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CORONARY ARTERY DISEASE. ANGINA Pectoris MYOCARDIAL INFARCTION (MI) Presenter Dave Jay S. Manriquez RN. February 21, 2009. Objectives. Coronary Artery Diseases Angina Types Mechanism Causes Clinical manifestation Complication Nursing care. Coronary Artery Disease.

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Coronary artery disease

CORONARY ARTERY DISEASE

ANGINA Pectoris

MYOCARDIAL INFARCTION (MI)

Presenter

Dave Jay S. Manriquez

RN.

February 21, 2009


Objectives
Objectives

  • Coronary Artery Diseases

    • Angina

      • Types

      • Mechanism

      • Causes

      • Clinical manifestation

      • Complication

      • Nursing care

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Coronary artery disease1
Coronary Artery Disease

Definition:

CAD is a term that refers to the effect of the accumulation of atherosclerosis plaque in the coronary arteries that obstructs blood flow to the myocardium

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Cont.

conditions result from CAD

1. Angina Pectoris

2. Myocardial Infarction

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Angina pectoris
Angina Pectoris

Definition:

Angina: Choking or suffocation.

Pectoris: Chest.

Angina pectoris, is the medical term used to describe acute chest pain or discomfort.

Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart.

It has 3 types

  • Stable Angina

  • Un stable angina &

  • Variant Angina (Prinzmetal’s or resting angina) :

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Cont.

Types of Angina

  • Stable angina:

    • People with stable angina have episodes of chest discomfort that are usually predictable. That occur on exertion or under mental or emotional stress.

      Normally the chest discomfort is relieved with rest,

       nitroglycerin (GTN) or both.

    • It has a stable pattern of onset, duration and intensity of symptoms.

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Cont.

  • Unstable angina:

    • It is triggered by an un predictable degree of exertion or emotion.

    • (progressive), more severe than stable. Characterized by increasing frequency & severity. Provoked by less than usual effort, occurring at rest &

    • interferes with pt lifestyle.

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Cont.

  • Variant Angina (Prinzmetal’s or resting angina) :

    occur spontaneously with no relationship to activity. Occurs at rest due to spasm. Pt discomfort that occurs rest usually of longer duration. Appears to by cyclic & often occurs at about the same time each day (usually at night). Thought to be caused by coronary artery spasm

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Causes
Causes

  • Coronary atherosclerosis (atheroma )

  • Factors increasing preload :

    • Hyperthyroidism

    • Exercise

    • Anemia

  • Factors increasing after load:

  • Hypertension

  • Aortic stenosis

  • Obstructive cardio myopathy

  • Coronary artery spasm

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Clinical manifestations
Clinical Manifestations

  • Characteristics: Squeezing, burning, pressing, choking, or bursting pressure.

  • Onset: Quickly or slowly

  • Location: Chest, right or left arms, shoulder, or neck, jaw.

  • Duration: Less then 5 minutes.

  • Associated: Dyspnea, Sweating, faintness, palpitation, dizziness ect.

  • Relieving: GTN and rest.

  • Aggravating: exertion, exercise, heavy meal, emotional upset, and anger.

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Investigations
Investigations

  • Electrocardiogram ( ECG)

  • Coronary angiography

  • Exercise Electrocardiogram (Stress test).

    Complications:

  • Myocardial infarction

  • Cardiac Arrhythmias

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Myocardium infarction
Myocardium Infarction

  • Myo means muscle, “Cardiac” heart, infarction means “death of tissues due to lack of blood supply”.

  • It is also called heart attack. It occurs when coronary arteries become blocked and the part of myocardial muscles become dead due to prolonged lack of oxygen supply to the muscle cells.

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Pathophysiology
PATHOPHYSIOLOGY

Coronary artery cannot supply enough blood to the heart in response to the demand due to CAD

Within 10 seconds myocardial cells experience ischemia

Ischemic cells cannot get enough oxygen or glucose

Ischemic myocardial cells may have decreased electrical & muscular function

Cells convert to anaerobic metabolism.

