ANGINA PECTORIS / MYOCARDIAL ISCHEMIA

Angina Pectoris / Myocardial Ischemia

Transient CHEST PAIN caused by insufficient blood flow to the myocardium resulting in myocardial ischemia.

Angina Pectoris / Myocardial Ischemia

Results when myocardial oxygen demand exceeds myocardial oxygen supply.

Angina Pectoris / Myocardial Ischemia

CAUSES
Atherosclerosis
is a condition in which a fatty substance/cholesterol builds up (plaques) inside the blood vessels and can block blood flow through the vessels partially or completely.

Angina Pectoris / Myocardial Ischemia

CAUSES
Hypertension
occurs when blood is forced through the arteries at an increased pressure.

 CAUSES Polycythemia Vera a blood disorder in which your bone marrow makes too many red blood cells that causes your blood to be thicker than normal, which can slow the rate of blood flow through your veins and arteries. Diabetes Mellitus Increases risk for atherosclerosis.

Angina Pectoris / Myocardial Ischemia

Angina Pectoris / Myocardial Ischemia

CAUSES
Thromboangiitis obliterans (Buergers Disease)
is a nonatherosclerotic segmental inflammatory disease that most commonly affects the small and medium-sized arteries, veins, and nerves of the arms and legs.

Angina Pectoris / Myocardial Ischemia

CAUSES
Aortic Regurgitation
is a condition that occurs when your heart's aortic valve doesn't close tightly

Angina Pectoris / Myocardial Ischemia CLINICAL MANIFESTATIONS PAIN

Transient Heaviness or tightness of chest Radiates down 1 or both arms, left shoulder, jaw, neck and back Relieved by rest

Angina Pectoris / Myocardial Ischemia

CLINICAL MANIFESTATIONS

Pallor Diaphoresis Dyspnea Faintness

Angina Pectoris / Myocardial Ischemia

CLINICAL MANIFESTATIONS

palpitations Dizziness Digestive disturbances

Types
TYPES
DURATION OF CP

Stable Unstable

<15 mins >15mins but <30 mins

RECURRE NCE Less frequent

More frequent; may occur at night

OTHERS

Intensity of pain increases

TYPES Variant

DURATION OF CP

RECURRE NCE

OTHERS
May result from coronary artery spasm

Longer and Occur in may occur early hours at rest of the day

Nocturnal

Night time

Associated with Rapid Eye Movement (REM) sleep

RECURRE OTHERS NCE Paroxysmal Angina When CP Decubitus client sits or stand ups Intractable chronic, incapacitating, unresponsive to intervention Postinfarction occurs after MI

TYPES

DURATION OF CP

Angina Pectoris / Myocardial Ischemia

PRECIPITATING EVENTS
exertion emotions eating a heavy meal Environment. Exposure to cold

Angina Pectoris / Myocardial Ischemia

COLLABORATIVE MGT
medications
Vasodilators: Nitroglycerine, Amyl
Nitrates, Isosorbide

Relaxes vascular smooth muscle peripheral resistance, systolic pressure, preload

Angina Pectoris / Myocardial Ischemia

Beta adrenergic
Propranolol (Inderal) Metoprolol (Lopressor) myocardial oxygen demand by HR, BP, myocardial contractility and calcium output

Angina Pectoris / Myocardial Ischemia

Calcium channel blockers
Verapamil (Isoptin), Nifedipine (Calcibloc), Diltiazem (Cardizem) Inhibit ion transportation to myocardial cells Has vasodilation effect Reduces coronary vasospasm

Angina Pectoris / Myocardial Ischemia

Platelet Aggregation Inhibitors
ASA, Dipyridamole (Persantin), Ticlopidine (Ticlid) Inhibit platelet aggregation, thereby preventing thrombus formation

Nursing Interventions in Drug Therapy

Nitroglycerine
Sitting or supine position prevents orthostatic hypotension Max of 3 doses @ 5 min interval Gradual change of position to prevent OH SL meds causes burning or stinging sensation under the tongue.

Nursing Interventions in Drug Therapy

Nitroglycerine
SL produces onset of action 1 2 mins and lasts for 30 mins Offer sips of water before giving SL nitrates Cessation from alcoholic drinks

Nursing Interventions in Drug Therapy

Beta-adrenergic blockers
Assess PR before administration Administer with food to prevent GI upset Do not admin PROPANOLOL to ASMATHIC & DM patients

Nursing Interventions in Drug Therapy

Calcium Channel Blockers
Assess HR and BP Monitor hepatic and renal function Admin. 1hr before or 2hrs after meal.

Nursing Interventions in Drug Therapy

Platelet Aggregation Inhibitors
Assess for S/Sx of bleeding Avoid straining at stool Dont give ASA with caumadin ASA should be given with food Observe for ASA toxicity - tinnitus

Nursing Interventions in Drug Therapy

Heparin Sodium
Assess for S/Sx of bleeding Keep protamin sulfate readily available Used for maximum of 2wks

Nursing Interventions in Drug Therapy

Caumadin
Assess for S/Sx of bleeding Keep vit. K readily available Monitor Prothrombin time Minimize green leafy vegetables

Treatment
Percutaneous Transluminal Coronary Angioplasty (PTCA) Intravascular Stenting Laser Therapy

Nursing Interventions
Diet
Low Na, low fat and low cholesterol, high fiber diet Avoid saturated fats

Surgical Management
Coronary Artery Bypass Graft
Reduces angina and improves activity tolerance Recommended if narrowing of one or more branches of the coronary arteries Main purpose is for MYOCARDIAL REVASCULARIZATION

Nursing Management in CABG

Promoting comfort
Relieve pain DOC: Nitroglycerine

Promoting Tissue Perfusion

Avoid over-fatigue Stop activity If symptoms persists

Nursing Management in CABG

Promoting activity and rest
Avoid overexertion DOC: Nitroglycerine before exercise

Facilitating Learning Promoting relief of anxiety

Nursing Management in CABG

Promoting comfort
Relieve pain DOC: Nitroglycerine

Promoting Tissue Perfusion

Avoid over-fatigue Stop activity If symptoms persists

Nursing Management in CABG

Promoting comfort
Relieve pain DOC: Nitroglycerine

Promoting Tissue Perfusion

Avoid over-fatigue Stop activity If symptoms persists