CARDIAC COND'S

							II. CARDIAC CONDITIONS 1. Angina Pectoris It is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. It is a common symptom of coronary heart disease (CHD) which occurs when vessels that carry blood to the heart become narrowed and blocked due to atherosclerosis. Characteristics:  Feels like a pressing or squeezing pain  Heaviness or discomfort  Aching, burning, choking, strangling and cramping pain  May be mild or severe and typically present with a gradual build up of discomfort and subsequent gradual fading away  Produce numbness or weakness in arms, wrists or hands Clinical Manifestations:  Diaphoresis – over sweating  Nausea  Indigestion  Dyspnea  Tachycardia  ↑ BP Location: Behind middle or upper 3rd sternum. Special Test: Levine test – the patient generally will make a fist over the site of pain. (+) if indicates diffuse deep visceral pain rather that point to it with his or her finger. Radiation: Usually radiates to neck, jaw, shoulders, arms, hands and posterior intrascapular area. More commonly on the left side. Duration: Usually lasts 1 to 5 minutes after stopping activity. Precipitating Factors:  Sexual intercourse  Eating a heavy meal  Exposure to extreme hot or cold weather  Emotional stress  Cigarette smoking Patterns: 1) Stable – most common variety; stable angina is paroxysmal chest pain or discomfort triggered by a predictable degree of exertion or motion; has stable pattern of onset, duration and intensity of symptoms. 2) Unstable – paroxysmal chest pain triggered by an unpredictable degree of exertion or motion which may occur at night; attacks characteristically increase in number, duration and intensity over time.

3) Variant Angina – Prinzmetal’s angina; similar to classic angina but is of longer duration and may occur while at rest. 4) Nocturnal Angina – occurs only during the night and possibly associated with the REM sleep that accompanies dreaming. 5) Angina Decubitus – is paroxysmal chest pain that occurs when the client reclines and lessens when the client sits or stands up. 6) Intractable Angina – is chronic incapacitating angina unresponsive to intervention. 7) Post Infarction Angina – occurs after MI, when residual ischemia may cause episodes of angina. Pathophysiology: ANGINA PECTORIS Symptoms of myocardial ischemia which means “Choking pain in the chest” ↓ Imbalance between myocardial O2 supply and demand ↓ Results in an accumulation of lactic acid and CO2 in ischemic areas of myocardium ↓ Prinzmetal’s angina – temporary occlusion caused by a spasm of the coronary artery Diagnostic Assessment: 1) ECG – records the electrical impulses of the heart.  An ECG taken in the presence of pain may document transient ischemic attacks.  An ECG taken during an episode of pain may also suggest the coronary artery involved and the amount of cardiac muscle affected by the ischemic event. 2) Exercise Electrocardiogram (Stress Test)  Done while you walk on a treadmill (stationary bicycle).  EKG will be observed if it’s abnormal when you exercise. 3) Radioisotope Imaging  Various nuclear imaging techniques are used as diagnostic tools to evaluate the myocardial muscle.  Regions of poor perfusion or ischemia appear as areas of diminished or absent activity “Cold Spots”. 4) Coronary Angiography – provides the most accurate information about the patency of the coronary arteries; allows the visualization of the artery and any partial or complete blockages.

2. Myocardial Infarction

3. Hypertension

4. Heart Failure