Management of Coronary Vascular Disorders Chapter 23

Management of Patients with Coronary Vascular Disorder, Atherosclerosis & Angina Pectoris

• The topic is the management of patients with coronary vascular disorder, atherosclerosis, and angina pectoris
• The speaker is Hanan Abdelrahman, RN, PhD, assistant professor at Sultan Qaboos University
• This is chapter 23 of a course

Learning Outcomes

• Learners will be able to describe the pathophysiology of coronary vascular disorders, including atherosclerosis and angina pectoris
• Learners will list clinical manifestations of coronary vascular disorders, including atherosclerosis and angina pectoris
• Learners will discuss treatment for coronary vascular disorders, including atherosclerosis and angina pectoris
• Learners will use the nursing process as a framework for patient care of coronary vascular disorders, including atherosclerosis and angina pectoris

Atherosclerosis

• Atherosclerosis is an abnormal buildup of lipid (or fatty substances) and fibrous tissue in the lining of arterial blood vessel walls
• This buildup blocks and narrows coronary vessels, reducing blood flow to the myocardium

Pathophysiology

• Atherosclerosis progression occurs in stages, beginning with endothelial injury (A)
• Followed by monocyte emigration and smooth muscle proliferation (B and C)
• This then develops into a fatty streak (D), followed by a fibrofatty atheroma (E)

Progression of Atherosclerosis

• Atherosclerosis progresses over time, with fatty streaks initially developing
• This is followed by fibrous plaque formation
• Over time, the plaque can become complicated, including ulceration, hemorrhage, and calcification
• These complications can lead to critical events like myocardial infarction, stroke, and gangrene

Risk Factors

• Modifiable: Hyperlipidemia, smoking, hypertension, diabetes mellitus, obesity, physical inactivity
• Non-modifiable: Family history of coronary artery disease (CAD), increasing age, gender, race

Clinical Manifestations

• Symptoms and complications of atherosclerosis stem from vessel obstruction
• Decreased blood flow to the cardiac muscle causes muscle injury/less oxygen, angina pectoris, chest pain
• Cardiac ischemia, low cardiac output, heart failure, and sudden death are possible outcomes

Management of Atherosclerosis

• Lifestyle changes: Healthy diet, regular physical activity, smoking cessation
• Medications: Cholesterol-lowering medications (statins), blood pressure medications (ACE inhibitors, beta-blockers, calcium channel blockers), Aspirin
• Procedures: Angioplasty, stenting, coronary artery bypass surgery

Angina Pectoris

• Angina pectoris is a clinical syndrome characterized by episodes of chest pain or pressure, usually caused by atherosclerosis
• It's often associated with significant obstruction of at least one major coronary artery
• Angina is commonly triggered by physical exertion, cold exposure, eating a heavy meal, or stress

Causes & Pathophysiology of Angina

• Reduced blood flow to the heart muscle due to narrowing or blockages in the coronary arteries
• Buildup of plaque (fatty deposits) on the artery walls (atherosclerosis)

Risk Factors of Angina

• Age, family history of heart disease, smoking, high blood pressure, high cholesterol, diabetes, sedentary lifestyle, stress, obesity
• Other medical conditions (kidney disease, peripheral artery disease, rheumatoid arthritis)

Triggers of Angina

• Physical exertion, exposure to cold, eating a heavy meal, stress and emotional situations

Types of Angina

• Stable: Predictable, consistent pain, usually short lasting; relieved with rest or medication
• Unstable: Occurs at rest or with minimal exertion, more severe and prolonged, may not go away with rest or medication; requiring immediate intervention
• Variant (Prinzmetal's): Occurs at rest, often at night, caused by coronary artery spasm (not a blockage)
• Silent: Occurs without typical symptoms

Clinical Manifestations of Chest Pain

• Symptoms can include, chest pain, shortness of breath, nausea, vomiting, pallor and diaphoresis and epigastric pain
• Angina chest pain may be described as a sensation of tightness, choking, or heaviness
• Pain often radiates to the neck, jaw, shoulders, back, or arms (often the left arm)
• Anxiety is common

Characteristics of Angina Chest Pain

• Pain is often retrosternal
• Pain may radiate to (neck, jaw, shoulders, back, arms)
• Usually accompanied by anxiety
• Pain subsides with rest or nitroglycerin
• Unstable angina is characterized by increasing frequency and severity of pain, not relieved by rest or medication, requiring emergency care

Assessment and Diagnostic Findings

• Health history
• Cardiac biomarkers
• ECG
• Stress test
• Echocardiography
• Cardiac catheterization/Angiography

Management of Angina

• Lifestyle changes: Regular exercise, heart-healthy diet, smoking cessation, stress reduction
• Medications: Nitroglycerin to relieve pain, beta-blockers to reduce the workload on the heart, calcium channel blockers to relax blood vessels, statins to lower cholesterol
• Procedures: Angioplasty, stenting, coronary artery bypass surgery
• Urgent medical care is necessary for unstable angina

Complications of Angina Pectoris

• Heart attack, heart failure, arrhythmias, stroke, anxiety and depression, sudden death

Nursing Process for Patient with Angina Pectoris

• Assessment: Patient history, vital signs, symptoms, medications
• Diagnosis: Ineffective tissue perfusion, acute pain, anxiety
• Planning: Medication administration, monitoring vital signs, education.
• Implementation: Administer medications, monitor symptoms and vital signs, provide education and emotional support
• Evaluation: Monitor effectiveness of the care plan, modify as needed.

Additional Information

• Self-administration of nitroglycerin should be detailed for patients.
• Always refer to the chart in question for specific details about procedure instructions.