Professional Documents
Culture Documents
Causes anemia fever thyrotoxicosis Decreased oxygen due to: Non-obstructive clot on an atherosclerotic plaque coronary vasospasm atherosclerotic obstruction without clot or vasospasm inflammation or infection (sore throat, gingivitis, tonsillitis)
ATHEROSCLEROSIS
CAD
ANGINA PECTORIS
ACS
Risk Factors Modifiable hyperlipidemia obesity smoking DM sedentary lifestyle Non-Modifiable age male race family history Others increased levels of o homocysteine o fibrin o lipoprotein infection inflammation LVH (left ventricular hypertrophy)
UNSTABLE ANGINA
MYOCARDIAL INFARCTION
ST-SEGMENT ELEVATION MI
PERCUTANEOUS CORONARY INTERVENTION
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY o A balloon tipped catheter is placed in a coronary vessel narrowed by plaque o The balloon is inflated and deflated to stretch the vessel wall and flatten the plaque INTRACORONARY ATHERECTOMY o A blade-tipped catheter is guided into a coronary vessel to the site of the plaque o Plaque is either cut, shaved, or pulverized then removed o Limited larger vessels INTRACORONARY STENT o A diamond mesh tubular device is placed in the coronary vessel o Prevents restenosis o Drug-eluting stents contain an anti-inflammatory drug, which decrease the inflammatory response CABG (CORONARY ARTERY BYPASS GRAFT) SURGERY o A graft is surgically attached to the aorta, and the other end of the graft is attached to a distal portion of the coronary vessel TRANSMYOCARDIAL REVASCULARIZATION o laser beam, small channels are formed in the myocardium
CLINICAL MANIFESTATIONS
CAD
SILENT ISCHEMIA
Absence of chest pain with documented evidence of an imbalance between myocardial oxygen supply and demand (ST DEPRESSION of 1mm or more). CIRCADIAN EVENT (occurs during the first few hours after awakening due to an increase in sympathetic nervous system activity) o Increase heart rate o Increase BP o Increase coronary vessel tone o Increase blood viscosity
DIAGNOSTIC EVALUATIONS
Characteristic chest pain and clinical history Nitroglycerin test relief of pain. Blood tests (Hemoglobin, fasting blood glucose, fasting lipid panel, coagulation studies, CRP, homocysteine, lipoprotein). Resting ECG may show LVH, ST-T wave changes, arrhythmias, and Q waves. ECG Stress Testing progressive increases of speed and elevation walking on a treadmill increase the workload of the heart. ST-T wave changes occur if myocardial ischemia is induced. Radionuclide Imaging a radioisotope, thallium 201, injected during exercise is imaged by a camera. Low uptake of the isotope by heart muscle indicates regions of ischemia induced by exercise. Images taken during rest show a reversal of ischemia. Radionuclide Ventriculography (gated blood pool scanning) red blood cells tagged with a radioisotope are imaged by camera during exercise and at rest. Wall motion abnormalities of the heart can be detected and ejection fraction estimated. Cardiac Catheterization coronary angiography performed during the procedure determines the presence, location, and extent of coronary lesion. PET (Positron-Emission Tomography) cardiac perfusion imaging with high resolution to detect very small perfusion differences caused by stenotic arteries. Electron-Beam CT detects coronary calcium, which is found in most, but not all, atherosclerotic plaque. Low specificity.
STOP SMOKING
NURSING ASSESSMENT
1. Ask patient to DESCRIBE anginal attacks. WHEN do attacks tend to occur? WHERE is the pain located? Does it RADIATE? Was the onset of pain SUDDEN or GRADUAL? How LONG did it LAST? Was the pain STEADY and UNWAVERING in quality? Was the discomfort accompanied by other symptoms? o SWEATING o LIGHT-HEADEDNESS o NAUSEA o PALPITATIONS o SHORTNESS OF BREATH How is the pain RELIEVED? 2. Obtain BASELINE ECG. 3. Assess patient and familys KNOWLEDGE of disease. 4. Identify patient and familys level of anxiety and use appropriate coping mechanism. 5. Gather information about the patients cardiac risk factors. Age Total cholesterol level HDL level Systolic BP Smoking status 10-year risk for development of CHD according to Framingham scoring method 6. Medical history Diabetes Heart failure Previous MI COPD 7. Identify factors that may contribute to NONCOMPLIANCE with prescribed drug therapy. 8. Review RENAL and HEPATIC STUDIES and CBC. 9. Discuss patient current ACTIVITY LEVELS. 10. Discuss patients BELIEFS about modification of risk factors and WILLINGNESS TO CHANGE.
Determine the 10-year risk of development of coronary heart disease (CHD) in men and women based on: AGE CHOLESTEROL HDL BP HYPERTENSION SMOKING
NURSING INTERVENTIONS
RELIEVING PAIN
Determine intensity of patients angina. o Compare pain experienced in the past. o Observe for other signs and symptoms (diaphoresis, sob, protective body posture, dusky facial color, changes in LOC. Position for comfort, FOWLERs promotes ventilation. OXYGEN (PRN) Obtain VS (5-10 min until angina subsides) Obtain 12-Lead ECG Antianginal Drug (PRN) Monitor for relief of pain and note duration of anginal episode Monitor for progression from stable to unstable angina Identify specific activities the patient may engage in that are below the level at which angina pain occurs. Notify staff when angina pain is experienced.
DECREASNG ANXIETY
Rule out physiologic etiologies for increasing anxiety before administering PRN sedatives. Auscultate patient for signs of HYPOPERFUSION. o Auscultate heart and lung sounds o Obtain a rhythm strip o Administer Oxygen PRN o Notify physician immediately Document all assessment findings, health care provider notification and response, and interventions and response. Explain reasons for hospitalization, diagnostic tests, and therapies. Encourage patient to verbalize fears and concerns about illness through frequent conversations. Answer patients questions. Administer anti-anxiety medication (PRN). Explain the importance of anxiety reduction to assist in control of angina. o Anxiety and fear put an increased stress on the heart, requiring the heart to use more oxygen. o Teach relaxation technique. Discuss measures to be taken when an anginal episode occurs. o Preparing client can decrease anxiety. o Allow patient to accurately describe angina.
Others: CAFFEINE increases heart rate and produce angina DIET PILLS, NASAL DECONGESTANTS increases heart rate and stimulate high BP ALCOHOL increase hypotensive adverse effect of drugs