Angina Pectoris

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

Angina Pectoris
Predisposing Factor Predisposing Factor

Atherosclerotic Physical Exertion

Disease Exposure to Cold
Eating Heavy
Meal
Emotional Stress

Obstruction of
major coronary Ischemia
artery
 Stable angina:
Unstable angina
Intractable or refractory angina
Variant angina (also called
Prinzmetal's angina)
Silent ischemia

Types of Angina
 Pain

Retrosternal area
Pain or discomfort is poorly localized
May radiate to the neck, jaw, shoulders,
and inner aspects of the upper arms,
usually the left arm.

Signs and Symptoms

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.

Medical Management
Nitroglycerin

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.
Medical Management
 Beta Adrenergic Blocking Agents
Calcium Channel Blockers
Aspirin
Clopidogrel and Ticlopidine
Heparin
Oxygen Administration

Medical Management
 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

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

Myocardial Infarction
Predisposing Factor Predisposing Factor

Atherosclerotic Physical Exertion

Disease Exposure to Cold
Eating Heavy
Meal
Emotional Stress

Complete
Obstruction of a Ischemia
coronary artery

Necrosis
Artery Obstructed Area Affected
Left anterior descending artery Anterior wall or septal MI
Circumflex artery Posterior wall or Lateral wall MI
Right coronary artery Inferior wall MI

Location of MI
Serum Enzymes and
Cardiac Markers Creatine Kinase

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

Diagnostic Test
Serum Enzymes and Lactate Dehydrogenase
Cardiac Markers (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

Diagnostic Test
Serum Enzymes and
Cardiac Markers Troponins

Troponin is a regulatory protein found in straited

muscles
Normal Value < 1.2 ng/mL(Troponin I)
- <0.2 ng/mL (Troponin T)
Rise 3 hours
Peaks 7 to 10 days(Troponin I)
- 10 to 14 days (Troponin T)

Diagnostic Test
Serum Enzymes and
Cardiac Markers 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

Diagnostic Test
Electrocardiogram

ST segment elevation
T wave inversion
Abnormal Q wave
(permanent)

Diagnostic Test
 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.

Forms of Acute Coronary Syndrome

 Place the client in a semi-Fowler'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.
Interventions, acute stage