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CORONARY ARTERY DISEASE (PowerPoint)

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					CORONARY ARTERY
DISEASE


ANGINA Pectoris
MYOCARDIAL INFARCTION (MI)
Presenter
Dave Jay S. Manriquez
RN.
February 21, 2009
                             Objectives
           Coronary Artery Diseases
               Angina
                 Types
                 Mechanism

                 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.


            conditions result from CAD
            1. Angina Pectoris
            2. Myocardial Infarction




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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 or
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         resting angina) : doctors.blogspot.com
                                                    Cont.

     Types of Angina
           Stable angina:
               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.
                It has a stable pattern of
                onset, duration and intensity
                of symptoms. www.health-nurses-
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                                                     Cont.
               Unstable angina:
                   It is triggered by an un
                    predictable degree of
                    exertion or emotion.
                   (progressive), more
                    severe than stable.
                    Characterized by
                    increasing frequency &
                    severity. Provoked by less
                    than usual effort,
                    occurring at rest &
                   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 :
              Hyperthyroidism
              Exercise
              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”.

       It is also called heart attack.
        It occurs when coronary
        arteries become blocked and
        the part of myocardial
        muscles become dead due to
        prolonged lack of oxygen
        supply to the muscle cells.


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            PATHOPHYSIOLOGY
            Coronary artery cannot supply enough blood to the
               heart in response to the demand due to CAD

              Within 10 seconds myocardial cells experience
                                ischemia

            Ischemic cells cannot get enough oxygen or glucose

              Ischemic myocardial cells may have decreased
                     electrical & muscular function

                Cells convert to anaerobic metabolism.

                   Cells produce lactic acid as waste

                Pain develops from lactic acid accumulation
                             www.health-nurses-
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               increase 02 requirements of myocardial cells
            ECG changes in Angina & MI

               Zone of Ischemia: T wave inversion
               Zone of Injury: ST elevation
               Zone of Necrosis: Abnormal Q wave




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    Sign and Symptom

    Classic symptom of heart attack
     are chest pain radiating to neck,
     jaws, back of shoulder, or left arm
    The pain can be felt like:
    Squeezing or heavy pressure
    A tight band on the chest
    An elephant sitting on the chest



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                                                Cont


            Other symptoms
              include:
             Shortness of breath
              (SOB)
             Weakness and
              tiredness
             Anxiety

             Lightheadedness

             Dizziness

             Nausea vomiting

             Sweating, which may
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            Collaborative Management
               Assessment:
               History
               Clinical manifestation
               Cardiovascular assessment
               Laboratory assessment
               Troponin T & I
               CK-MB



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            Radiographic Assessment


            ECG
            Stress Test
            Myocardial perfusion imaging
            MRI
            Cardiac Catheterization




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            IMPORTANT INFORMATION TO
            REMEMBER



       Increase supply of             Decreasing the demand of
       Oxygen                         Oxygen:
                                      • Stop activity and lie down
                                      (CBR)
                                      •Take Tab. Angisid sublingually
                                      and wait till it dissolves.
                                      If pain continues take up to 03
                                      Tab. Angisid one every five
                                      minutes. If pain is not relieved
                                      yet take another tab. and rush to
                                      EMERGENCY services.
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IMMEDIATE MANAGEMENT OF MI:


      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


               Recognize the symptoms
               Reduce your risk factors:
               Lose weight
               Quit Smoking
               Keep your cholesterol at a normal level.
               Keep your blood pressure under control.
               Use techniques to ease stress.
               Control blood sugar level.
               Eat Right
               REGULER EXERCISE

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            COMPLICATIONS OF MI:

               Arrhythmias
                   Atrial arrhythmias.
                   Ventricular arrhythmias.
                   Bradycardia and heart block.
                   Asystol.
               Hypertension.
               LV failure.
               Cardiogenic shock.

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               CARDIAC REHABILITATION:

Cardiac rehabilitation provides a venue for
continued education, re-enforcement of lifestyle
modification, and adherence to a comprehensive
prescription of therapies for recovery from MI,
which includes exercise training
Goals of Rehabilitation program:
Develop   a program for progressive physical
activity
Lives as full, vital and productive life

Remain within the limits of the heart’s ability to
respond to increases in activity and stress.

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            FOLLOW UP




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