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Sergio age 57 is an extremely active woman who cares for her house an dyard and is an avid gardener. Over last few months she has noticed brief twinges of chest pain while she is working. She comes to the hospital when she experiences severe anterior chest pain while raking leaves. Her work-up shows the presence of Angina Pectoris

is chest pain due to ischemia ( lack of oxygen supply ) of the heart muscle generally due to obstruction or spasm of the coronary arteries ( hearts blood vessel)

The heart is a muscle (myocardium) and gets its blood supply from the coronary arteries. Blood carries the oxygen and nutrients the heart muscle needs to keep pumping. When the heart does not get enough blood, it can no longer function at its full capacity.

Precipitating Factors
H E - hypertension, hypothyroidism, elevation of blood cells

hyperbilirubinemia, Diabetes Miletus

A atherosclerosis oR oral contraceptives (prolonged use) T thrombo angitis obliterans (burgers disease) S smoking, sedentary lifestyle, obesity

Precipitated/enhanced by the following 4Es E excessive exercise demand of o2 is not

equal to heart

E extreme cold environment causes

vasoconstriction, heart deprive of o2

E extreme response to emotional situation E excessive eating

Signs and Symptoms

C chest clunching H heaviness (feeling of) very tight E 4 Es S sudden substernal pain of short

T travels (pain), radiates to arm,

back,axilla more of upper side of abdomen

Associated symptoms:

P palpitation T tachycardia D dyspnea D - diaporesis

Goal of Care Decrease Cardiac Worklaod 1.Complete bed rest 2. Drug

A. NTG (Nitroglycerine and nitrates)
N no heat no moisture because it would decompose the drug and its potency I immediate response to chest pain  sublingual no foods with drug Burning sensation Do not swallow saliva

T three doses Maximum doses of 5 mins. Interval Sign of ventricular fibrillation if pain is not relieved Rush to nearest hospital if pain is not relieved R replace the stocks after 6 months The potency of drug disappears A avoid apply in hairy areas (percutaneous type) T take sips of water This is due to diaphoresis E expect some burning sensation on the tongue Indicative of drug potency

E expect some burningsensation on the tongue Indicative of drug potency S sit, lie and rest Do not extend more effort S side effects of NTG Orthtostatic hypotension Dizziness Flushing sensation S - should carry the drug all the time

Antihypertensive Drugs
A. Ace Inhibitors
Decreases left ventricular after load with subsequent decrease in heart rate thereby reducing cardiac workload of the heart and increasing cardiac output

B. Beta Blockers
Inhibits the sympathetic stimulation of receptors that are located in the conduction system of the heart

C. Calcium Channel Blockers

Inhibit calcium movement within the heart muscle and coronary vessels. Promote vasodilatation and prevent artery spasm

3. Administer oxygen inhalation Slow inflow of 02 inhalation ( 1-2L/min) Educate watchers Place patient in semi fowlers 4.Diet No sodium, saturated foods, caffeine and avoid gas forming foods

5. Monitor Vital signs PVC pre ventricular contraction More than 5 PVC, pending cardiac arrest, refer to physician 6. Discharge Planning Prevent 4E s Health teaching  Prevent terminal stage of IHD Take drugs before doing activity