Brief Description

Anatomy And Physiology

Pathophysiology
Laboratory
Drug Study
Nursing Care Plan
Angina
Definition pectoris
-chest pain
due to ischemia of
the heart muscle,
generally due to
obstruction or
spasm of the
Symptoms
•Chest discomfort - pressure, heaviness,
tightness, squeezing, burning, or choking sensation
•Anginal pains - epigastrium (upper central
abdomen), back, neck, jaw, or shoulders.
*Pain may be accompanied by
breathlessness, sweating and nausea in some
cases.
r risk factors
rette smoking
etes
cholesterol
blood pressure
ntary lifestyle
ly history of premature heart di
 Three main types of
angina:
1.Stable angina
2.Unstable angina
3.Variant angina
(Prinzmetal’s angina)
Diagnosis
•Exercise Electrocardiogram
or
graded exercise test
•Nuclear Cardiology
•Coronary Angiography
Treatment
The main goals of treatment in
angina pectoris are relief of
symptoms, slowing progression of
the disease, and reduction of
future events, especially heart
attacks and of course death.
•aspirin (75 mg to 100 mg) /day
-beneficial for all patients with stable angina that have
no problems with its use.
•Beta blockers
-have a large body of evidence in morbidity and
mortality benefits and short-acting nitroglycerin medications
are used for symptomatic relief of angina.
•A new therapeutic class, called If inhibitor, has recently
been made available: ivabradine provides pure heart rate
reduction, leading to major anti-ischemic and antianginal
efficacy.
•Calcium channel blockers
-vasodilators commonly used in chronic stable angina.
•ACE inhibitors
-statins are the most frequently used lipid/cholesterol
modifiers which probably also stabilise existing atheromatous
plaque.
•Ranolazine (Ranexa)
- A new class of anti anginal drug that was approved by
the Food and Drug Administration

•Identifying and treating risk factors for further coronary

heart disease is a priority in patients with angina. This is a
new class of antimeans testing for elevated cholesterol and
other fats in the blood, diabetes and hypertension (high blood
pressure).
•Encouraging stopping smoking and weight optimization.
•Exercise
 Definition
Myocardial infarction
- the blood
supply to a part
of the heart is
interrupted,
most commonly
due to rupture
of a vulnerable
Symptoms
•chest pain
(typically radiating to the left arm)

•shortness of breath
•nausea, vomiting
•palpitations
•sweating
•anxiety
Immediate treatment
Morphine sulfate
Oxygen therapy
Nitroglycerine
Aspirin
Risk factors
risk factors for atherosclerosis are generally
risk factors for myocardial infarction:
•Older age
•Male sex
•Tobacco smoking
•Hypercholesterolemia
(more accurately hyperlipoproteinemia, especially high
low density lipoprotein and low high density lipoprotein)

•Hyperhomocysteinemia-high
homocysteine, a toxic blood amino acid that is elevated
when intakes of vitamins B2, B6, B12 and folic acid are
insufficient

•Diabetes (with or without insulin resistance)

•High blood pressure
Diagnosis
•Serial 12-lead ECG
•ECG
•Serial cardiac enzymes and
proteins (creatine,troponin and myoglobin)
•Leukocytosis, increase in
ESR secondary to
•Nuclear imaging identify
areas of infarction
•Cardiac catheterization
Treatment
•Thrombolytic therapy - to
restore vessel patency

•PTCA- open block or

narrowed arteries

•Oxygen administration
•Sublingual NTG- to relieve
pain(don’t give if BP is < 90/60 mmHg or HR<50 or>100
bpm

•Morphine
•Aspirin to inhibit platelet aggregation
•Lidocaine to combat arrhythmias
Complications
•Congestive heart failure
•Myocardial rupture
•Life-threatening
arrhythmia
•Pericarditis
Lab Studies
•Troponin is the preferred biomarker for
diagnosis.

•Creatine kinase–MB level  

•Myoglobin levels  
•Complete blood count - CBC is
indicated if anemia is suspected as a precipitant. Transfusion
with packed red blood cells may be indicated.
•Leukocytosis may be observed within several
hours after an AMI. It peaks in 2-4 days and returns to levels
within the reference range within 1 week.

•Chemistry profile
•C-reactive protein (CRP) is a
marker of acute inflammation. Patients without biochemical
evidence of myocardial necrosis but with elevated CRP level
are at increased risk of a subsequent ischemic event.
•Erythrocyte sedimentation
rate (ESR) rises above reference range values
within 3 days and may remain elevated for weeks.

•Serum lactate dehydrogenase

(LDH) level rises above the reference range within 24
hours of MI, reaches a peak within 3-6 days, and returns to
the baseline within 8-12 days
Imaging Studies
•Chest radiography
•Echocardiography
•Technetium-99m sestamibi
scan
•Thallium scanning: Thallium
accumulates in the viable myocardium.
•Perfusion imaging for measurement of
infarct size to evaluate reperfusion therapies.
•Novel "hot spot" imaging
radiopharmaceuticals that visualize
infarction or ischemia are currently undergoing evaluation
and hold promise for the future.
•Recent advances include dual-source 64-
slice CT scanning that can do a full scan in 10
seconds and produce high-resolution images that allow fine
details of the patient's coronary arteries to be seen.
Nursing Considerations
•Assess and record the severity
and radiation of pain and
administer analgesics
•Avoid IM injections
•Check patients BP after giving
NTG specially the first dose
•Frequently monitor ECG to
detect rate changes or
arrhythmias
•During periods of chest pain,
obtain 12 lead ECG, BP and
pulmonary artery catheter
•Auscultate for adventitious
breath sounds, S3 or S4 gallops
and new onset heart murmurs
•Provide a stool softener to
prevent staining during
defecation which causes vagal
•Assist patient with ROM
exercises
•If patient is immobilized by
severe MI, reposition every 2
hours
•Measure for and apply anti-
•Provide emotional support to
patient and help reduce stress
and anxiety
•Teach patient about drug
therapy and other treatment
measures to promote