Podcast
Questions and Answers
What causes angina pectoris?
What causes angina pectoris?
- Reduced heart rate
- Increased physical activity
- Insufficient blood flow to the myocardium (correct)
- Excessive oxygen supply to the myocardium
Which type of angina pectoris lasts for more than 15 minutes?
Which type of angina pectoris lasts for more than 15 minutes?
- Prinzmetal’s angina
- Nocturnal angina
- Unstable angina (correct)
- Stable angina
Which type of angina is characterized by chest pain that occurs at rest due to coronary artery spasm?
Which type of angina is characterized by chest pain that occurs at rest due to coronary artery spasm?
- Post infarction angina
- Intractable angina
- Stable angina
- Prinzmetal’s angina (correct)
Which of the following conditions is NOT a cause of angina pectoris?
Which of the following conditions is NOT a cause of angina pectoris?
What is a characteristic feature of stable angina?
What is a characteristic feature of stable angina?
What physiological process increases due to diminished myocardial oxygenation in angina pectoris?
What physiological process increases due to diminished myocardial oxygenation in angina pectoris?
Which type of angina is also known as refractory angina?
Which type of angina is also known as refractory angina?
Chest pain that occurs in a sitting or lying position is known as what type of angina?
Chest pain that occurs in a sitting or lying position is known as what type of angina?
Which of the following are considered provoking factors for Angina?
Which of the following are considered provoking factors for Angina?
What is a common characteristic of chest pain associated with Angina?
What is a common characteristic of chest pain associated with Angina?
Which treatment is traditionally used to relieve anginal pain?
Which treatment is traditionally used to relieve anginal pain?
What assessment is crucial following an episode of chest pain?
What assessment is crucial following an episode of chest pain?
Which nursing intervention helps to decrease patient anxiety during an angina episode?
Which nursing intervention helps to decrease patient anxiety during an angina episode?
What is the primary cause of Myocardial Infarction (MI)?
What is the primary cause of Myocardial Infarction (MI)?
Which dietary component should be avoided to manage heart health effectively?
Which dietary component should be avoided to manage heart health effectively?
What is a typical early sign of a Myocardial Infarction?
What is a typical early sign of a Myocardial Infarction?
What cardiac enzyme is typically released first after a myocardial infarction (MI)?
What cardiac enzyme is typically released first after a myocardial infarction (MI)?
What is the primary consequence of myocardial necrosis?
What is the primary consequence of myocardial necrosis?
Which type of myocardial infarction affects the entire thickness of the heart muscle?
Which type of myocardial infarction affects the entire thickness of the heart muscle?
During the first 24 hours after MI, which complication is most likely to occur?
During the first 24 hours after MI, which complication is most likely to occur?
What is a significant risk during the granulation phase within 10 days post-MI?
What is a significant risk during the granulation phase within 10 days post-MI?
Which of the following is NOT a common cause of myocardial infarction?
Which of the following is NOT a common cause of myocardial infarction?
What happens in the zone of injury surrounding an area of myocardial necrosis?
What happens in the zone of injury surrounding an area of myocardial necrosis?
What occurs to the heart size and functionality within two months after an MI?
What occurs to the heart size and functionality within two months after an MI?
What is the primary effect of nitroglycerine on coronary vessels?
What is the primary effect of nitroglycerine on coronary vessels?
What is a common nursing consideration when administering beta-blockers?
What is a common nursing consideration when administering beta-blockers?
Which drug category ends with 'sartan' and is used to block angiotensin II receptors?
Which drug category ends with 'sartan' and is used to block angiotensin II receptors?
What important monitoring is required for patients taking statins?
What important monitoring is required for patients taking statins?
What should be done if a patient experiences a burning sensation after placing a nitroglycerine tablet under their tongue?
What should be done if a patient experiences a burning sensation after placing a nitroglycerine tablet under their tongue?
Which calcium channel blocker should be administered 1 hour before or 2 hours after a meal?
Which calcium channel blocker should be administered 1 hour before or 2 hours after a meal?
What is the primary purpose of morphine sulfate in the context of myocardial infarction (MI)?
What is the primary purpose of morphine sulfate in the context of myocardial infarction (MI)?
What is the primary action of statins on cholesterol levels?
What is the primary action of statins on cholesterol levels?
Which of the following medications is contraindicated in patients with pancreatitis?
Which of the following medications is contraindicated in patients with pancreatitis?
What is the antidote for beta blocker poisoning?
What is the antidote for beta blocker poisoning?
What should a nurse monitor for in a patient receiving anti-thrombotic agents like Lovenox and Heparin?
What should a nurse monitor for in a patient receiving anti-thrombotic agents like Lovenox and Heparin?
What is the main concern when administering meperidine (Demerol) to a patient?
What is the main concern when administering meperidine (Demerol) to a patient?
What dietary modification should a patient on Warfarin Sodium (Coumadin) implement?
What dietary modification should a patient on Warfarin Sodium (Coumadin) implement?
What should be kept at the bedside when administering morphine sulfate?
What should be kept at the bedside when administering morphine sulfate?
