Week 4 Flashcards
Cardiovascular causes of chest pain
Coronary heart disease Myocardial ischaemia Coronary artery spasm Myocardial infarction Pericarditis Pulmonary embolism Mitral valve prolapse Ca usually secondary cancer
Non-cardiovascular causes of chest pain
Dissecting Thoracic Aneurysm Herpes Zoster Oesophageal reflux Oesophageal spasm Hiatus hernia Pneumonia Pneumothorax Pleurisy Peptic ulceration Gallbladder disease Musculoskeletal pain Costochondritis
Coronary artery disease
Atherosclerosis is most common cause of CAD:
Abnormal collection of fats/fibrous tissue within the arterial wall/lumen
Formation accelerates with smoking/dyslipidaemia/diabetes/hypertension/genetic disposition
Potentially results in:
Vessel stenosis/occluding blood flow to the myocardium
Aneurysm
Can impede coronary blood flow depriving muscles of oxygen:
Causing ischaemia
Angina pectoris demonstrates ischaemia of cardiac muscle
Non-modifiable risk factors of CAD
Age Gender Ethnicity Genetic predisposition Low birth weight Diabetes mellitus Hormonal / biochemical factors
Modifiable risk factors of CAD
Blood cholesterol Tobacco smoking High blood pressure Overweight / obesity Diet Alcohol consumption Social class Geographical distribution
Stable angina
Pain occurs with increasing workload Stable atherosclerotic plaque Pain stable and predictable occurs with emotion or exertion Crescendo/decrescendo pain Radiates to neck/shoulders/ arms lasting 2 – 5 mins Relieved by rest ECG – T Wave inversion during angina Cardiac markers normal
Acute coronary syndrome
Pain increasing with coronary artery spasm or unstable plaque/thrombus blockage
Pain occurs at rest and is increasing in severity/frequency
Pain last 10 mins or longer and radiates to neck left shoulder/arm
ECG – ST segment depression with
T Wave inversion (~ diagnostic)
Cardiac marker may be initially normal/have late elevation
Management of angina/ACS
A to E
Oxygen at 6L/min via Hudson Mask- only if sats are 94 or below and hypoxic
Medicate as prescribed
Assess chest pain
Assessing chest pain
P – precipitating factors: Presenting complaint sudden onset? woken by pain? Induced by exercise/ exertion?
Q – quality: How severe is the pain? Use pain scale Is this like the usual pain? Does the pain change on movement or inspiration?
R – radiation: Does the pain radiate anywhere? Through to the back To the shoulder Up into the neck and jaw Down the arm/arms
S – severity: Are there associated symptoms? Sweating Nausea Vomiting Dyspnoea
T – time of onset:
When did the pain start?
Nursing observations/monitoring
Reassure patient – rest Baseline observations ? Need for cardiac monitoring 12 lead ECG IV access Troponin (T & I) levels and cardiac enzymes (CK – creatine kinase) Contact Dr
Diagnostic tests
Electrocardiogram: Serial Reveal ischaemia Reveal injury Reveal infarction
Cardiac troponins:
Troponin I and T : biochemical markers
2-3times during a 12- to 16-hour period.
Cardiac enzymes: Early detection after heart damage: 4 – 6 hours. Raised CK indicator of muscle damage CK-MB heart CK-MM muscle
Chest Xray:
Size and location of the heart.
Demonstrate hypertrophy in heart failure
Echocardiogram:
Allows examination of valves and myocardial wall movements.
Holter Monitoring: if dysrythmias present, syncope.
Coronary Artery/vasodilator drugs oral Anginine (Glyceryl trinitrate)
Give if prescribed and usually takes it If BP > 90 systolic Monitor BP (and Heart Rate!) Effects: reduce pain Cause peripheral and coronary vasodialtion Reduces myocardial oxygen demand Increase blood flow Side effects: dilates blood vessels
Long acting nitrate preparations – Isosorbide dinitrate (isordil), Isosrbide Mononitrate (Imdur)
Development of tolerance
Side effects:
General: hypersensitivity to nitrates
CNS: dizziness and hypotension, headache,
GIT: nausea, vomiting
CV: palpitation, postural hypotension, tachycardia
Contraindicated: increased intracranial pressure, hypersensitivity to nitrates
Administer: empty stomach
Beta blockers – metoprolol, atenolol, propanolol
Block cardiac-stimulating effects of norepinephrine and epinephrine Reduce: Heart rate Myocardial contractility Blood pressure reduces myocardial oxygen demand Contraindicated: Bradycardia AV conduction blocks Cardiogenic shock NB: Asthma and COPD
Calcium Channel Blockers – verapamil, diltiazem, and nifedipine
Vasodilators Reduces myocardial oxygen demand Lowers blood pressure Long term prophylaxis **dysrhythmias, heart failure and hypotension
