CORONARY ARTERY DISEASE

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

04/19/23www.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



Cont.

conditions result from CAD1. 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) :04/19/23

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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.04/19/23


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.



PATHOPHYSIOLOGYCoronary 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

ECGStress TestMyocardial perfusion imagingMRICardiac 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.04/19/23


Intervention

Medication:Morphine Sulphate Nitrates (GTN)Beta blockersCalcium Channel BlockerAnti platelets / Anti coagulant Thrombolytic therapy



Surgical management

PTCA (Percutaneous Transluminal Coronary Angioplasty



Coronary Artery Bypass Graft surgery (CABG)



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

Goals of Rehabilitation program:Develop a program for progressive physical activityLives as full, vital and productive life Remain within the limits of the heart’s ability to respond to increases in activity and stress.



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