Cardiovascular Disorders Angina

8/13/2019 Cardiovascular Disorders Angina

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Cardiovascular Disorders

Atherosclerosis


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Atherosclerosis

Risk factors

Non-modifiable

Gender

Genetics

Age

Culture/Ethnic


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Atherosclerosis

Modifiable Risk Factors

Smoking

Hyperlipidemia

Hypertension

Diabetes

Obesity

Sedentary lifestyle Stress

Psychosocial


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Notes

Psychosocial-type A personality aggressive, compulsive,perfectionism,

Diabetes encourages plaque formation. Changes to microvascular(collateral circulation) makes wall sticky and encourages clotformation platelet aggregation

Smoking is proportional to amount of cigarettes smoked.Catecholomine release causes tachycardia, increase in bloodpressure. Vasoconstriction of coronary arteries. Platelet adhesion

Smoking also decreases oxygen and increases carbon monoxide.

Diabetics tend to have higher ldl and vldl levels.

Sedentary lifestyle increases lipids, helps to lower blood sugar.

Reduces stress and lowers blood pressure. Stress increases catecholomines, increase heart rate,.

Catecholomines are epinephrine, norepinephrine and dopamine

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Atherosclerosis

Coronary arteries arise from the coronary sinus

from the base of the Aorta

Provide nutrients to cardiac muscle

CAD

Obstruct blood flow to the heart muscle

Lumen is obstructed

Causes ischemia

Supply of nutrients does not meet demand


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Notes

Ischemia- decreased blood supply to an

organ

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Atherosclerosis

Symptoms are related to the amount of

obstruction

Death may occur if left untreated


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Angina Pectoris

Angina-spasmodic, cramp like, choking feeling

Pectoris-chest/ Breast area

Decreased blood supply when moreoxygenated blood is needed

Cold

Stress

Exertion

Anxiety


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Notes

Cold causes vasoconstriction

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Angina Pectoris

Unstable

Occurs at rest


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Angina Pectoris

Signs and Symptoms Pain

Chest, back, jaw, throat, left arm, shoulder, neck

Dyspnea

Anxiety

Apprehension

Diaphoresis

nausea

Symptoms in women may appear differently than inmen


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Notes

Heaviness or tightness to chest, feels like

indigestion, denial, squeezing,

Women-palpitations, chest discomfort

during rest, pain in abdomen,

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Angina Pectoris

Treatment

Usually can be relieved by rest since pain iscaused by temporary lack of oxygen supply tothe heart

Assess vital signs

Administer oxygen Check ECG monitor

Nitroglycerin SL X 3, 5 minutes apart PRN Vasodilator

Angina Pectoris can be a precursor to an MI

Notify MD if Nitroglycerin is not effective, thiscould be a sign of MI


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Notes

Always check blood pressure prior to

administering nitroglycerin since it is a

vasodilator

Causes headache due to vasodilation of

cerebral vessels/ warn patient

Tell story of pt in room 259

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Angina Pectoris

Assessment

Subjective

Pain- assess location, intensity, radiation, duration,

precipitating factors

What reliefs the pain?

Have the episodes of pain increased?

Is the pain becoming more severe


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Angina Pectoris

Objective Data

Look for signs the patient may be in pain such as

rubbing elbows or chest

Note any changes in vital signs such as

tachycardia, increase in blood pressure

Diaphoresis

Anxiety Pale


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Angina Pectoris

Diagnostic Tests

ECG

Rhythm changes or elevation

Holter Monitor

Exercise Stress Test

Thallium Scanning

PET

Coronary Angiography


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Notes

Make sure students know that a patient

maintains a journal during a holter monitor

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Angina Pectoris

Medical Management

Control Symptoms

Daily Aspirin

Vasodilators

Beta-adrenergic blocking agents

Calcium channel blocking agents

Nitroglycerin SL


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Angina Pectoris

Surgical Interventions

Angioplasty (PTCA)

Stent Placement

CABG


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Angina Pectoris

Surgical Interventions PTCA (Percutaneous Transluminal Coronary

Angioplasty Invasive Sterile technique Performed by Cardiologist Sign consent for CABG due to potential for complications Done under Fluoroscopy Need sedation Assess for allergy to iodine, shellfish, contrast

Femoral or Brachial artery is used to cannulate the coronaryarteries

Complications include hemorrhage, vessel closure, need forsurgery, MI,


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Angina Pectoris

Treatment

Coronary Stent Placement

Expandable, meshlike structure

Designed to help hold the arterial wall open

Need to have anticoagulant therapy

Sedation usually given

Assess for allergy to shellfish, iodine, contrast

Complications include hemorrhage at insertion site,

injury to arterial wall, dysrhythmias, emergencysurgery, stent thrombosis, acute MI

Hospital stay for 1-3 days


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Angina Pectoris

Treatment

CABG (Coronary Artery Bypass Graft)

Surgical management

Veins from legs or internal mammary artery is

used

Patient requires at least one night stay in ICU and

about 5 days in the hospital Cardiac rehabilitation is usually ordered afterward

Patient should not use a trapeze bar


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Notes

Internal mammary is preferred since this is

more like an artery. Veins need to be

turned inside out due to valves

Internal mammary artery lasts longer (15

years)

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Cardiovascular Disorders Angina

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