coronary artery-disease-cvs-2-es-1-1230806172121287-1-090303010929-phpapp02
TRANSCRIPT
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CORONARY ARTERY DISEASE
ANGINA Pectoris MYOCARDIAL INFARCTION (MI)Presenter Dave Jay S. Manriquez RN.February 21, 2009
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Objectives Coronary Artery Diseases
Angina Types Mechanism Causes Clinical manifestation Complication Nursing care
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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 CAD1. Angina Pectoris 2. Myocardial Infarction
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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) :04/12/23
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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.04/12/23
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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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Mechanism Of Angina
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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 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
Electrocardiogram ( ECG) Coronary angiography Exercise Electrocardiogram (Stress test).
Complications: Myocardial infarction Cardiac Arrhythmias
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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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PATHOPHYSIOLOGYCoronary 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
Zone of Ischemia: T wave inversion Zone of Injury: ST elevation Zone of Necrosis: Abnormal Q wave
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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
Assessment: History Clinical manifestation Cardiovascular assessment Laboratory assessment Troponin T & I CK-MB
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Radiographic Assessment
ECGStress TestMyocardial perfusion imagingMRICardiac Catheterization
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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:
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.04/12/23
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Intervention
Medication:Morphine Sulphate Nitrates (GTN)Beta blockersCalcium Channel BlockerAnti platelets / Anti coagulant Thrombolytic therapy
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Surgical management
PTCA (Percutaneous Transluminal Coronary Angioplasty
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Coronary Artery Bypass Graft surgery (CABG)
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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
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:
Arrhythmias Atrial arrhythmias. Ventricular arrhythmias. Bradycardia and heart block. Asystol.
Hypertension. LV failure. Cardiogenic shock.
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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 activityLives 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
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