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35 Cards in this Set
- Front
- Back
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Angina
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Imbalance between oxygen supply and oxygen demand
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Normal coronary arteries
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supply the myocardium with blood to meet metabolic needs
Dilate when the myocardium needs more blood |
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CAD: coronary arteries occluded with atherosclerosis
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can't supply the myocardium with blood for normal workload
Usually 75% occlusion before angina results or symptoms are noticed |
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Other causes of angina
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Coronary artery spasm
Coronary arteritis Hypotension -spinal anesthesia -antihypertensives -blood loss Aortic valve stenosis Blood disorders -anemia, polycythemia |
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Ischemia
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1. exercise or stress
2. increased oxygen demand 3. coronary arteries can't accomodate (can't dilate) 4. Anaerobic metabolism 5. formation of lactic acid 6. pain occurs |
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Anaerobic metabolism causes lactic acid formation
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Lactic acid irritates myocardial fibers
Pain transmitted cardiac nerve and upper thoracic posterior nerve roots Pain can be referred Pain called ANGINA |
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Symptoms of Angina
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Not felt the same way by everyone
-tightening, squeezing -indigestion Women mostly feel anxious Any kind of pain from the umbilicus up could be MI |
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Symptoms include
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Tightening, pressure, squeezing, or aching sensation in the chest, arms, back, shoulders, neck, or jaw
Indigestion An ache that begins or spreads to the neck, jaw, throat, shoulder, back or arms |
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Associated symptoms include:
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SOB
diaphoresis weakness dizziness nausea vomiting uneasiness (anxiety) |
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Precipitating factors:
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exertion (increased oxygen demand & workload on heart, increased HR)
Emotions (release of catecholamines Heavy meal Hot or cold environment |
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Onset
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Sudden pain
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Duration (Stable Angina)
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3-5 minutes
Rarely longer than 20 minutes Relieved by rest or nitrates SL nitroglycerine (vasodilates) coronary artery, BP can plummet, they can get a HA |
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Intensity (Stable Angina)
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Rated on a scale from 1-10
Usually less than 5 Varies by individual |
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If angina persists, an MI, or damage to the heart muscle can occur
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Any pain >20 minutes need to call 911 and get to the hospital
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Types of Angina
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Stable (very predictable)
Unstable Variant |
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Stable Angina (Pain is always consistent)
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Syndrome of at least several weeks duration provoked by predictable activities that increase oxygen demands
should not be increasing in severity Should be relieved by rest, NTG, or oxygen |
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Management of Stable Angina
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Precipitating factors
Education Medication PTCI (cardiac cath for extent of CAD) |
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Unstable Angina (Pain is worse, comes at rest, need to go right to the hospital to be stabilized)
Placque formation may be starting to rupture, chest pain persists |
Recurring progressive episodes of angina pectoris lasting longer than 15 minutes and poorly relieved by rest or NTG
Deteriorating chronic angina ST or T wave changes associated with ischemia No change in cardiac enzymes or EKG evidence of acute MI |
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Management for Unstable Angina
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Need immediate hospitalization
Stabilize PTCI (Cardiac cath) Medication |
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Stable vs Unstable Angina
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Characteristics
Duration Precipitating event severity relief management |
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Variant or Prinzmetal's Angina
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Coronary arteries spasm
Occurs at rest Elevated STs Can be associated with cocaine Usually happens in women with small coronary arteries Hx of migraines or raynauds disease is more susceptible to prinzmetal's angina Treated with Calcium Channel Blockers |
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A note about women: Anterior MI
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Women under 50 are twice as likely to die after an AMI than men in the same age group
Women are 55% less likely than men to participate in cardiac rehab Women present with significant fatigue, anxiety. Thought they were having an anxiety attack. |
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Management of Variant Angina
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NTG
Ca Channel Blockers Vasodilate bring more blood to myocardium |
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Snapshot of the EKG
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the EKG wave that reflects the movement of electricity through the myocardium
Myocardial tissue that is ischemic or injured will transmit the electricity differently |
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What can you see on an EKG? (12 lead)
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P: begins with the firing of the SA node
-represents depolarization of the fibers in the atria QRS: represents depolarization from the AV node through the ventricles |
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What can you see on an EKG? (12 lead)
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PR Interval: Delay of transmission through the AV node, accounts for the time sequence from P to QRS
Width of the QRS represents time it takes ventricles to depolarize T: represents repolarization of the ventricles |
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Ischemia and ST Segment Depression
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Ischemia causes a change in repolarization (T wave area)
You will see changes in the ST segment and T-wave if the myocardium is ischemic ST Segment depression |
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EKG changes: ST depression, flipped T's
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Ischemic
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ST elevation
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Injury
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Angina Case Study
30-year old man with a hx of smoking, alcohol abuse, and cocaine use Presents with frequent episodes of chest pain, shortness of breath and diaphoresis while at rest Episodes of chest pain usually awaken him early in the morning and lasted a few minutes Tox screens negative for alcohol and controlled substances at time of admission |
Prinzmetal's Angina
Cardiac cath revealed hyperventilation-induced total occlusion of the proximal left circumflex artery Resolved with administration of intracoronary nitroglycerine and Diltiazem Symptoms controlled with oral nitrates and calcium-channel blockade during follow-up of two years |
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Goals of therapy
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Increase coronary artery blood supply
Reduce demands on the heart Relief of pain Modify risk factors |
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Health promotion activities
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Take medications as prescribed
Know what activities bring on angina and modify or avoid them Dress warmly in cold weather, avoid physical exertion in the cold air Allow plenty of time to accomplish a task If you become tired, sleep or rest Avoid eating large meals Dietary changes |
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Health promotion activities
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Limit caffeine
Avoid situations that trigger angina (outbursts of temper or excitement) Stop smoking Control diabetes Health maintenance -lose weight, get enough sleep, balanced diet, regular exercise, avoid exposure to infectious diseases Perform activities at a moderate pace |
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Viagra (Sildenafil)
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Enhances effects of nitric oxide released during sexual stimulation
-enhanced blood flow to the corpus cavernosum and erection Contraindicated with concurrent nitrate therapy: risk for serious and potentially fatal hypotension Caution with serious underlying cardiovascular disease |
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Nursing diagnosis with interventions
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Pain r/t myocardial ischemia
Activity intolerance r/t development of chest pain with exertion Knowledge deficit r/t disease process, medications, reduction of risk factors, lifestyle changes, symptoms to report |