Which medication should not be given together with Coumadin to prevent increased bleeding risk?
Which medication should not be given together with Coumadin to prevent increased bleeding risk?
What is a common nursing consideration regarding thrombolytic therapy?
What is a common nursing consideration regarding thrombolytic therapy?
Study Notes
Angina Pectoris/Myocardial Ischemia
- Characterized by insufficient blood flow to the myocardium, leading to inadequate oxygen supply and transient chest pain.
- Causes include atherosclerosis, hypertension, diabetes mellitus, thromboangiitis obliterans, polycythemia vera, and aortic regurgitation.
- Pathophysiology involves reduced coronary tissue perfusion, diminished myocardial oxygenation, anaerobic metabolism, and increased lactic acid production, resulting in chest pain.
Types of Angina Pectoris
- Stable Angina: Most common type; pain lasts less than 15 minutes, relieved by rest or nitroglycerin, recurrence less frequent.
- Unstable Angina: Pain exceeds 15 minutes, unrelieved by rest or nitroglycerin, more frequent recurrence, requires aggressive therapy.
- Prinzmetal’s (Vasospastic) Angina: Episodic angina occurring at rest due to coronary artery spasm, responds to vasodilators.
- Intractable Angina (Refractory): Chronic pain unresponsive to interventions.
- Nocturnal Angina: Occurs at night, associated with REM sleep.
- Angina Decubitus: Pain occurs when sitting or lying down.
- Post-infarction Angina: Develops after myocardial infarction due to residual ischemia.
Clinical Manifestations
- Transient substernal or precordial chest pain, described as squeezing, burning, or tightness.
- Pain may radiate to arms, shoulders, jaw, neck, or back, often resembling gas or heartburn.
- Precipitated by physical exertion, relieved by rest and nitroglycerine.
Assessment of Chest Pain
- Consider precipitating factors (e.g., exertion, emotion, eating, environment).
- Assess quality, region, severity, timing, and current treatment of the pain.
Subsequent Assessment
- Obtain a 12-lead ECG to evaluate heart activity.
- Review medical history and current drug therapy.
Additional Clinical Manifestations
- Symptoms may include pallor, diaphoresis, dyspnea, faintness, palpitations, and dizziness.
Nursing Interventions
- Assess chest pain level and duration; place the patient in a comfortable position.
- Monitor vital signs every 5-10 minutes until pain subsides.
- Administer oxygen and nitroglycerine as ordered and monitor pain relief.
- Instruct to avoid overexertion and stop activities immediately.
- Maintain patient emotional well-being, provide education about the condition, and teach relaxation techniques.
Dietary Recommendations
- Low sodium, low fat, high fiber diet; limit saturated fats; opt for white meats.
- Read nutrition labels carefully to avoid high cholesterol foods.
Myocardial Infarction (MI)
- Results from prolonged blood flow deprivation leading to lack of oxygen and myocardial tissue death (necrosis).
- Early MI signs: Release of cardiac enzymes (CK-MB, troponin, myoglobin) within hours after injury.
- Inflammatory response occurs within 24-36 hours, potentially leading to complications like pericarditis and cardiogenic shock.
Degree of Damage to the Heart Muscle
- Ischemia: Temporary deprivation of oxygen; cells may recover.
- Injury: Inflamed and damaged cells; most commonly from ischemia.
- Necrosis/Infarction: Irreversible damage; death of myocardial tissue.
Classification of Myocardial Infarction
- Transmural (Q wave) Infarction: Necrosis involves the entire thickness of the heart muscle.
- Subendocardial Infarction: Affects innermost heart lining layers.
- Intramural Infarction: Patchy areas of damage often due to long-standing angina.
Nursing Considerations for Medications
- Morphine Sulfate: Analgesic for MI; reduces preload and afterload.
- Thrombolytics: Agents like streptokinase dissolve thrombus; watch for bleeding.
- Anticoagulants (e.g., Heparin, Warfarin): Prevents clotting; monitor for bleeding complications.
- Anti-platelet Agents: Aspirin and others prevent thrombus formation; watch for GI bleeding.
- Nitroglycerine: Promotes vasodilation, increasing blood flow for chest pain relief.
Medication Classes
- ACE Inhibitors: End in “pril,” improve blood flow to the heart by blocking angiotensin conversion.
- Beta-Blockers: Decrease myocardial oxygen demand; assess heart rate before administration, contraindicated in asthma and diabetes.
- Calcium Channel Blockers: Promote vasodilation of coronary arteries; monitor heart rate and blood pressure.
- Statins: Lower LDL and increase HDL; monitor liver function and muscle health.
Additional Patient Care
- Educate patients on lifestyle modifications, medication adherence, and the importance of monitoring symptoms.
- Ensure proper follow-up for any signs of adverse medication effects.
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Description
Test your understanding of angina pectoris and myocardial ischemia. This quiz covers the pathophysiology, causes, and relevant conditions like atherosclerosis, hypertension, and diabetes mellitus that contribute to inadequate oxygen supply to the myocardium.
