Ischemic Heart Disease Nursing PDF

ISCHEMIC HEART DISEASE (IHD) CORONARY ARTERY DISEASE U s a ma M Abd el a a l , PhD, M D Professor of Internal Medicine  MY TO N A Y A AR ON OR C  S E...

ISCHEMIC HEART DISEASE (IHD) CORONARY ARTERY DISEASE U s a ma M Abd el a a l , PhD, M D Professor of Internal Medicine  MY TO N A Y A AR ON OR C  S E EA D IS R Y T E AR R Y NA R O CO Myocardial ischaemia occurs when there is an imbalance between the supply of oxygen (and other essential myocardial nutrients) and the myocardial demand for these substances Mechanical casuses of cornonary obstruction Atheroma Thrombosis Spasm Embolus Coronary ostial stenosis Coronary arteritis (e.g. in SLE). There can be a decrease in the flow of oxygenated blood tis due to: Anaemia Hypotension causing decreased coronary perfusion pressure An increased demand for oxygen : Increase in cardiac output (e.g. thyrotoxicosis) Myocardial hypertrophy (e.g. from aortic stenosis or hypertension).  NS T IO T A EN ES PR AL IC L IN C Asymptomatic Underlying pathology  I S OR CT PE N A G I AN  Chest pain is generally described as ‘heavy’, ‘tight’ or ‘gripping’. Typically, the pain is central/retrosternal and may radiate to the jaw and/or arms. Angina can range from a mild ache to a most severe pain that provokes sweating and fear. There may be associated breathlessness Provoked by physical exertion, especially after meals and in cold, windy weather or by anger or excitement Relieved (usually within minutes) with rest or nitrate Types Unstable angina Angina of recent onset (20min, often associated with nausea, sweatiness, dyspnoea, palpitations. Signs Distress, anxiety, pallor, sweatiness, Increases pulse or low BP There may be signs of heart Mortality 50% of deaths occur within 2h of onset of symptoms. Up to 7% die before discharge. Worse prognosis if: elderly, LV failure, and ST changes  MI OF NS TI O L I CA MP C O 1. Heart failure 2. Cardiogenic shock 3. Cardiac arrest 4. Bradyarrythmia± heart block 5. Tachyarrhythmias 6. Pericarditis 7. Systemic embolism 8. Cardiac tamponade 9. Mitral regurgitation 10. Left ventricular aneurysm