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Coronary Artery Disease, Angina pectoris, Myocardial Infarction

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The prolong complications of coronary artery disease such as angina pectoris, myocardial infarction, cardiac heart failure, its management and surgical mgt.

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Coronary Artery Disease, Angina pectoris, Myocardial Infarction

  1. 1. CORONARY ARTERY DISEASE ANGINA Pectoris MYOCARDIAL INFARCTION (MI) Presenter Dave Jay S. Manriquez RN. February 21, 2009
  2. 2. Objectives <ul><li>Coronary Artery Diseases </li></ul><ul><ul><li>Angina </li></ul></ul><ul><ul><ul><li>Types </li></ul></ul></ul><ul><ul><ul><li>Mechanism </li></ul></ul></ul><ul><ul><ul><li>Causes </li></ul></ul></ul><ul><ul><ul><li>Clinical manifestation </li></ul></ul></ul><ul><ul><ul><li>Complication </li></ul></ul></ul><ul><ul><ul><li>Nursing care </li></ul></ul></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  3. 3. 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 06/08/09 www.health-nurses-doctors.blogspot.com
  4. 4. Cont. <ul><li>conditions result from CAD </li></ul><ul><li>1 . Angina Pectoris </li></ul><ul><li>2. Myocardial Infarction </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  5. 5. Angina Pectoris <ul><li>Definition: </li></ul><ul><li>Angina: Choking or suffocation. </li></ul><ul><li>Pectoris: Chest. </li></ul><ul><li>Angina pectoris, is the medical term used to describe acute chest pain or discomfort. </li></ul><ul><li>Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart. </li></ul><ul><li>It has 3 types </li></ul><ul><li>Stable Angina </li></ul><ul><li>Un stable angina & </li></ul><ul><li>Variant Angina (Prinzmetal’s or resting angina) : </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  6. 6. Cont. <ul><li>Types of Angina </li></ul><ul><li>Stable angina : </li></ul><ul><ul><li>People with stable angina have episodes of chest discomfort that are usually predictable. That occur on exertion or under mental or emotional stress. </li></ul></ul><ul><ul><li>Normally the chest discomfort is relieved with rest, </li></ul></ul><ul><ul><li>  nitroglycerin (GTN) or both. </li></ul></ul><ul><ul><li>It has a stable pattern of onset, duration and intensity of symptoms. </li></ul></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  7. 7. Cont. <ul><li>Unstable angina: </li></ul><ul><ul><li>It is triggered by an un predictable degree of exertion or emotion. </li></ul></ul><ul><ul><li>(progressive), more severe than stable. Characterized by increasing frequency & severity. Provoked by less than usual effort, occurring at rest & </li></ul></ul><ul><ul><li>interferes with pt lifestyle. </li></ul></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  8. 8. Cont. <ul><li>Variant Angina (Prinzmetal’s or resting angina) : </li></ul><ul><li>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 </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  9. 9. <ul><li>Mechanism Of Angina </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  10. 10. 06/08/09 www.health-nurses-doctors.blogspot.com
  11. 11. Causes <ul><li>Coronary atherosclerosis (atheroma ) </li></ul><ul><li>Factors increasing preload : </li></ul><ul><ul><li>Hyperthyroidism </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Anemia </li></ul></ul><ul><li>Factors increasing after load: </li></ul><ul><li>Hypertension </li></ul><ul><li>Aortic stenosis </li></ul><ul><li>Obstructive cardio myopathy </li></ul><ul><li>Coronary artery spasm </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  12. 12. Clinical Manifestations <ul><ul><li>Characteristics: Squeezing, burning, pressing, choking, or bursting pressure. </li></ul></ul><ul><ul><li>Onset: Quickly or slowly </li></ul></ul><ul><ul><li>Location: Chest, right or left arms, shoulder, or neck, jaw. </li></ul></ul><ul><ul><li>Duration: Less then 5 minutes. </li></ul></ul><ul><ul><li>Associated: Dyspnea, Sweating, faintness, palpitation, dizziness ect. </li></ul></ul><ul><ul><li>Relieving: GTN and rest. </li></ul></ul><ul><ul><li>Aggravating: exertion, exercise, heavy meal, emotional upset, and anger. </li></ul></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  13. 13. Investigations <ul><li>Electrocardiogram ( ECG) </li></ul><ul><li>Coronary angiography </li></ul><ul><li>Exercise Electrocardiogram (Stress test). </li></ul><ul><li>Complications: </li></ul><ul><li>Myocardial infarction </li></ul><ul><li>Cardiac Arrhythmias </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  14. 14. Myocardium Infarction <ul><li>Myo means muscle, “Cardiac” heart, infarction means “death of tissues due to lack of blood supply”. </li></ul><ul><li>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. </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  15. 15. PATHOPHYSIOLOGY <ul><li>Coronary artery cannot supply enough blood to the heart in response to the demand due to CAD </li></ul><ul><li>Within 10 seconds myocardial cells experience ischemia </li></ul><ul><li>Ischemic cells cannot get enough oxygen or glucose </li></ul><ul><li> Ischemic myocardial cells may have decreased electrical & muscular function </li></ul><ul><li>Cells convert to anaerobic metabolism. </li></ul><ul><li>Cells produce lactic acid as waste </li></ul><ul><li>Pain develops from lactic acid accumulation </li></ul><ul><li>Pt feels anginal symptoms until receiving demand increase 02 requirements of myocardial cells </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  16. 