week 5- angina Flashcards
(39 cards)
Coronary Artery Disease
Also known as Coronary Heart Disease (CHD)
Most common form of heart disease
Atherosclerosis:
Build of plaque (fats, cholesterol) within the arterial wall
Leading risk factor for cardiovascular disease
Affects larger arteries (eg: coronary arteries, aorta, carotid arteries)
Arteriosclerosis:
thickening or hardening of the arterial wall, often associated with aging
Pathophysiology of chd
Exact cause Unknown
Thought to occur due to blood vessel damage that causes an inflammatory response
Intimal artery surface fatty streaks
Plaque formation causes partial or complete blockage of artery
Stable vs Unstable plaques:
Unstable plaque rupture leads to platelet adhesion and rapid thrombus formation
Blockage may be sudden or gradual
May result in ischemia (CELL DEATH BECAUSE OF NO O2)or infarction(NO O2 AND DAMAGE)
Heart disease and stroke are ___of the three leading causes of death in Canada
two
—% of all deaths caused by cardiovascular disease
29
Prevalence:
how many people in the population have the condition at a specific point in time (ie: 1.3 million Canadians)
Incidence:
the number of incidences of a certain condition, over a certain time period, in a specific population (70,000 MI’s annually)
Women and Heart Disease
New research suggests more similarities than differences between men and women Women may describe pain differently Fatigue **most predominant symptom Shortness of breath Indigestion Anxiety Frequently dismissed or misdiagnosed
Myocardial Infarction in Women
Number one killer of Canadian women
MI presentation more “typical” than angina
More likely to present with NSTEMI (non-ST-segment-elevation myocardial infarct)
More likely to reinfarct within 1 year
Poorer prognosis following acute MI
angina
Temporary imbalance between the coronary arteries’ ability to supply oxygen & cardiac muscle’s demand for O2 = Ischemia
Referred to as a vague sensation, a strange feeling, pressure, or ache in the chest
An unpleasant feeling described as constrictive, squeezing, heaving, choking, or suffocating sensation
Also caused by: anemia, hypoxia due to hypotension, dysrhythmias
Stable Angina
chest pain occurs intermittently over a long period of time with the same pattern of onset, duration and intensity
some ay deny feeling pain, often describe pressure or ache in the chest
Unpleasant feeling often described as constrictive, squeezing, heavy, choking, or suffocating sensation
**NB: rarely sharp or stabbing and usually does not change with position or breathing
Many c/o indigestion or a burning sensation in the epigastric region
Most c/o pain substernal, radiating to various locations see Lewis, Figure 36-5, p 904
Pain usually brief (3 to 5 minutes) and commonly resides when precipitant factor is relieved
- pain at rest unusual
EKG: usually transient ST segment depression, indicative of ischemia
relieved by nitroglycerin
Unstable Angina
pain that is new, occurs at rest, or has a worsening pattern
pain is easily provoked by minimal to no exertion, during sleep or rest
pain has progressed rapidly in past few hours, days or weeks
pain refractory to nitroglycerin
Stable Angina Triggers
Exertion (most common) ie raking, snow shoveling, lift heavy objects
Emotional stress
Exposure to very hot or cold temperatures
Heavy meals
Smoking
Sexual activity
Drug Therapy
Decrease O2 demand and/or increase O2 supply
Short-acting nitrates: Sublingual nitroglycerin
Long-acting nitrates: isosorbide dinitrate (Isordil)
β-adrenergic blockers: metoprolol
Calcium channel blockers if β-adrenergic blockers are poorly tolerated, contraindicated, or do not control anginal symptoms
Angiotensin-converting enzyme (ACEI) inhibitors
Angiotension Receptor Blockers (ARBs)
Low dose ASA (antiplatelet)
Short-acting nitrates: first-line therapy for angina
Action:
- dilate peripheral blood vessels -> decreased systemic vascular resistance, venous pooling, and decreased venous blood return to the heart.
- dilating coronary arteries and collateral vessels -> may increase blood flow to ischemic areas of heart
Usually relieves pain in approx. 3 minutes, duration 30 – 60 minutes.
Dose:
1 tablet or spray sublingually (directly under the tongue) allow tab to dissolve
NB: symptoms unchanged or worse in 5 minutes -> EMS
no tingling sensation and chest pain persists -> EMS
Patient ed.: - 1)proper use of nitro, 2)easy accessible to patient all times, 3)store in tightly closed dark glass bottle, 3) adverse effects – increase heart rate, pounding headache, dizziness or flushing, orthostatic hypotension 4) once bottle opened, get new meds in 6 months
Chronic Stable Angina-Diagnostic Studies
Health history*** Symptom Assessment: PQRST Physical exam Laboratory studies 12-lead ECG Chest x-ray Echocardiogram Exercise stress test
PQRST
SYMPTOM ASSESSMENT
P – precipitating events
Q- quality of pain (what the pain feel like?)
R – radiation of pain (where is the pain located? Does pain
radiate to other areas? If so, where?)
S – severity of pain ( how would you rate your pain on a
scale 0 – 10 10 being the most severe pain)
T – timing (when did the pain begin? Has the pain
changed since this time? Have you had this type of
pain before?)
ACS: Unstable Angina
May occur at rest
Responds poorly to SL nitroglycerin…or not at all
Requires morphine to manage pain
Difficult to differentiate from MI
ECG changes (ST depression) noted
No elevation of cardiac markers Troponin or CK-MB
Prinzmetal’s Angina (also called Variant Angina)
Due to vasospasm
Often occurs at rest
Infarction:
- results from sustained ischemia, causing
irreversible myocardial cell death
- within 20 minutes of sustained ischemia–cellS die
Manifestations OF AMI
- Pain – heaviness, pressure, tightness, burning
- Location – substernal, or epigastric area, radiate to neck, jaw, arms or back
- Timing– rest, asleep, or awake, commonly in AM
**Clients with diabetes more likely to experience silent (asymptomatic) AMI due to cardiac neuropathy
*Women may also have atypical presentation
May seek treatment for atypical symptoms
*Older Adults: change in mental status (confusion), shortness of breath, pulmonary edema, dizziness, or a dysrhythmia
*Skin- ashen, clammy, & cool to touch
*CV – BP & HR may be elevated initially, BP may drop d/t decreased CO, if severe – decreased renal perfusion & urine output. Crackles may be notes, JVD, hepatic engorgement, peripheral edema
*GI-Nausea & Vomiting
*Fever – temp may increase within first 24h up to 380C
Morphine sulfate –
decreases myocardial O2 demand, relaxes smooth muscle, reduces circulating catecholamine; 2 – 4 mg dose q 5 – 15min; adverse effects: resp depression, hypotension, bradycardia, severe vomiting
