Angina Pectoris &

Acute Myocardial
Infarction
Angina Pectoris
Angina pectoris is a clinical syndrome
usually characterized by episodes or
paroxysms of pain or pressure in the
anterior chest
Predisposing Factors
Family history of premature
cardiovascular disease
Age
Gender
Race
Precipitating Factors
Hyperlipidemia
Smoking
Hypertension
Diabetes mellitus
Obesity
Physical Inactivity

Types of Angina
Stable angina:

Unstable angina :

Intractable or refractory angina:

Variant angina (also called

Prinzmetal's angina):

Silent ischemia

Signs and Symptoms:

Pain
o Retrosternal area
o Pain or discomfort is poorly
localized
o May radiate to the neck, jaw,
shoulders, and inner aspects of
the upper arms, usually the left
arm.
Medical Management
NITROGLYCERIN
Instruct the patient to make
sure the mouth is moist, the
tongue is still, and saliva is not
swallowed until the nitroglycerin
tablet dissolves
Advise the patient to carry the
medication at all times as a
precaution.
Instruct the patient to renew the
nitroglycerin supply every 6
months.
Inform the patient that the
medication should be taken in
anticipation of any activity that
may produce pain.
Advise the patient that if pain
persists after taking three
sublingual tablets at 5-minute
intervals, emergency medical
services should be called.
Advise the patient to sit down
for a few minutes when taking
nitroglycerin to avoid
hypotension and syncope.
Beta Adrenergic Blocking
Agents
Calcium Channel Blockers
Aspirin
Clopidogrel and Ticlopidine
Heparin
Oxygen Administration
Bleeding Precautions
Applying pressure to the site of
any needle puncture for a
longer time than usual

Avoiding intramuscular (IM)

injections
Avoiding tissue injury and
bruising from trauma or use of
constrictive devices

Myocardial Infarction
Myocardial infarction occurs when
myocardial tissue is abruptly and
severely deprived of oxygen. An area
of the myocardium is permanently
destroyed

Location of MI

Is an enzyme found in muscle and

brain tissue tat reflects tissue
catabolism resulting from cell trauma
Normal Value 26 to 174 units/L
Rise 6 hours
Peaks 18 hours
Returns to normal 2 to 3 days

2. Lactate Dehydrogenase
(LDH)
The LDH isoenzymes affected by acute
myocardial infarction are LDH1 and
LDH2
Normal Value 140 to 280
units/L
Rise 24 hours
Peaks 48 to 72 hours
Returns to normal 7 to 14 days
3. Troponins
Troponin is a regulatory protein found
in straited muscles
Normal Value < 1.2
ng/mL(Troponin I)
- <0.2 ng/mL(TroponinT)
Rise 3 hours
Peaks 7 to 10 days(Troponin I)
- 10 to 14 days (Troponin
T)
4. Myoglobin
It is an oxygen-binding protein found
in striated muscle that releases
oxygen at very low tensions
Normal Value < 90 mcg/L
Rise 1 hour
Peaks 4 6 hours
Returns to Normal 24 36
hours
5. Electrocardiogram

Diagnostic Test
Serum Enzymes and Cardiac
Markers
1. Creatine Kinase

Forms of Acute Coronary

Syndrome
Unstable angina:
S/Sx of coronary ischemia
Normal ECG or cardiac Markers
ST-segment elevation MI:
ECG evidence of acute MI
NonST-segment elevation
MI:
elevated cardiac biomarkers
No definite ECG evidence of acute MI.
Interventions, acute stage

Place the client in a semiFowler's position to enhance

comfort and tissue oxygenation.
Administer oxygen at 2 to 4
L/min by nasal cannula as
prescribed.
Establish an IV access route.
Administer nitroglycerin as
prescribed.
Interventions, acute stage
Administer morphine sulfate
as prescribed to relieve chest
discomfort that is unresponsive
to nitroglycerin.
Obtain a 12-lead ECG.
Administer IV
antidysrhythmics as
prescribed.
Monitor thrombolytic
therapy, which may be
prescribed within the first 12
hours of the coronary event.