CORONARY ARTERY DISEASE

1. CORONARY ARTERY DISEASE ANGINA Pectoris MYOCARDIAL INFARCTION (MI) Presenter Dave Jay S. Manriquez RN. February 21, 2009

2. Objectives • Coronary Artery Diseases • Angina • Types • Mechanism • Causes • Clinical manifestation • Complication • Nursing care www.health-nurses-doctors.blogspot.com

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 www.health-nurses-doctors.blogspot.com

4. Cont. conditions result from CAD 1. Angina Pectoris 2. Myocardial Infarction www.health-nurses-doctors.blogspot.com

5. 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) : www.health-nurses-doctors.blogspot.com

6. 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. www.health-nurses-doctors.blogspot.com

7. 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. www.health-nurses-doctors.blogspot.com

8. 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 www.health-nurses-doctors.blogspot.com

9. Mechanism Of Angina www.health-nurses-doctors.blogspot.com

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11. Causes • Coronary atherosclerosis (atheroma ) • Factors increasing preload : • Hyperthyroidism • Exercise • Anemia • Factors increasing after load: • Hypertension • Aortic stenosis • Obstructive cardio myopathy • Coronary artery spasm www.health-nurses-doctors.blogspot.com

12. 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. www.health-nurses-doctors.blogspot.com

13. Investigations • Electrocardiogram ( ECG) • Coronary angiography • Exercise Electrocardiogram (Stress test). Complications: • Myocardial infarction • Cardiac Arrhythmias www.health-nurses-doctors.blogspot.com

14. 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. www.health-nurses-doctors.blogspot.com

15. 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 www.health-nurses-doctors.blogspot.com

16. ECG changes in Angina & MI • Zone of Ischemia: T wave inversion • Zone of Injury: ST elevation • Zone of Necrosis: Abnormal Q wave www.health-nurses-doctors.blogspot.com

17. 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 www.health-nurses-doctors.blogspot.com

18. Cont Other symptoms include: • Shortness of breath (SOB) • Weakness and tiredness • Anxiety • Lightheadedness • Dizziness • Nausea vomiting • Sweating, which may be profuse www.health-nurses-doctors.blogspot.com

19. Collaborative Management • Assessment: • History • Clinical manifestation • Cardiovascular assessment • Laboratory assessment • Troponin T & I • CK-MB www.health-nurses-doctors.blogspot.com

20. Radiographic Assessment ECG Stress Test Myocardial perfusion imaging MRI Cardiac Catheterization www.health-nurses-doctors.blogspot.com

21. 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. www.health-nurses-doctors.blogspot.com

22. 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. www.health-nurses-doctors.blogspot.com

23. Intervention • Medication: Morphine Sulphate Nitrates (GTN) Beta blockers Calcium Channel Blocker Anti platelets / Anti coagulant Thrombolytic therapy www.health-nurses-doctors.blogspot.com

24. Surgical management • PTCA (Percutaneous Transluminal Coronary Angioplasty www.health-nurses-doctors.blogspot.com

25. Coronary Artery Bypass Graft surgery (CABG) www.health-nurses-doctors.blogspot.com

26. 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 www.health-nurses-doctors.blogspot.com

27. 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 www.health-nurses-doctors.blogspot.com

28. COMPLICATIONS OF MI: • Arrhythmias • Atrial arrhythmias. • Ventricular arrhythmias. • Bradycardia and heart block. • Asystol. • Hypertension. • LV failure. • Cardiogenic shock. www.health-nurses-doctors.blogspot.com

29. 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. www.health-nurses-doctors.blogspot.com

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