Unit 2 CHAPTER 35 Angina, Acute Coronary Syndrome, Myocardial Infarction, Coronary Artery Bypass (CABG) Flashcards
Which of the following go under the umbrella of Coronary artery disease (CAD)?
Coronary artery disease (CAD) is a broad term that includes chronic stable angina and acute coronary syndrome (ACS).
What is the number one cause of CAD
Atherosclerosis is the primary factor in the development of CAD.
What is Angina Pectoris
Angina pectoris is chest pain caused by a temporary imbalance between the coronary arteries’ ability to supply oxygen and the cardiac muscle’s demand for oxygen.
What is Unstable Angina?
is chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitation.
- Unrelieved with rest and/or medication.
- Risk for myocardial infarction – call 911
What is Stable Angina?
is chest discomfort that occurs with moderate-to- prolonged exertion in a pa ern that is familiar to the patient. The frequency, duration, and intensity of symptoms remain the same over several months. CSA results in only slight limitation of activity and is usually associated with a fixed atherosclerotic plaque.
What is atypical angina
Many women of any age experience atypical angina. Atypical angina manifests as indigestion, pain between the shoulders, an aching jaw, or a choking sensation that occurs with exertion. Other symptoms may include unusual fatigue, shortness of breath, dizziness, palpitations, generalized anxiety or weakness and flulike symptoms
What is stable angina relieved by?
It is usually relieved by nitroglycerin (NTG) or rest and often is managed with drug therapy
If angina last longer than 30 minutes what is that indicative of?
Myocardial infarction
Signs and symptoms of Angina in older adults
- **Recognize that chest pain may not be evident in the older patient. **Examples of associated symptoms are unexplained -dyspnea,
-confusion, or
-Gastrointestional symptoms.
Abdominal pain or cramping.
Bloating.
Change in bowel habits.
Constipation.
Diarrhea.
Incomplete bowel movements.
Narrow stools.
Rectal bleeding or bloody stools.
-chest pain
Signs and symptoms of angina
pain, pressure, tightness, discomfort, squeezing, heaviness, or burning in the chest.
Types of Angina
Chronic Stable Angina
* Relieved with rest and/or medication *
Unstable Angina
* Causes severe activity limitations.
* Unrelieved with rest and/or medication.
* Risk for myocardial infarction – call 911
-
Prinzmetal Angina – occurs when at rest, most often from
physical exhaustion or emotional stress – most often caused by spasms rather than blockage
Which of the 3 Angina is more of a priority?
1.Chronic Stable Angina
2.Unstable Angina
3.Prinzmetal Angina
Unstable Angina
* Causes severe activity limitations.
* Unrelieved with rest and/or medication.
* Risk for myocardial infarction – call 911
Which of the 3 are caused by emotional stress
1.Chronic Stable Angina
2.Unstable Angina
3.Prinzmetal Angina
3.Prinzmetal Angina
Which of the following Medications can treat Unstable or Stable Angina ?
A.Sildenifil
B. Nitroglycerin
C. Magnesium
B. Metoprolol
B. Nitroglycerin
The pressure may last longer than 15 minutes or may be poorly relieved by rest or nitroglycerin.
What should you ask the patient prior to administering Nitroglycerin?
Before administering NTG, ensure that the patient has not taken any phosphodiesterase inhibitors for erectile dysfunction, such as sildenafil, tadalafil, avanafil, or vardenafil, within the past 24 to 48 hours.
Concomitant use of NTG with these inhibitors can cause profound hypotension. Remind patients not to take these medications within 24 to 48 hours of one another.
Some phosphodiesterase inhibitors are also used in the treatment of pulmonary arterial hypertension (PAH). Patients with PAH cannot stop taking the phosphodiesterase inhibitor. As a result, NTG is contraindicated in this patient population.
Side effects Nitroglycerin
Side effects and adverse reactions
* Headache
* Flushing
* Dizziness, weakness
* Syncope
Adverse effects Nitroglycerin
Orthostatic hypotension, chest pain, dyspnea, tachycardia, paradoxical bradycardia, palpitations, methemoglobinemia
Life threatening: MI, pulmonary edema
Patient teaching admin of Nitro
Teach the patient to hold the NTG tablet under the tongue and drink 5 mL (1 teaspoon) of water, if necessary, to allow the tablet to dissolve.
NTG spray is also available and is more quickly absorbed. Pain relief should begin within 1 to 2 minutes and should be clearly evident in 3 to 5 minutes
STOP ALL ACTIVITY
. After 5 minutes, recheck the patient’s pain intensity and vital signs. If the blood pressure (BP) is less than 100 mm Hg systolic or 25 mm Hg lower than the previous reading, lower the head of the bed and notify the health care provider.
If the patient is experiencing some but not complete relief and vital signs remain stable, another NTG tablet or spray may be used. In 5-minute increments, a total of three doses may be administered in an attempt to relieve angina pain.
If the patient uses NTG spray instead of the tablet, teach him or her to sit upright and spray the dose under the tongue.
Which of the following medications is a maintenance medication for Angina?
A. Nitroglycerin
B. Aspirin
C. Celcoxib
D. Isosorbide
D. Isosorbide
When used regularly on a long-term basis, this helps prevent angina attacks from occurring.
Patient teaching- Administartion of Nitroglycerin
Sit down and rest when chest pain occurs and take nitro. If chest
pain not relieved or worse call 911
* Demonstrate how SL tablets are administered
* Storage of nitro in original container away from heat, moisture, and
light
* Rotate sites with patch or paste may apply on arms or thighs to
keep from hairy areas.
May use acetaminophen for headache relief
Do not stop beta blocker or calcium channel abruptly- teach to
monitor heart rate and blood pressure
Notify HCP for consistent dizziness or faintness
Diagnostic test used for Angina and Mi
- ECG * Chest X-ray * Stress Test * Thallium Scan * Myocardial Perfusion Study * Echocardiography * Transesophageal
Echocardiography - Cardiac Catheterization * Magnetic Resonance Imaging
(MRI) * CT Angiography - coronary
arteries * Electrophysiology Studies * Ablation
What is the cause of Angina?
Increase in heart rate
Increase in BP
Results in rupture of the atherosclerotic plaque
Fibrin cap is gone:
Blood flowing thru coronary artery is exposed to the lipid-rich core of the plaque
Blood seeps into the plaque and it expands, platelets aggregate and form a new
thrombus on the swollen area Partial or complete occlusion occurs
What is Acute Coronary Syndrome/
Disorder including unstable angina and myocardial infarction; results from obstruction of the coronary artery by ruptured atherosclerotic plaque and leads to platelet aggregation(“clumping”), thrombus formation, and vasoconstriction.
Which of the following is an indication that the patient has Acute Coronary Syndrome?
A. They feel chest pain on exercise
B.They feel chest pain while resting
C. They have an increased amount of perfusion to vital organs
D. their Ejection Fraction is 65%
They feel chest pain while resting
A sign and symptom of ACS IS
UNSTABLE ANGINA
Unstable Agina: Unstable angina (UA) is chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitation.
