Kingdom Of Saudi Arabia

Ministry Of Education
King Saud University
Faculty Of Nursing

Acute Coronary
, angina pectoris and
myocardial infraction
: Prepared By : Student ID
Abeer Al Mutairi 439203903
Aljawhara mohammad 439203985
Sahar khawaji 439203590
: Supervised By
Dr. Delail Alosaimy
 : Objectives
• Revise the anatomy and physiology of the heart
• Define the coronary artery diseases.
• Describe risk factors of coronary artery diseases.
• Angina pectoris:
• Define angina pectoris
• Describe 2 types of angina,
• Describe the Clinical manifestation
• List the diagnostic procedures of angina.
• Describe the medical management of angina.
• Describe the surgical management of angina
• Myocardial infarction:
• Define myocardial infarction.
• Describe the clinical manifestations of myocardial infarction.
• List diagnostic measures.
• Describe the complications of myocardial infarction.
• List the emergency nursing for chest pain
 Anatomy and
physiology of
Coronary Artery

• Coronary arteries supply blood to

the heart muscle.
• Like all other tissues in the body,
the heart muscle needs oxygen-
rich blood to function, and oxygen
depleted blood must be carried
away.
• The coronary arteries run along
the outside of the heart and have
small branches that dive into the
heart muscle to bring it blood.
:The two main coronary arteries are

Left main coronary artery (LMCA). The left main coronary artery supplies blood to the
left side of the heart muscle (the left ventricle and left atrium). The left main coronary
.divides into other branches

Right coronary artery (RCA). The right coronary artery supplies blood to the right
ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes,
,which regular the heart rhythm. The right coronary artery divides into other branches
Why are the coronary arteries important?

• Since coronary arteries deliver blood to the heart muscle,

any coronary artery disorder or disease can have serious
implications by reducing the flow of oxygen and nutrients to the
heart muscle. ------This can lead to a heart attack and possibly
death.
• Atherosclerosis (a buildup of plaque in the inner lining of an
artery causing it to narrow or become blocked) is the most
common cause of heart disease.
 It is describe the effects of a reduction or
complete obstructionof the blood
flow(and oxygen transport)
Coronary --------------------------------------------through
Artery Disease the coronary
arteries--------------------------------------------
(CAD) as a result of narrowing (atherosclerosis)
.and/or blood clot (thrombus)
 It is hardening of the arteries, is a condition in
.which plaque builds up inside the arteries

Plaque is made of cholesterol, fatty substances,

cellular waste products, calcium and fibrin (a
.clotting material in the blood)
Atherosclerosis
.Atherosclerosis is a type of arteriosclerosis

Arteriosclerosis is a general term for the

.thickening and hardening of arteries
 Plaque may partially or totally block the
blood's flow through an artery in the
heart, brain, pelvis, legs, arms or
What damage .kidneys
does
atherosclerosis
?cause
Some of the diseases that may develop
; as a result of atherosclerosis include
coronary
peripheral
heart disease, carotid artery chronic kidney
artery disease
angina (chest ,disease .disease
(PAD) and
,pain)
 Risk Factors of CAD

Unmodifiable risk factors are:

• Age
• Gender (sex)
• Race and Genetic inheritance.
:Modifiable risk factors include
Elevated serum lipids, .1
(hypercholesterolaemia)
”Uncontrolled Hypertension, “silent killer .2
,Smoking .3
,Obesity .4
Physical inactivity .5
Stress in daily living .6
Uncontrolled control of diabetes mellitus .7
 Angina pectoris literally translated
as; pain (angina) in the chest
(pectoris)

Angina :Angina classically consists of

Pectoris

reterosternal constricting discomfort

----which may radiate to: arm, the
throat, the jaw, the teeth, the back
.or the epigastrium
 .Exercise .1

Exercise after a large meal .2

Precipitating
.Stress on anxiety .3

factors --- Walking on a cold or windy day .4

Chest Pain Exertion .5

Cold weather .6

Anger .7

Fear .8
 Site (Region) and radiation :
• Substernal with radiation to the neck, left arm or jaw,
Chest Pain upper chest, epigastric, left shoulder, intrascapular

assessment Quality:
• Heaviness
• Tightness
• Squeezing
• Choking
• Suffocation
• Smothering
 :Definition of Levine’s sign
When the patient localizes the
chest pain by clenching their fist
over the sternum (typically
radiating to the left arm or left
.side of the neck)
Types of
Angina Stable angina
1-Chest pain: -Predictable and
consistent pain that -occurs on
exertion and -is relieves by rest. -It
is usually relieves within 2-10
minutes by rest.
2. Shortness of breath,
3. Sweating,
4. palpitations and weakness
5. Symptoms tend to be worse: -
in the morning, -after heavy meals
and -in cold weather. People with
stable angina are at increased risk
of Anterior Myocardial Infarction
AMI and sudden death.
Unstable angina
History of recent onset of
experiencing angina symptoms
,(within the past 4 - 6 weeks)
The discomfort /chest pain has
:become
More frequent, more easily .1
triggered, more severe or
prolonged or less responsive to
,nitrate therapy
discomfort /chest pain and .2
associated symptoms occurring in
the absence of physical or
emotional press and lasting more
. than 20 minutes
It can cause sudden death or .3
.result in myocardial infarction
 :Medical Management for Angina Pectoris
Nitroglycerin Beta-adrenergic blocking agent.1
Calcium channel blocking agent .2
Antiplateletand anticoagulant .3
Management Heparin .4

