CORONARY ARTERY DISEASE

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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 CAD
• 1. 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 hearts 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 (Prinzmetals 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 (Prinzmetals 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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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

• 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

• ECG
• Stress Test
• Myocardial perfusion imaging
• MRI
• Cardiac 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.

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Intervention

• Medication
• Morphine Sulphate
• Nitrates (GTN)
• Beta blockers
• Calcium Channel Blocker
• Anti 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
  activity
• Lives as full, vital and productive life
• Remain within the limits of the hearts ability
  to respond to increases in activity and stress.

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