Cells produce lactic acid as waste

Pain develops from lactic acid accumulation

Pt feels anginal symptoms until receiving demand increase 02 requirements of myocardial cells

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Ecg changes in angina mi
ECG changes in Angina & MI

  • Zone of Ischemia: T wave inversion

  • Zone of Injury: ST elevation

  • Zone of Necrosis: Abnormal Q wave

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Sign and symptom
Sign and Symptom

  • Classic symptom of heart attack are chest pain radiating to neck, jaws, back of shoulder, or left arm

  • The pain can be felt like:

  • Squeezing or heavy pressure

  • A tight band on the chest

  • An elephant sitting on the chest

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Cont

Other symptoms include:

  • Shortness of breath (SOB)

  • Weakness and tiredness

  • Anxiety

  • Lightheadedness

  • Dizziness

  • Nausea vomiting

  • Sweating, which may be profuse

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Collaborative management
Collaborative Management

  • Assessment:

  • History

  • Clinical manifestation

  • Cardiovascular assessment

  • Laboratory assessment

  • Troponin T & I

  • CK-MB

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Radiographic assessment
Radiographic Assessment

ECG

Stress Test

Myocardial perfusion imaging

MRI

Cardiac Catheterization

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Important information to remember
IMPORTANT INFORMATION TO REMEMBER

  • Increase supply of Oxygen

  • Decreasing the demand of Oxygen:

  • Stop activity and lie down (CBR)

  • Take Tab. Angisid sublingually and wait till it dissolves.

  • If pain continues take up to 03 Tab. Angisid one every five minutes. If pain is not relieved yet take another tab. and rush to EMERGENCY services.

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Immediate management of mi
IMMEDIATE MANAGEMENT OF MI:

GOALS:

  • To prolong life.

  • Minimize infarct size.

  • Reverse ischemia.

  • Reduce cardiac work.

  • Prevent and treat complications.

    A) INITIAL TREATMENT:

  • Rapid triage.

  • OMI (oxygen, monitor and I/V line).

  • Check vital signs and O2 saturation.

  • ECG within 10 minutes and repeat ECG.

  • Blood samples for enymes, CBC, lytes, and lipid profile.

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Intervention
Intervention

  • Medication:

    Morphine Sulphate

    Nitrates (GTN)

    Beta blockers

    Calcium Channel Blocker

    Anti platelets / Anti coagulant

    Thrombolytic therapy

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Surgical management
Surgical management

  • PTCA (Percutaneous Transluminal Coronary Angioplasty

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Coronary artery bypass graft surgery cabg
Coronary Artery Bypass Graft surgery (CABG)

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Nursing diagnosis
Nursing Diagnosis

  • Acute pain R/T imbalance between myocardial oxygen supply and demand

  • Ineffective tissue perfusion R/T interruption of arterial blood flow

  • Ineffective coping R/T effects of acute illness and major changes in life style

  • Impaired gas exchange related to ineffective breathing pattern and decreased systemic tissue perfusion.

  • Anxiety related to present status and unknown future, possible lifestyle changes, pain, and perceived threat of death.

  • Activity intolerance related to fatigue

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Prevention
Prevention

  • Recognize the symptoms

  • Reduce your risk factors:

  • Lose weight

  • Quit Smoking

  • Keep your cholesterol at a normal level.

  • Keep your blood pressure under control.

  • Use techniques to ease stress.

  • Control blood sugar level.

  • Eat Right

  • REGULER EXERCISE

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Complications of mi
COMPLICATIONS OF MI:

  • Arrhythmias

    • Atrial arrhythmias.

    • Ventricular arrhythmias.

    • Bradycardia and heart block.

    • Asystol.

  • Hypertension.

  • LV failure.

  • Cardiogenic shock.

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Cardiac rehabilitation
CARDIAC REHABILITATION:

Cardiac rehabilitation provides a venue for continued education, re-enforcement of lifestyle modification, and adherence to a comprehensive prescription of therapies for recovery from MI, which includes exercise training

Goals of Rehabilitation program:

  • Develop a program for progressive physical activity

  • Lives as full, vital and productive life

  • Remain within the limits of the heart’s ability to respond to increases in activity and stress.

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Follow up
FOLLOW UP

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