of angina :Oxygen administration .5

:Surgical Management in Angina Pectoris
pectoris Percutaneous Transliuminal Coronary Angioplasty (PTCA) .1
Coronary artery bypass grafting surgeries (CABG): It is still major .2
.intervention in the treatment of patients with coronary heart disease
Atherectomy: It is an invasive interventional procedure that involves .3
.the removal of the atheroma, or plaque, from a coronary artery
Transmyocardial Laser Revascularization (TMLR): A cardiac, surgeon .4
utilizes the laser to create approximately 20 to 40 channels to allow
.oxygen-rich blood to reach prove deprived areas of the patient's heart
 commonly known as heart attack happens when
there is marked reduction or loss of blood flow
through one or more of the coronary arteries,
.resulting in cardiac muscle ischemia and necrosis
It is an acute
It is a sudden or complete cessation of blood
myocardial flow, as may result from a thrombus, results in
necrosis of myocardial tissue (myocardial
infarction .infarction)
(AMI)
Critical restriction to blood flow occurs when the
diameter of the lumen is reduced by more than
.half
 diffuse steady
substernal pain of a
:Chest pain is severe
crushing and
;squeezing nature

Clinical not relieved by rest or may radiate to the

sublingual vasodilator arms (commonly the
Manifestations therapy, but requires left), shoulders, neck,
;narcotics ;back, and/or jaw
of MI

continues for more resulting in an increase

than 15 minutes and in heart rate, blood
may produce anxiety pressure and
,and fear .respiratory rate
• Vital signs: • Level of Consciousness:
1. Dyspnea, 1. Severe anxiety,
2. Cardiac arrhythmia 2. Disorientation
(premature ventricular and/or 3. confusion, altered level of
atrial beats). consciousness
3. Palpitations, 4. Restlessness fainting,
4. Hypertension or hypotension. • GIT:
5. Bradyeardiaor tachycardia. 1. Nausea, vomiting,
• Skin: 2. Hiccups and a typical
1. Diaphoresis symptoms, epigastricor
abdominal.
2. cool clammy skin
• Activity Marked weakness
3. facial pallor.
 Ambulatory .2
Cardiac Enzyme .3
.Elecrocardiographic.1 Electrocardiography
Studies
(holter Monitoring)
Diagnostic
:Measures
It measure the levels of These include the
enzymes and proteins enzyme creatine kinase
that are linked with (CK), and the proteins
injury of the heart troponin I (TnI) and
.muscle .troponinT (TnT)
 Thrombolytic Therapy.1

Analgesic .2
Medical
Management Softeners and laxatives .3

of Myocardial
:Infarction Beta-blockers .4

Primary angioplasty .5

Emergent PTCA .6
 Complications of acute
Myocardial Infarctions

•1-Cardiac Arrhythmias:
• The most common complications alter MI are
arrhythmias.
• present in 80% of MI patients.
 Do not Do not allow the patient to move even for few steps as
allow .this could upset the heart rhythm leads to cardiac arrest

Do not Do not transport the patient, but call emergency

Emergency transport number

Nursing care Keep Keep calm & patient comfortable and give room to

during chest
breath

pain Do not Do not leave the patient alone

leave

Give sublingual Nitroglycerine and monitor vital signs till

Give . ambulance arraives
 • Lewis, Sh. L., Dirksen Sh. R and Heitkemper M. Mc. ( 2014)
Medical Surgical Nursing, 9th ed. Elsevier, Canada

• Study Guide for Brunner & Suddarth’s Text book of Medical-

Surgical Nursing, the most recent edtion, Wolters Klumer,
Lippincott Williams & Wilkins, China
• Carpenito L. J. (2015): Nursing Diagnosis “Application to
Clinical Practice” 16thWolters Klumer, Lippincott Williams &

References Wilkins, China

• Hinkle J. L. and Cheever, K. H. (2014): Brunner & Suddarth’s

Textbook of Medical Surgical Nursing 13th ed., Wolters
Klumer, Lippincott Williams & Wilkins, China

• Emergency Medicine Secrets 4th EditionOxford Handbook of

Trauma for Southern Africa.Care of the Critically ill surgical
Patient – Ian Anderson.
Thank you