week 4 Flashcards
Cardiovascular conditions
CHD (coronary heart disease) Angina ACS (acute coronary syndrome) AMI (acute myocardial infarction) Heart failure Cardiomyopathy Endocarditis Aneurysm
Causes of Chest Pain:
Cardiovascular
(Coronary heart disease) Myocardial ischaemia Coronary artery spasm Myocardial infarction Pericarditis Pulmonary embolism Mitral valve prolapse Ca usually secondary cancer
Causes of Chest Pain:
Non-Cardiovascular
Dissecting Thoracic Aneurysm Herpes Zoster Oesophageal reflux Oesophageal spasm Hiatus hernia Pneumonia Pneumothorax Pleurisy Peptic ulceration Gallbladder disease Musculoskeletal pain Costochondritis
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
Atherosclerosis can Potentially results in:
Vessel stenosis/occluding blood flow to the myocardium
Aneurysm
Atherosclerosis can impede coronary blood flow depriving muscles of oxygen:
Causing ischaemia
Angina pectoris demonstrates ischaemia of cardiac muscle
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
Medicate as prescribed
Electrocardiogram - ECG
Serial
Reveal ischaemia
Reveal injury
Reveal infarction
Chest x-ray
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.
Nursing Care
Detect arrhythmias early Provide oxygen Bed rest or initial minimal activity 12 lead ECGs Serial blood tests IV cannula to administer drugs
Pain Management
Morphine Reduces respiratory rate anxiety myocardial oxygen demand blood pressure venous return
Ongoing management
Repeat ECGs
Observe for associated symptoms
Evaluate effectiveness of interventions
If pain continues ?
