Means: Squeezing Pain
Angina
Angina ______ with age
Increases
Stable angina: Lasts less than \_\_\_ minutes. Is triggered by exertion or emotional \_\_\_\_\_\_\_. Requires greater than \_\_\_% stenosis Involves reversible \_\_\_\_\_\_\_\_\_ injury
20
stress
70
myocyte
What is it if angina lasts longer than 20 min?
Myocardial infarction
In which type of angina does everything work under normal circumstances but when something abnormal happens (Like running up stairs) patient feels the pain.
Stable Angina
Signs and Symptoms of Stable angina: (4)
- Chest pain less than 20 minutes
- Pain that radiates
- Diaphoresis
- SOB
Type of angina that occurs at rest
unstable
Unstable Angina: Involves a ruptured \_\_\_\_\_\_\_\_\_\_ and thrombosis. Only \_\_\_\_\_\_\_\_ occlusion results. Reversible \_\_\_\_\_\_\_\_\_ injury Is blood flow still present?
plaque
partial
myocyte
Yes, but decreased.
Type of angina that:
- Is caused by vasospasm
- Is unrelated to exertion
- Has reversible myocyte injury (If less than 20 minutes)
Prinzmetal
Angina = ___ demand is greater than supply
O2
Best option for a person suffering angina: Decrease what?
The work of the heart
When you decrease the HR you decrease the work of the heart but you also increase _________ and the coronary artery perfusion (fill) during.
Diastole
When does the heart “eat” (fill).
Diastole
Most anginas come with an EKG that reflects what?
ST depression
What type of angina comes with ST elevation?
Prinzmetal
- Prinzmetal angina comes with ST elevation because?
2. ST elevation is what also shows up when a patient is having a ____ ?
blood flow is totally cut off
MI
What does STEMI stand for?
ST elevated MI
How should a nurse teach a patient taking nitroglycerine to position themselves and why?
Sit or lie down before taking because it will work really quickly and drop blood pressure.
Why is nitroglycerine dissolved under the tongue?
To avoid first pass metabolism.
What happens if nitroglycerine doesn’t relieve the pain in 5 minutes?
Take another one
Nitroglycerine is indicated for Q5M. How many doses can be taken?
3
Ways that nitro can be administered? (5)
Sublingual tabs Translingual spray oral capsules SR transdermal patch topical ointment
Can you crush isosorbide mononitrate?
No
How long does isosorbide mononitrate last?
12 hours
What kind of drug is isosorbide mononitrate?
Nitrate
MOA of nitrates:
reduces cardiac oxygen demand by decreasing left ventricular pressure and preload
Discuss why a client might take nitroglycerin prior to a stressful event.
Rapid-acting preparations also can be used for acute prophylaxis of angina. For this purpose, they are taken just before anticipated exertion
Identify which clients might benefit from a long acting or transdermal nitrate:
These would be for someone looking to prevent an angina episode. These are not for an acute attack.
Because sublingual administration of nitroglycerine works fast, this route is ideal for (2):
- Terminating an ongoing attack and
2. Short-term prophylaxis when exertion is anticipated.
Effects of sublingual nitroglycerin begin rapidly—in ___ to ___ minutes—and persist up to __ hour.
1-3
1 hour
By lowering the blood pressure, nitroglycerin can activate what reflex?
baroreceptor reflex,
By lowering the blood pressure, nitroglycerin can activate baroreceptor reflex causing:
(reflex tachycardia) sympathetic stimulation of the heart
What can prevent the reflex tachycardia response that comes with nitroglycerine:
Pretreatment with a beta-blocker or verapamil can prevent
How does increasing time spent in diastole help the client with angina?
It increases the time blood flows through myocardial vessels.
What is the goal heart rate when administering a beta blocker?
50-60 beats per minute
Why cant you use beta blockers to treat prinzmetal angina?
Because it involves coronary vasospasm and beta blockers can make that worse.
Adverse effects of isosorbide mononitrate?
Headache (50%),
Orthostasis,
Flushing (esp the face),
Dizziness
Nitroglycerine can be taken every ___ minutes
5
Nitrates have interactions with drugs containing:
PDE 5 (The enzyme that breaks down cGmp)
