Angina Pectoris and Myocardial Ischemia Quiz

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Questions and Answers

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?

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?

Post infarction angina

Intractable angina

Stable angina

Prinzmetal’s angina (correct)

Which of the following conditions is NOT a cause of angina pectoris?

Increased physical fitness Signup and view all the answers

What is a characteristic feature of stable angina?

Chest pain is relieved by rest Signup and view all the answers

What physiological process increases due to diminished myocardial oxygenation in angina pectoris?

Anaerobic metabolism Signup and view all the answers

Which type of angina is also known as refractory angina?

Intractable angina Signup and view all the answers

Chest pain that occurs in a sitting or lying position is known as what type of angina?

Angina decubitus Signup and view all the answers

Which of the following are considered provoking factors for Angina?

Emotion Signup and view all the answers

What is a common characteristic of chest pain associated with Angina?

Transient and paroxysmal Signup and view all the answers

Which treatment is traditionally used to relieve anginal pain?

Oxygen and Nitroglycerine Signup and view all the answers

What assessment is crucial following an episode of chest pain?

Obtain a 12 lead ECG Signup and view all the answers

Which nursing intervention helps to decrease patient anxiety during an angina episode?

Minimizing emotional outburst Signup and view all the answers

What is the primary cause of Myocardial Infarction (MI)?

Prolonged lack of blood flow Signup and view all the answers

Which dietary component should be avoided to manage heart health effectively?

Saturated fats Signup and view all the answers

What is a typical early sign of a Myocardial Infarction?

No physical changes to the heart muscle yet Signup and view all the answers

What cardiac enzyme is typically released first after a myocardial infarction (MI)?

Myoglobin Signup and view all the answers

What is the primary consequence of myocardial necrosis?

Irreversible damage to myocardial tissue Signup and view all the answers

Which type of myocardial infarction affects the entire thickness of the heart muscle?

Transmural infarction Signup and view all the answers

During the first 24 hours after MI, which complication is most likely to occur?

Cardiogenic shock Signup and view all the answers

What is a significant risk during the granulation phase within 10 days post-MI?

Increased risk of cardiac rupture Signup and view all the answers

Which of the following is NOT a common cause of myocardial infarction?

Myocardial ischemia Signup and view all the answers

What happens in the zone of injury surrounding an area of myocardial necrosis?

There is significant inflammation and damage Signup and view all the answers

What occurs to the heart size and functionality within two months after an MI?

Scarring occurs, affecting size and functionality Signup and view all the answers

What is the primary effect of nitroglycerine on coronary vessels?

Promotes relaxation and vasodilation Signup and view all the answers

What is a common nursing consideration when administering beta-blockers?

Assess the heart rate before administration Signup and view all the answers

Which drug category ends with 'sartan' and is used to block angiotensin II receptors?

Angiotensin II Receptor Blockers Signup and view all the answers

What important monitoring is required for patients taking statins?

Creatine kinase (CPK) levels Signup and view all the answers

What should be done if a patient experiences a burning sensation after placing a nitroglycerine tablet under their tongue?

Continue using as it indicates potency Signup and view all the answers

Which calcium channel blocker should be administered 1 hour before or 2 hours after a meal?

Cardizem Signup and view all the answers

What is the primary purpose of morphine sulfate in the context of myocardial infarction (MI)?

To relieve pain and improve hemodynamics Signup and view all the answers

What is the primary action of statins on cholesterol levels?

Decrease total cholesterol and triglycerides Signup and view all the answers

Which of the following medications is contraindicated in patients with pancreatitis?

Morphine sulfate Signup and view all the answers

What is the antidote for beta blocker poisoning?

Glucagon Signup and view all the answers

What should a nurse monitor for in a patient receiving anti-thrombotic agents like Lovenox and Heparin?

Signs of bleeding Signup and view all the answers

What is the main concern when administering meperidine (Demerol) to a patient?

Hypotension from vagolytic effect Signup and view all the answers

What dietary modification should a patient on Warfarin Sodium (Coumadin) implement?

Limit green leafy vegetables Signup and view all the answers

What should be kept at the bedside when administering morphine sulfate?

Naloxone HCL Signup and view all the answers

Which medication should not be given together with Coumadin to prevent increased bleeding risk?

Aspirin (ASA) Signup and view all the answers

What is a common nursing consideration regarding thrombolytic therapy?

Assess for neurologic status changes Signup and view all the answers

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.