Angina Pectoris & Myocardial Infarction PDF

Lesson 3: Angina Pectoris & Myocardial Infarction THURSDAY, October 10, 2024 Angina Pectoris “chest pain” High blood pressure High...

Lesson 3: Angina Pectoris & Myocardial Infarction THURSDAY, October 10, 2024 Angina Pectoris “chest pain” High blood pressure High cholesterol or triglycerides Other health conditions Not enough exercise Obesity Emotional Stress Medications Drug misuse Cold temperatures Types of Angina Stable angina This is the most common. Predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin. Last for 5-10min Unstable angina WHAT CAUSES ANGINA PECTORIS? You can have this while you're at rest or not very active. Angina can be a symptom of coronary artery disease The pain can be strong and long-lasting (more than (CAD). This is when arteries that carry blood to your 20mins) and it may come back again and again. heart become narrowed and blocked. This can May not be relieved with rest or nitroglycerin. happen because of: Variant angina (Prinzmetal’s angina) o Hardening of arteries due to atherosclerosis (the This type is rare. buildup of fats, cholesterol and other substances Thought to be caused by coronary artery vasospasm in and on the artery walls) (heart arteries suddenly tighten or narrows). o A blood clots It might happen at night while you're sleeping or o Plaque in an artery that can rupture (unstable resting. plaque) Microvascular angina With this type, you have chest pain but no coronary artery blockage. Instead, it happens because you smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women. Intractable or Refractory Angina Severe incapacitating chest pain Silent Angina Objective evidence of ischemia (such as electrocardiographic changes with a stress test), but patient reports no pain. Poor blood flow through a narrowed heart valve Lessened pumping of the heart muscle Coronary artery spasm Symptoms These are the most COMMON SYMPTOMS of angina: A pressing, squeezing, or crushing pain, usually in Risk Factors the chest or ear lobes under your breastbone Increasing Age Pain may also occur in your upper back, both arms, Family history of heart disease neck, Tobacco use Pain radiating in your arms, shoulders, jaw, neck, or Diabetes back 1 NCM 112 Oxygenation CIRUJALES ROMER BSN3B  Lesson 3: Angina Pectoris & Myocardial Infarction THURSDAY, October 10, 2024 Shortness of vasodilators. It works by breath relaxing the blood Diaphoresis vessels so the heart does (profuse not need to work as hard sweating) and therefore does not need Weakness and as much oxygen fatigue Antiplatelet medications Feeling faint prevent platelet aggregation and anticoagulants prevent thrombus formation Pharmacological Interventions 1. CLASS: Calcium channel blockers “dipine” MECHANISM OF ACTION: Calcium channel blockers have negative inotropic effects. Calcium channel blockers are medications used to lower blood pressure. They work by preventing calcium from entering the cells of the heart and arteries. Calcium causes the Diagnostics heart and arteries to squeeze (contract) more Electrocardiogram (ECG) - Records the electrical strongly. By blocking calcium, calcium channel activity of the heart, shows abnormal rhythms blockers allow blood vessels to relax and open. (arrhythmias), and detects heart muscle damage. Stress test - (usually with ECG; also called treadmill or exercise ECG) Given while you walk on a treadmill or pedal a stationary bike, to monitor your heart's ability to function when placed under stress such as during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, or to determine safe levels of exercise after a heart attack or heart surgery. A special type of stress test uses medicine to. stimulate the heart as if you were exercising Cardiac catheterization - With this procedure, a wire is passed into the coronary arteries. Next a contrast agent is injected into your artery. X-ray images are taken to locate the narrowing, blockages, and other abnormalities of specific arteries. Cardiac MRI - This test can find the amount of blood flow to the heart muscle. It may not be available at all medical centers. Coronary CT scan - This test looks at the amount of calcium and plaque inside of the blood vessels of the heart. Plans or Goals Major patient goals include: Immediate and appropriate treatment when angina occurs. Prevention of angina. Dihydropyridines: nifedipine (Procardia, Adalat), Reduction of anxiety. amlodipine (Norvasc) elevidipine (Cleviprex), Awareness of the disease process and understanding nicardipine (Cardene), felodipine (Plendil) of the prescribed care. nimodipine (Nimotop) Adherence to the self-care program. Nan-dihydropyridines: diltiazem (Cardizem), Absence of complications. verapamil (Calan Isoptin) Pharmacological Interventions Nitroglycerin gives long-term and short-term reduction of myocardial oxygen consumption through selective vasodilation within three (3) minutes. Nitroglycerin is in a class of medications called 2 NCM 112 Oxygenation CIRUJALES ROMER BSN3B  Lesson 3: Angina Pectoris & Myocardial Infarction THURSDAY, October 10, 2024 (additional infos) Examples of beta blockers taken by mouth include: INDICATIONS: Acebutolol Cardiac arrhythmia Atenolol (Tenormin) hypertension Bisoprolol (Zebeta) angina pectoris Metoprolol (Lopressor,ToprolXL) tocolysis in preterm labor Nadolol (Corgard) Raynaud’s phenomenon Nebivolol (Bystolic) migraine prophylaxis Propranolol (Inderal, InnoPranXL) Routes of Admin: IV, PO SIDE EFFECTS: General: headache, dizziness, flushing of the (additional infos) skin, peripheral edema, hypotension INDICATIONS: Hypertension 1. Dihydropyridines: reflex tachycardia, gingival Coronary artery disease; angina pectoris, myocardial hyperplasia infarction 2. Non-dihydropyridines: bradycardia, constipation and Arrhythmias hyperprolactinemia Heart failure Essential tremor CONTRAINDICATION/CAUTIONS: Glaucoma Pre-existing bradycardia Migraine prophylaxis Heart block Routes of Administration: PO, IV, Opth Heart failure Use with caution: hepatic and renal disease SIDE EFFECTS: Interactions: digoxin, grapefruit o Bradycardia o Hypotension NURSING CONSIDERATIONS: o Fatigue ASSESSMENT AND MONITORING o Dizziness Vital signs, CBC, sodium, potassium, creatinine, BUN, o Bronchospasm and dyspnea liver function tests, and urinalysis, ECG o Headache For angina: frequency and severity of symptoms o Depression Monitor for side effects and therapeutic response o Hallucination o Insomnia and nightmares CLIENT EDUCATION o Erectile dysfunction Purpose of medication o Decreased libido Self-administration o Hyperglycemia Take exactly as prescribed, do not stop abruptly o Hypertriglyceridemia Swallow whole; do not divide, crush, or chew o Hyperkalemia Avoid grapefruit juice and limit caffeine o Hypoglycemia unawareness Side effects Hypotension and reflex tachycardia: change CONTRAINDICATIONS AND CAUTIONS positions slowly Bradycardia Peripheral edema: elevate legs Hypotension Constipation: increase fiber and fluids Decompensated heart failure Gingival hyperplasia: good dental hygiene Second or third degree AV block (sudden fail to Lifestyle modifications cardiovascular health for conduct or complete heart block) Heart rate and blood pressure self- monitoring Asthma Report persistent side effects, hypotension, COPD bradycardia; seek medical attention if angina not Diabetes relieved by rest or medication Raynaud phenomenon (a problem that causes decreased blood flow to the fingers.) 2. CLASS: BETA BLOCKERS: Basta beta blocker, -olol Severe hepatic or renal disease ‘yan! MECHANISM OF ACTION: Beta-blockers reduces myocardial oxygen consumption by blocking beta adrenergic stimulation of the heart. Beta blockers, also known as beta adrenergic blocking agents, are medications that reduce blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Betablockers cause the heart to beat more slowly and with less force, which lowers blood pressure 3 NCM 112 Oxygenation CIRUJALES ROMER BSN3B  Lesson 3: Angina Pectoris & Myocardial Infarction THURSDAY, October 10, 2024 MYOCARDIAL INFARCTION (HEART Pathophysiology ATTACK) It is defined as death of a segment of heart muscle, which follows interruption of it's blood supply SYMPTOMS: CARDIOVASCULAR: Ischemia Low cardiac output Chest pain-chest pain occurs suddenly, severe