2. Students will
Conceptualize ischemic heart disease with its etiology
and pathogenesis
Explain syndrome of CAD
Discuss the risk factors and relate sign and symptoms,
investigations to pathophysiology of IHD
Discuss about treatment and prognosis
Discuss about the nursing management of patient
with IHD
3.
4. IHD – A group of closely related syndromes caused by an
imbalance between the myocardial oxygen demand and blood
supply.
Usually caused by decreased coronary artery flow
Four syndromes :
Angina pectoris ( chest pain )
Acute myocardial infarction
Chronic ischemic heart disease and congestive heart failure
Sudden cardiac death
The most common cause of IHD is coronary atherosclerosis
Less commonly it is due to vasospasm and vasculitis
5.
6. Age – risk increases with age
Sex – males are more prone and females are prone after 10 yrs as
postmenopausal decrease in cardiac protective estrogen
Race – non whites increased risk
Modifiable risk factors
Elevated lipid levels
Hypertension
Obesity
Tobacco use
Diabetes mellitus
Sedentary lifestyle and stress
7.
8. Role of clinical stenosis and obstruction
Role of acute plaque change
Role of coronary thrombus
Role of vasoconstriction
Role of inflammation
9.
10.
11.
12.
13.
14. Angina Pectoris
Acute MI
Chronic IHD with Congestive Heart Failure
Sudden cardiac deadth.
16. STABLE ANGINA PECTORIS
It is relieved by rest or nitroglycerine
> Character - substernal chest pain,pressure,heaviness
including squezing,burning,choking
- may produce in numbness or weakness in arms, wrists or
hands
- associated symptoms include diaphoresis, nausea,
dypsnea,tachycardia,increased BP
- women may experience chest pain,jawpain,shortness of
breath
Location – behind middle or upper third of sternum
Radiation – radiates to neck , jaw , shoulder , arms ,hands and
posterior intrascapular area
Duration – lasts 2 to 15 min after stopping activity
17.
18. Chest pain occuring at rest
No increase on oxygen demand
Lack of blood flow to heart due to plaque
Lasts longer than 10 min
Unrelieved by rest or sublingual nitroglycerine
SILENT ISCHEMIA
Absence of ischemia with imbalance between myocardial
oxygen demand and bkood supply
ST elevation in ECG
Increase heart rate , blood pressure and blood viscosity.
19. ANTIANGINAL
i. Nitrates : vasodilation of arteries
ii. Cardioselective Beta Adrenergic Blockers : inhibit sympathetic stimulation
iii. Calcium channel blockers : inhibit movement of calcium with heart muscle
and coronary vessel
ACE INHIBITORS - Remodelling the vacular endothelium
ANTILIPID AGENTS – Reduce total cholesterol and triglyceride level
ANTIPLATELET AGENTS – Decrease platelet aggregation
FOLIC ACID AND B COMPLEX VIT – Treat increased homocystiene levels
20. Characteristic chest pain and clinical history
Nitroglycerin test : relief of pain with nitroglycerine
Blood tests : cardiac markers , creatine kinase and its
isoenzyme CK- MB , homocycteine and lipoprotien
,hemoglobin to rule out anemia
12 lead ECG which may show LVH , ST elevation, arrythmias
ECG stress testing
21. Treadmill test ( TMT ) : changes in ST elevation
Cardiac cathetorization : determines the presence ,
location and extent of coronary lesions.
Position emission tomography ( PET Scan ) : detect very
small perfusion differences caused by arteries.
Computed tomography ( CT Scan ) : detects coronary
calcium
Radionuclide imaging : indicates regions of ischemia
induced by exercise
22.
23. Participate in normal daily program of activities that
do not produce chest discomfort and shortness of
breath
Avoid activities like walking against the wind,
extremes of temperature , emotionally stressful
situations
Rest after each meal
Do not carry heavy objects
24. Carry nitroglycerine at all time
Place nitroglycerine under the tongue at first sign of chest
discomfort
Stop all efforts or activity, sit and take nitroglycerine tablet
Repeat dosage in 5 min for total of 3 tablets if relief is not
obtained
Keep a record of the number of tablets taken to evaluate
change in anginal pattern
Take nitroglycerine prophylactically to avoid pain known to
occur with certain activities
25. Instruct patient on administration of transdermal
nitroglycerine patches
a) Remove previous patch ; fold in half so that the medication
does not touch your fingertips and will not be accessible in
trash
b) Wipe area with tissue to remove any residual medication
c) Apply patch to a clean ,dry and non hairy area of body
d) Rotate administrationn sites
e) Instruct patient not to remove patch for swimming or
bathing
Teach patient about potential adverse effects of medications
a) Constipation
b) Ankle edema
c) Dizziness
27. Inform patient the methods of stress reduction
Review low fat and low cholesterol diet
a. Omega 3 improve arterial health and decrease BP,
triglycerides and the growth of atherosclerosis
plaque.
b. Omega 3 oils can be found in fatty fish.
Instruct patient to avoid excessive caffeine intake s it
increases heart rate and produce angina
Encourage patient to avoid alcohol
28.
29. ACUTE PAIN related to an imbalance in oxygen supply
and demand
DECREASED CARDIAC OUTPUT related to reduced
heart rate
ANXIETY related to chest pain
31. RELIEVING PAIN
Determine intensity of patients angina
Fowlers position
Administer oxygen , if appropriate
Obtain BP , HR , RR
Administer anti-anginal drug
Take vital signs every 5 to 10 min until angina pain subsides
Monitor progression of stable angina to unstable angina
32. MAINTAINING CARDIAC OUTPUT
Take BP and HR in sitting position {evaluate
orthostatic hypotension which occurs during drug therapy
}.
Note changes in BP more than 10 mmHg and changes in
HR of more than 10 beats/min
Note patients complaints of headache and dizziness
Continuous ECG monitoring
33. DECREASING ANXIETY
Explain to patient the importance of anxiety reduction to assist
in control of angina
{ Angina and fear increase stress on heart, requiring the heart to use more oxygen }