Atherosclerosis & Angina Pectoris PDF

M A NAGE M E NT OF PATIE NTS W ITH CORONA RY VA S CU LA R DIS ORDE R ATHE RO S CLE RO S IS & A N GIN A P E CTO RIS CHAPTER23 Hanan Abdelrahman RN, PhD Assistant professor, Sultan Qaboos University ...

M A NAGE M E NT OF PATIE NTS W ITH CORONA RY VA S CU LA R DIS ORDE R ATHE RO S CLE RO S IS & A N GIN A P E CTO RIS CHAPTER23 Hanan Abdelrahman RN, PhD Assistant professor, Sultan Qaboos University  LEARNING OUTCOMES On completion of this class, the learner will be able to: 1. Describe the pathophysiology of coronary vascular disorders including atherosclerosis, angina pectoris. 2. List clinical manifestations of coronary vascular disorders including atherosclerosis, angina pectoris. 3. Discuss treatment of coronary vascular disorders including atherosclerosis, angina pectoris. 4. Use the nursing process as a framework for care of the patient of coronary vascular disorders including atherosclerosis, angina pectoris.  ATHEROSCLEROSIS Atherosclerosis is an abnormal accumulation of lipid [or fatty substances] and fibrous tissue in the lining of arterial blood vessel walls. substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium. PAT H O P H YS I O L O G Y https://www.youtube.com/watch?v=SO2E10yy87c P RO G R E S S I O N O F AT H E RO S C L E RO S I S  RISK FACTORS Modifiable Risk Factors Non-modifiable Hyperlipidemia Family history of CAD Smoking, tobacco use Increasing age Hypertension Gender Diabetes mellitus Race Obesity Physical inactivity  CLINICAL MANIFESTATIONS Symptoms and complications are related to the location and degree of vessel obstruction Decrease blood flow to cardiac muscle Epigastria distress, Muscle injury/Less Long or extensive pain that O2 death of muscle radiates to jaw or left arm, Cardiac Ischemia SOB, Angina Pectoris atypical symptoms in Low cardiac output women Chest Pain Heart failure Sudden Death  q Lifestyle changes: Healthy diet: A diet that is low in saturated and trans fats, and high in fruits, vegetables, whole grains, lean proteins, and healthy M A N AG E M E N T O F fats such as olive oil. AT H E RO S C L E RO S I S Regular physical activity helps improve circulation, lower blood pressure, and improve cholesterol levels, all of which can reduce the risk of atherosclerosis. Smoking cessation: can significantly reduce the risk of atherosclerosis and other cardiovascular diseases.  q Medications Cholesterol-lowering medications: Statins are commonly prescribed to lower LDL ("bad") cholesterol levels and reduce the risk of atherosclerosis. M A N AG E M E N T O F Blood pressure medications: Medications such as ACE AT H E RO S C L E RO S I S inhibitors, beta-blockers, and calcium channel blockers can help lower blood pressure and reduce the risk of atherosclerosis. Aspirin: Aspirin can help prevent blood clots from forming in the arteries, reducing the risk of heart attack and stroke. Refer to ( TABLE 23-1)  q Procedures Angioplasty: A procedure that involves inserting a balloon-tipped catheter into the narrowed artery and M A N AG E M E N T O F inflating it to open the artery and improve blood flow. AT H E RO S C L E RO S I S Stenting: A procedure that involves inserting a small mesh tube (stent) into the artery to keep it open. Coronary artery bypass surgery: A surgical procedure that involves rerouting blood around a blocked or narrowed section of the coronary artery.  ANGINA PECTORIS What Is Angina? a clinical syndrome usually characterized by episodes of pain (or pressure) in the anterior chest. It is usually caused by atherosclerotic disease. Angina is associated with a significant obstruction of at least one major coronary artery.  CAUSES & PATHOPHYSIOLOGY Causes 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) https://www.youtube.com/watch?v=YhcA2yB0IJQ  Risk Factors Age Family history of heart disease Smoking RISK High blood pressure High cholesterol FACTORS OF Diabetes ANGINA 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 Angina Stress and emotional situation  TYPES OF ANGINA Type of Angina Description It has predictable (i.e., expected frequency) and consistent (i.e., expected severity) pain. Stable angina Usually lasts a short time (5 minutes or less), Pain goes away with rest or medication. Occurs at rest or with minimal exertion. Unstable angina Pain may be more severe and last longer than stable angina and may not go away with rest or medication. Rare type of angina that occurs at rest, often in the middle of the night. Variant (Prinzmetal's) angina Caused by a spasm of the coronary arteries, rather than a blockage. Occurs without the typical symptoms of chest pain or discomfort. Silent angina Detected during routine tests, such as an ECG or stress test.  