatty fish.
 Instruct patient to avoid excessive caffeine intake s it
increases heart rate and produce angina
 Encourage patient to avoid alcohol

29.  ACUTE PAIN related to an imbalance in oxygen supply
and demand
 DECREASED CARDIAC OUTPUT related to reduced
heart rate
 ANXIETY related to chest pain

30.  Relieving pain
 Maintainingcardiac output
 Decreasing anxiety

31.  RELIEVING PAIN
 Determine intensity of patients angina
 Fowlers position
 Administer oxygen , if appropriate
 Obtain BP , HR , RR
 Administer anti-anginal drug
 Take vital signs every 5 to 10 min until angina pain subsides
 Monitor progression of stable angina to unstable angina

32.  MAINTAINING CARDIAC OUTPUT
 Take BP and HR in sitting position {evaluate
orthostatic hypotension which occurs during drug therapy
}.
 Note changes in BP more than 10 mmHg and changes in
HR of more than 10 beats/min
 Note patients complaints of headache and dizziness
 Continuous ECG monitoring

33.  DECREASING ANXIETY
Explain to patient the importance of anxiety reduction to assist
in control of angina
{ Angina and fear increase stress on heart, requiring the heart to use more oxygen }