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Flashcards in Week 4 Deck (19):
1

Cardiovascular causes of chest pain

Coronary heart disease
Myocardial ischaemia
Coronary artery spasm
Myocardial infarction
Pericarditis
Pulmonary embolism
Mitral valve prolapse
Ca usually secondary cancer

2

Non-cardiovascular causes of chest pain

Dissecting Thoracic Aneurysm
Herpes Zoster
Oesophageal reflux
Oesophageal spasm
Hiatus hernia
Pneumonia
Pneumothorax
Pleurisy
Peptic ulceration
Gallbladder disease
Musculoskeletal pain
Costochondritis

3

Coronary artery disease

Atherosclerosis is most common cause of CAD:
Abnormal collection of fats/fibrous tissue within the arterial wall/lumen
Formation accelerates with smoking/dyslipidaemia/diabetes/hypertension/genetic disposition

Potentially results in:
Vessel stenosis/occluding blood flow to the myocardium
Aneurysm
Can impede coronary blood flow depriving muscles of oxygen:
Causing ischaemia
Angina pectoris demonstrates ischaemia of cardiac muscle

4

Non-modifiable risk factors of CAD

Age
Gender
Ethnicity
Genetic predisposition
Low birth weight
Diabetes mellitus
Hormonal / biochemical factors

5

Modifiable risk factors of CAD

Blood cholesterol
Tobacco smoking
High blood pressure
Overweight / obesity
Diet
Alcohol consumption
Social class
Geographical distribution

6

Stable angina

Pain occurs with increasing workload
Stable atherosclerotic plaque
Pain stable and predictable occurs with emotion or exertion
Crescendo/decrescendo pain
Radiates to neck/shoulders/ arms lasting 2 – 5 mins
Relieved by rest
ECG – T Wave inversion during angina
Cardiac markers normal

7

Acute coronary syndrome

Pain increasing with coronary artery spasm or unstable plaque/thrombus blockage
Pain occurs at rest and is increasing in severity/frequency
Pain last 10 mins or longer and radiates to neck left shoulder/arm
ECG – ST segment depression with
T Wave inversion (~ diagnostic)
Cardiac marker may be initially normal/have late elevation

8

Management of angina/ACS

A to E
Oxygen at 6L/min via Hudson Mask- only if sats are 94 or below and hypoxic
Medicate as prescribed
Assess chest pain

9

Assessing chest pain

P – precipitating factors:
Presenting complaint
sudden onset?
woken by pain?
Induced by exercise/ exertion?


Q – quality:
How severe is the pain?
Use pain scale
Is this like the usual pain?
Does the pain change on movement or inspiration?

R – radiation:
Does the pain radiate anywhere?
Through to the back
To the shoulder
Up into the neck and jaw
Down the arm/arms

S – severity:
Are there associated symptoms?
Sweating
Nausea
Vomiting
Dyspnoea

T – time of onset:
When did the pain start?

10

Nursing observations/monitoring

Reassure patient – rest
Baseline observations
? Need for cardiac monitoring
12 lead ECG
IV access
Troponin (T & I) levels and cardiac enzymes (CK – creatine kinase)
Contact Dr

11

Diagnostic tests

Electrocardiogram:
Serial
Reveal ischaemia
Reveal injury
Reveal infarction

Cardiac troponins:
Troponin I and T : biochemical markers
2-3 times during a 12- to 16-hour period.

Cardiac enzymes:
Early detection after heart damage: 4 – 6 hours.
Raised CK indicator of muscle damage
CK-MB heart
CK-MM muscle

Chest Xray:
Size and location of the heart.
Demonstrate hypertrophy in heart failure

Echocardiogram:
Allows examination of valves and myocardial wall movements.
Holter Monitoring: if dysrythmias present, syncope.

12

Coronary Artery/vasodilator drugs
oral Anginine (Glyceryl trinitrate)

Give if prescribed and usually takes it
If BP > 90 systolic
Monitor BP (and Heart Rate!)
Effects: reduce pain
Cause peripheral and coronary vasodialtion
Reduces myocardial oxygen demand
Increase blood flow
Side effects: dilates blood vessels

13

Long acting nitrate preparations – Isosorbide dinitrate (isordil), Isosrbide Mononitrate (Imdur)

Development of tolerance
Side effects:
General: hypersensitivity to nitrates
CNS: dizziness and hypotension, headache,
GIT: nausea, vomiting
CV: palpitation, postural hypotension, tachycardia
Contraindicated: increased intracranial pressure, hypersensitivity to nitrates
Administer: empty stomach

14

Beta blockers – metoprolol, atenolol, propanolol

Block cardiac-stimulating effects of norepinephrine and epinephrine
Reduce:
Heart rate
Myocardial contractility
Blood pressure
reduces myocardial oxygen demand
Contraindicated:
Bradycardia
AV conduction blocks
Cardiogenic shock
NB: Asthma and COPD

15

Calcium Channel Blockers – verapamil, diltiazem, and nifedipine

Vasodilators
Reduces myocardial oxygen demand
Lowers blood pressure
Long term prophylaxis
**dysrhythmias, heart failure and hypotension

16

Morphine

Pain management
Reduces:
respiratory rate
anxiety
myocardial oxygen demand
blood pressure
venous return

17

Nursing care

Detect arrhythmias early
Provide oxygen
Bed rest or initial minimal activity
12 lead ECGs
Serial blood tests
IV cannula to administer drugs

ongoing management:
Repeat ECGs
Observe for associated symptoms
Evaluate effectiveness of interventions

18

Why take an ECG

Detect and monitor changes in heart rate and rhythm
Make clinical diagnosis
Assess treatments

19

What is an ECG

Electrocardiogram
Recording of the electrical activity of the heart