Coronary Artery Disease Cvs 2 Es 1 1230806172121287 1 1
Coronary Artery Disease Cvs 2 Es 1 1230806172121287 1 1
DISEASE
¡ 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.
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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
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resting angina) : doctors.blogspot.com
Cont.
Types of Angina
¡ Stable angina:
l 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.
l It has a stable pattern of
onset, duration and intensity
of symptoms. www.health-nurses-
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Cont.
¡ Unstable angina:
l It is triggered by an un
predictable degree of
exertion or emotion.
l (progressive), more
severe than stable.
Characterized by
increasing frequency &
severity. Provoked by less
than usual effort,
occurring at rest &
l 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 :
l Hyperthyroidism
l Exercise
l 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”.
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PATHOPHYSIOLOGY
Coronary artery cannot supply enough blood to the
heart in response to the demand due to CAD
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Sign and Symptom
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Cont
Other symptoms
include:
¡ Shortness of breath
(SOB)
¡ Weakness and
tiredness
¡ Anxiety
¡ Lightheadedness
¡ Dizziness
¡ Nausea vomiting
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Radiographic Assessment
ECG
Stress Test
Myocardial perfusion imaging
MRI
Cardiac Catheterization
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IMPORTANT INFORMATION TO
REMEMBER
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-
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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
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COMPLICATIONS OF MI:
¡ Arrhythmias
l Atrial arrhythmias.
l Ventricular arrhythmias.
l Bradycardia and heart block.
l Asystol.
¡ Hypertension.
¡ LV failure.
¡ Cardiogenic shock.
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CARDIAC REHABILITATION:
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FOLLOW UP
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