16. ECG changes in Angina & MI <ul><li>Zone of Ischemia: T wave inversion </li></ul><ul><li>Zone of Injury: ST elevation </li></ul><ul><li>Zone of Necrosis: Abnormal Q wave </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  17. 17. Sign and Symptom <ul><li>Classic symptom of heart attack are chest pain radiating to neck, jaws, back of shoulder, or left arm </li></ul><ul><li>The pain can be felt like: </li></ul><ul><li>Squeezing or heavy pressure </li></ul><ul><li>A tight band on the chest </li></ul><ul><li>An elephant sitting on the chest </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  18. 18. Cont <ul><li>Other symptoms include: </li></ul><ul><li>Shortness of breath (SOB) </li></ul><ul><li>Weakness and tiredness </li></ul><ul><li>Anxiety </li></ul><ul><li>Lightheadedness </li></ul><ul><li>Dizziness </li></ul><ul><li>Nausea vomiting </li></ul><ul><li>Sweating, which may be profuse </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  19. 19. Collaborative Management <ul><li>Assessment: </li></ul><ul><li>History </li></ul><ul><li>Clinical manifestation </li></ul><ul><li>Cardiovascular assessment </li></ul><ul><li>Laboratory assessment </li></ul><ul><li>Troponin T & I </li></ul><ul><li>CK-MB </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  20. 20. Radiographic Assessment <ul><li>ECG </li></ul><ul><li>Stress Test </li></ul><ul><li>Myocardial perfusion imaging </li></ul><ul><li>MRI </li></ul><ul><li>Cardiac Catheterization </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  21. 21. IMPORTANT INFORMATION TO REMEMBER Increase supply of Oxygen <ul><li>Decreasing the demand of Oxygen: </li></ul><ul><li>Stop activity and lie down (CBR) </li></ul><ul><li>Take Tab. Angisid sublingually and wait till it dissolves. </li></ul><ul><li>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. </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  22. 22. IMMEDIATE MANAGEMENT OF MI: <ul><li>GOALS: </li></ul><ul><li>To prolong life. </li></ul><ul><li>Minimize infarct size. </li></ul><ul><li>Reverse ischemia. </li></ul><ul><li>Reduce cardiac work. </li></ul><ul><li>Prevent and treat complications. </li></ul><ul><li>A) INITIAL TREATMENT: </li></ul><ul><li>Rapid triage. </li></ul><ul><li>OMI (oxygen, monitor and I/V line). </li></ul><ul><li>Check vital signs and O2 saturation. </li></ul><ul><li>ECG within 10 minutes and repeat ECG. </li></ul><ul><li>Blood samples for enymes, CBC, lytes, and lipid profile. </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  23. 23. Intervention <ul><li>Medication: </li></ul><ul><li>Morphine Sulphate </li></ul><ul><li>Nitrates (GTN) </li></ul><ul><li>Beta blockers </li></ul><ul><li>Calcium Channel Blocker </li></ul><ul><li>Anti platelets / Anti coagulant </li></ul><ul><li>Thrombolytic therapy </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  24. 24. Surgical management <ul><li>PTCA (Percutaneous Transluminal Coronary Angioplasty </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  25. 25. Coronary Artery Bypass Graft surgery (CABG) 06/08/09 www.health-nurses-doctors.blogspot.com
  26. 26. Nursing Diagnosis <ul><li>Acute pain R/T imbalance between myocardial oxygen supply and demand </li></ul><ul><li>Ineffective tissue perfusion R/T interruption of arterial blood flow </li></ul><ul><li>Ineffective coping R/T effects of acute illness and major changes in life style </li></ul><ul><li>Impaired gas exchange related to ineffective breathing pattern and decreased systemic tissue perfusion. </li></ul><ul><li>Anxiety related to present status and unknown future, possible lifestyle changes, pain, and perceived threat of death. </li></ul><ul><li>Activity intolerance related to fatigue </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  27. 27. Prevention <ul><li>Recognize the symptoms </li></ul><ul><li>Reduce your risk factors: </li></ul><ul><li>Lose weight </li></ul><ul><li>Quit Smoking </li></ul><ul><li>Keep your cholesterol at a normal level. </li></ul><ul><li>Keep your blood pressure under control. </li></ul><ul><li>Use techniques to ease stress. </li></ul><ul><li>Control blood sugar level. </li></ul><ul><li>Eat Right </li></ul><ul><li>REGULER EXERCISE </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  28. 28. COMPLICATIONS OF MI: <ul><li>Arrhythmias </li></ul><ul><ul><li>Atrial arrhythmias. </li></ul></ul><ul><ul><li>Ventricular arrhythmias. </li></ul></ul><ul><ul><li>Bradycardia and heart block. </li></ul></ul><ul><ul><li>Asystol. </li></ul></ul><ul><li>Hypertension. </li></ul><ul><li>LV failure. </li></ul><ul><li>Cardiogenic shock. </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  29. 29. CARDIAC REHABILITATION: <ul><li>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 </li></ul><ul><li>Goals of Rehabilitation program : </li></ul><ul><li>Develop a program for progressive physical activity </li></ul><ul><li>Lives as full, vital and productive life </li></ul><ul><li>Remain within the limits of the heart’s ability to respond to increases in activity and stress. </li></ul>06/08/09 www.health-nurses-doctors.blogspot.com
  30. 30. FOLLOW UP 06/08/09 www.health-nurses-doctors.blogspot.com