immobilizing chest pain that not relieved by rest, position change and medications. Severity more than angina pectoris Duration -more than 15 minutes and not relieved by nitroglycerine Radiation pain radiated to nose, jaw, shoulder and upper left arm and downward 4th and 5th fingers Decrease pulse rate. Bradycardia (Decrease pulse rate) Hypertension Risk Factors: Myocardial infarction- Modifiable risk factors: Diaphoresis-excessive sweating ECG changes ST segment and T wave changes, also Tobacco use show tachycardia, bradcardia, or dysrhythimas. High blood cholesterol or triglyceride levels Dysarrithmias Lack of exercise Obesity RESPIRATORY: Stress Shortness of breath. Nonmodifiable risk factors: Pulmonary edema Family history of heart disease Chest heaviness Older age Dyspnea- difficulity of brathing Diabetes Fatigue High blood pressure Causes: Coronary artery disease (atherosclerosis). Blood clot Coronary artery spasm GENITOURINARY Decreased Urinary Output May Indicate Cardiogenic Shock. Gastrointestinal- Nausea And Vomiting Skin- Cool, Clammy, Diaphoretic, And Pale Appearance on Skin 4 NCM 112 Oxygenation CIRUJALES ROMER BSN3B  Lesson 3: Angina Pectoris & Myocardial Infarction THURSDAY, October 10, 2024 SURGICAL MANAGEMENT: DIAGNOSTIC EVALUATION: Angioplasty and stent placement (percutaneous coronary Physical Examination revascularization): History Collection Stress Test ECG Chest Xray Echocardiogram Cardiac Catheterization (Angiogram) Troponin Test COMPLICATIONS: Heart attack Heart failure Abnormal heart rhythm (arrhythmia) PREVENTION: Quit smoking Coronary Artery Bypass Surgery Control conditions such as high blood pressure, high cholesterol and diabetes Stay physically active Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains Maintain a healthy weight Reduce and manage stress MEDICAL MANAGEMENT: Various drugs can be used to treat coronary artery disease, including: Vasodilators (These drugs act as blood vessel dilator): o Nitrates Beta-Blockers (Decrease work load in heart): o Propranolol 20-40 mg Calcium channel blocker (They improve coronary blood flow): Nursing Management: o Nifedipine Instruct the client regarding the purpose of diagnostic o Verapamil medical-& surgical procedures and the pre- & post Anticoagulant Drugs: procedure expectations. o Heparin: Assist the client to identify risk factors that can be  Opiate Analgesic (For reduce pain) modified, and set goals that will promote change in o Morphine sulphate lifestyle to reduce the impact of risk factors. Thrombolytic Drugs: Instruct client regarding a low-calorie, low-sodium, low- o Streptokinase, Urokinase cholesterol, low-fat diet with an increase in dietary fiber. Antihypertensive drugs Stress that dietary changes are not temporary and must be maintained for life, ANTIHYPERTENSIVE MEDICINES Provide community resources to client regarding exercise, Methydopa - This medication is used alone or with other smoking cessation and stress reduction. medications to treat high blood pressure (hypertension). Impaired gas exchange related to decreased blood flow Lowering high blood pressure helps prevent strokes, heart as evidenced by breathlessness attacks, and kidney problems. Methyldopa works by Acute pain related to disease condition as evidenced by relaxing blood vessels so blood can flow more easily. patient verbalization Sodium nitroprusside - It is used for lowering the blood Impaired physical mobility related to weakness as pressure. evidenced by patient is unable to perform daily activity. Amlodipine - Amlodipine is used with or without other Imbalanced nutrition less than body requirement related medications to treat high blood pressure. Lowering high to less intake of food as evidenced by weight loss blood pressure helps prevent strokes, heart attacks, and Disturbed sleep pattern related to hospitalization as kidney problems. Dose-10 mg,20 mg. evidenced by patient verbalization, Anxiety related to hospitalization as evidenced by patient asking too many questions. Knowledge deficit related to disease process and treatment as evidenced by patient is having many doubts 5 NCM 112 Oxygenation CIRUJALES ROMER BSN3B