Chest Pain SOB Nausea & Vomiting CLINICAL M A N I F E S TAT I O N S Pallor Diaphoresis Epigastric pain  CHA RACTE RIS TICS OF A NGINA CHE S T PA IN May be described as tightness, choking, or a heavy sensation Frequently retrosternal and may radiate to neck, jaw, shoulders, back or arms (usually left) Anxiety frequently accompanies the pain The pain of typical angina subsides with rest or NTG Unstable angina is characterized by increased frequency and severity and is not relieved by rest and NTG. Requires medical intervention!  Health history Cardiac Biomarkers ASSESSMENT AND ECG DIAGNOSTIC Stress test FINDINGS Echocardiography Cardiac catheterization/Angiography  Lifestyle changes: can help reduce risk factors for angina and improve heart health. This includes regular exercise, a heart-healthy diet, smoking cessation, and stress reduction techniques. M A N AG E M E N T OF ANGINA Medications: There are several medications used to manage angina, including nitroglycerin to relieve symptoms, beta- blockers to reduce the workload on the heart, and calcium channel blockers to relax the blood vessels. Statins may also be prescribed to lower cholesterol levels and reduce the risk of heart disease. Refer to (Table 23-2)  QUESTION The nurse is caring for a patient who has severe chest pain after working outside on a hot day and is brought to the emergency center. The nurse administers nitroglycerin to help alleviate chest pain. Which side effect should concern the nurse the most? A. Dry mucous membranes B. Heart rate of 88 bpm C. Blood pressure of 86/58 mm Hg D. Complaints of headache  ANSWER C. Blood pressure of 86/58 mm Hg Rationale: Nitroglycerin dilates vessels in the body. Dilation of the veins causes venous pooling of blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. If the patient is hypovolemic, the decrease in filling pressure can cause a significant decrease in cardiac output and blood pressure. This patient was working outside on a hot day, and the possibility of dehydration and hypovolemia should be considered. Dry mucous membranes can cause poor absorption of sublingual nitroglycerin but is not the most concerning. B and D are insignificant findings.  Please refer to chart 23-3 regarding Self- M A N AG E M E N T OF ANGINA Administration of Nitroglycerine. (very important)  Oxygen therapy: is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and to decrease pain. M A N AG E M E N T OF ANGINA Surgical procedures may be necessary to treat angina. This includes angioplasty and stenting to open blocked arteries or bypass surgery to reroute blood flow around a blocked artery.  Cardiac rehabilitation: is a program that combines exercise, education, and counseling to help improve heart health and reduce the risk of complications. M A N AG E M E N T OF ANGINA Emotional support: Angina can be a stressful and anxiety-provoking condition. Emotional support from family, friends, or a healthcare provider can help reduce stress and improve quality of life.  N U R S I N G P R O C E S S F O R PAT I E N T W I T H A N G I N A P E C TO R I S Refer to the textbook (page 2038) Nursing Process Step Example Actions for Angina Pectoris Patient Assessment Assess patient's history of chest pain, vital signs, symptoms, and medications. Ineffective tissue perfusion related to reduced blood flow to the heart. Diagnosis Acute pain related to angina pectoris. Anxiety related to chest pain and fear of heart attack. Administer nitroglycerin to relieve pain and anxiety. Monitor vital signs and symptoms. Planning Encourage rest and avoidance of triggers. Educate on medication adherence, healthy diet, and stress management Administer medication, monitor vital signs and symptoms, provide education and Implementation emotional support. Monitor effectiveness of care plan, modify plan as needed based on changes in Evaluation patient's condition.  Complete blockage of blood flow to the heart muscle Heart attack due to severe blockage in the coronary artery. Weakening of the heart muscle over time, leading to Heart failure the inability of the heart to pump enough blood to meet the body's needs. Abnormal heart rhythms or irregular heartbeats that CO M P LI C AT I O N S Arrhythmias can be caused by angina. O F A N GINA P ECTO R IS Increased risk of stroke due to underlying heart disease, Stroke such as atherosclerosis. Stressful and anxious living conditions due to angina, Anxiety and leading to anxiety and depression, which can impact a depression person's quality of life. Sudden death in severe cases of untreated angina, Death especially in individuals with underlying heart disease or risk factors. QUESTIONS? Thank you!