Angina Flashcards
episodes of pain or pressure in the anterior chest which may radiate to the left arm. Pain is caused by insufficient coronary blood flow resulting in ischemia. Usually relieved by nitroglycerin and rest
Angina Pectoris
- anterior deep chest pain, ranging from mild discomfort to agonizing pain and pressure
- pain radiates to occipital area, jaw, neck, shoulders, back or arms
- described as tightness, heaviness, choking sensation
- may experience numbness in arms, wrists or hands
- may have dyspnea, diaphoresis, or lightheadedness especially in the elderly patients
- Nausea and vomiting are common, and indigestion as well
- usually subsides with rest or nitorglycerin
- slight limitation of activity
presenting symptoms of chronic stable angina
this type of angina is more present in women. They often describe as flu like symptoms, feeling draggy and not like themselves. indicative of low vitamin D
atypical angina
what causes angina?
ischemia (lack of blood flow to the heart.
- moderate to prolonged physical exertion
- heavy meal consumption
- stress or emotional strain
chronic stable angina
how is angina typically relived?
nitroglycerin and rest
- indigestion
- pain between the shoulders
- fatigue
- aching neck/jaw pain
- chocking sensation with exertion
- sleep disturbance
- dyspnea
symptoms of atypical angina
- no reported chest discomfort
- indigestion
- shortness of breath
- disorientation/confusion
Atypical angina in older adults
unstable angina that lasts longer than 15 minutes, presents with chest pain with minimal exertion and emotional stress, is not relieved with nitroglycerin and rest, and increases in occurrence, severity and intensity leads to what? (symptoms at rest indicates unstable)
acute coronary syndrome (which leads to a heart attack)
Sodium (reflects fluid balance: wherever salt goes water goes)
Potassium
Hypokalemia: can cause increased cardiac irritability
Hyperkalemia: can cause cardiac dysrhythmias
Calcium: affects blood coagulation and neuromuscular irritability
Magnesium: low levels lead to prolonged QT interval and increased cardiac irritability
BUN/Creatinine: kidney function
-lower glucose levels improve cardiac function
- C Reactive Protein: if present in the blood non-specific indicator inflammation or infection which can have a role in the development and progression of atherosclerosis
labs important to assess angina.
must be assessed prior to invasive procedures
coagulation studies (PTT and APTT)
homocysteine levels assess for the risk of coronary vascular disease and the patient must be NPO for _____ hours before the test
12
found only in patients with myocardial muscle ischemia or necrosis, so any rise in value indicates possible MI (levels rise within 3-6 hours)
Troponins T and 1
most specific for MI (rises 2-3 hours after cardiac cells are injured and remains elevated for 12 hours
Creatinine Kinase MB (CK-MB)
is a small oxygen-binding protein found in heart and skeletal muscled which is released when heart or skeletal muscles are injured
Myoglobin
_____________ provides a graphic record of the heart’s electrical activity.
Used to detect
Cardiac dysrhythmias
Electrolyte imbalances
Conduction abnormalities
Enlarged heart chambers ischemia/infarction,
Effects of drugs
electrocardiogram
what should the patient do before and exercise stress test?
patients should rest, avoid smoking and use of alcohol. No food 2 hours prior to test.
what stress test is used when the patient can not tolerate exercise ?
pharmacological ECG (Stress Test) is an invasive test. must have IV access for this.
What is the target heart rate to be achieved for a cardiac stress test?
80-90% of maximum predicted heart rate.
-discontinue test if HR gets to high
for a Trans-Esophageal Echocardiography (TEE) how long should a patient be NPO?
- TEE examines cardiac structurre and function
- be aware of the airway and swallowing abilities after test.
4 to 6 hours before and 4 hours afterward.
What medicine can a patient not receive before a CT scan?
Glucophage (Metformin)
when doing an ______ one must assess for claustrophobia, and remove all metal devices
MRI
-most invasive procedure
-Diagnostic CAD, determines extent of atherosclerosis, measures oxygen saturation and pressures in the heart
Pre-Procedure:
-Assess hypersensitivity to iodine, seafood or contrast dyes
-No Glucophage 48 hours prior to or after test
-Assess renal function
-Discontinue anti-coagulation medications/food 6-8 hours prior to test
Post-procedure
-Assess insertion site for bleeding
-Keep patient flat for 6 hours
-Monitor distal pulses and check VS q15 min then q 30 mins then q4h
Cardiac Catherization
why is a non enteric coated aspirin given to those suspected of chest pain?
to promote blood flow
M – morphine: best thing for chest pain (vasodilates, helps with anxiety, helps with pain and helps with adequate perfusion to tissues)
O – oxygen
N – nitrate
A – aspirin
steps to help someone in the emergency room presenting with chest pain.
