Brief DescriptionAnatomy And And

PhysiologyPathophysiology

LaboratoryDrug Study

Nursing Care Plan

Definition-chest

pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries.

Angina pectoris

Symptoms•Chest discomfort - pressure, heaviness, tightness, squeezing, burning, or choking sensation

•Anginal pains - epigastrium (upper central abdomen), back, neck, jaw, or shoulders.

*Pain may be accompanied by breathlessness, sweating and nausea in some cases.

Major risk factors • cigarette smoking• diabetes•high cholesterol• high blood pressure• sedentary lifestyle • family history of premature heart disease.

Three main types of angina:1.Stable angina 2.Unstable angina3.Variant angina

(Prinzmetal’s angina)

Diagnosis•Exercise Electrocardiogram or

graded exercise test•Nuclear Cardiology•Coronary Angiography

TreatmentThe main goals of

treatment in angina pectoris are relief of symptoms, slowing progression of the disease, and reduction of future events, especially heart attacks and of course death.

•aspirin (75 mg to 100 mg) /day

-beneficial for all patients with stable angina that have no problems with its use.

•Beta blockers-have a large body of evidence in morbidity and

mortality benefits and short-acting nitroglycerin medications are used for symptomatic relief of angina.

•A new therapeutic class, called If inhibitor, has recently been made available: ivabradine provides pure heart rate reduction, leading to major anti-ischemic and antianginal efficacy.

•Calcium channel blockers

-vasodilators commonly used in chronic stable angina.

•ACE inhibitors -statins are the most frequently used lipid/cholesterol

modifiers which probably also stabilise existing atheromatous plaque.

•Ranolazine (Ranexa)- A new class of anti anginal drug that was approved by

the Food and Drug Administration

•Identifying and treating risk factors for further coronary heart disease is a priority in patients with angina. This is a new class of antimeans testing for elevated cholesterol and other fats in the blood, diabetes and hypertension (high blood pressure).•Encouraging stopping smoking and weight optimization.•Exercise

Definition- the

blood supply to a part of the heart is interrupted, most commonly due to rupture of a vulnerable plaque.

Myocardial infarction

Symptoms •chest pain (typically radiating to the left arm)

•shortness of breath•nausea, vomiting•palpitations•sweating•anxiety

Immediate treatmentMorphine sulfateOxygen therapyNitroglycerineAspirin

Risk factorsrisk factors for atherosclerosis are

generally risk factors for myocardial infarction:

•Older age•Male sex•Tobacco smoking•Hypercholesterolemia

(more accurately hyperlipoproteinemia, especially high low density lipoprotein and low high density lipoprotein)

•Hyperhomocysteinemia-high homocysteine, a toxic blood amino acid that is elevated when intakes of vitamins B2, B6, B12 and folic acid are insufficient

•Diabetes (with or without insulin resistance)

•High blood pressure•Obesity

Diagnosis•Serial 12-lead ECG•ECG•Serial cardiac enzymes and proteins (creatine,troponin and myoglobin)

•Leukocytosis, increase in ESR secondary to inflammation

•Nuclear imaging identify areas of infarction•Cardiac catheterization

Treatment•Thrombolytic therapy - to restore vessel patency

•PTCA- open block or narrowed arteries

•Oxygen administration

•Sublingual NTG- to relieve pain(don’t give if BP is < 90/60 mmHg or HR<50 or>100 bpm

•Morphine•Aspirin to inhibit platelet aggregation

•Lidocaine to combat arrhythmias

Complications•Congestive heart failure•Myocardial rupture•Life-threatening arrhythmia•Pericarditis•Cardiogenic shock

Lab Studies•Troponin is the preferred biomarker for diagnosis.

•Creatine kinase–MB level  •Myoglobin levels  •Complete blood count - CBC is indicated if anemia is suspected as a precipitant. Transfusion with packed red blood cells may be indicated.

•Leukocytosis may be observed within several hours after an AMI. It peaks in 2-4 days and returns to levels within the reference range within 1 week.

•Chemistry profile•C-reactive protein (CRP) is a marker of acute inflammation. Patients without biochemical evidence of myocardial necrosis but with elevated CRP level are at increased risk of a subsequent ischemic event.

•Erythrocyte sedimentation rate (ESR) rises above reference range values within 3 days and may remain elevated for weeks.

•Serum lactate dehydrogenase (LDH) level rises above the reference range within 24 hours of MI, reaches a peak within 3-6 days, and returns to the baseline within 8-12 days

Imaging Studies•Chest radiography•Echocardiography•Technetium-99m sestamibi scan•Thallium scanning: Thallium accumulates in the viable myocardium.

•Perfusion imaging for measurement of infarct size to evaluate reperfusion therapies.

•Novel "hot spot" imaging radiopharmaceuticals that visualize infarction or ischemia are currently undergoing evaluation and hold promise for the future.

•Recent advances include dual-source 64-slice CT scanning that can do a full scan in 10 seconds and produce high-resolution images that allow fine details of the patient's coronary arteries to be seen.

•MRI can identify wall thinning, scar, delayed enhancement (infarction), and wall motion abnormalities (ischemia).

Nursing Considerations•Assess and record the severity and radiation of pain and administer analgesics•Avoid IM injections•Check patients BP after giving NTG specially the first dose

•Frequently monitor ECG to detect rate changes or arrhythmias•During periods of chest pain, obtain 12 lead ECG, BP and pulmonary artery catheter measurements and monitor them for changes

•Auscultate for adventitious breath sounds, S3 or S4 gallops and new onset heart murmurs•Provide a stool softener to prevent staining during defecation which causes vagal stimulation and may slow heart rate

•Assist patient with ROM exercises•If patient is immobilized by severe MI, reposition every 2 hours•Measure for and apply anti-embolism stockings to prevent venostasis and thrombophlebitis

•Provide emotional support to patient and help reduce stress and anxiety•Teach patient about drug therapy and other treatment measures to promote compliance