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Chronic Stable Angina
- Onset: exertion or emotional stress
- after 10 secs, contractility stops, lactic acid builds up
- after 20 min, cardiac cells die, irreversible damange
- 4-6 hrs necrosis of entire myocardium
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Chronic Stable Angina Pain
- intermittent over long period
- same pattern of onset, duration, intensity
- c/o pressure in chest
- located: neck, jaw, shoulders, down arms, btwn shoulders
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Chronic Stable Angina ECG
ST depression and/or T wave inversion
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Chronic Stable Angina Drugs
- Take same time of day prior to occurence of pain
- wait 30-60 min before starting activities
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Which Chronic stable angina occurs in diabetics?
- Silent ischemia
- neuropathy=decrs. nerves in heart
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Which chronic stable angina occurs at night?
- Nocturnal Angina
- not always when asleep or in recumbent position
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Which chronic stable angina occurs when lying down?
- Angina decubitus
- pain relieved by standing or sitting
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Which chronic stable angina relieved by standing or sitty
Angina decubitis
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Which chronic stable angina occurs at rest or during REM sleep?
- Prinzmetal's
- common in pt w hx of migraine HA, raynaud's phenomenon
- triggered by smoking, histamine, angiotension, E, drugs that cause vasoconstriction
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ECG for Prinzmetal's Angina?
ST elevation
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relief for prinzmetal's?
by moderate exercise, spontaneously or with drugs (Ca2+ blockers, nitrates)
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Dx Test for Chronic Stable Angina
- Cardiac cath
- PCI (not for pt with 3 blocked CAD)
- Coronary angio
- Labs: troponin, CK-MB, myoglobin, lipid, CBC C-reactive, homocysteine
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Chronic Stable Angina Pt teaching
- Anitplatelet agent, antianginal therapy, ace inhib
- Beta-adrenergic blocker, BP
- Chol, smoking cessation
- Diet, diabetes
- Education, exercise
- Flu vax
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Chronic Stable Angina drugs--Beta blockers
decrease HR, BP, contractility
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Chronic Stable Angina drugs
Ca channel blockers
- HR, BP control
- decrease coronary artery spasms
- given for Prinzmetal
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Chronic Stable Angina drugs--ACE inhib
- aterial vasodilation
- decr. BP, afterload, myocardio O2consumption
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Acute Coronary Syndrome (ACS) includes
- unstable angina
- NSTEMI
- STEMI
-
ACS caused by
plaque ruptures-->blood, platelet aggregate-->thrombus
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Unstable angina onset?
- at rest or minimal activity
- worsens in increasing frequency
-
Unstable angina sxs?
- ECG: nstemi or stemi
- pain unrelieved by rest or NTG
- n/v
- cold sweat
- sudden SOB rather than chest pain (>65 yo)
- fever
- initially high bp and hr then decrease due to decre CO
- women have prodromal sxs like an 'aura'
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What is an MI?
- sustained ischemia
- usu invovles blocked LV
-
MI pain
- severe, immobilizing
- NOT RELIEVED with rest, change of position or NTG
-
MI onset
while active or rest, asleep, awake
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MI S/s
- temp
- skin: ashen, cold, clammy
- Increase BP, HR, then drops
- low CO = low urine output
- Chest pain
- SOB
- ALOC
- Crackles, rhonchi
- Peripheral edema
- jugular vein distention
- RV dysfxn
- pulmonary edema
- epigastric discomfort w or w/o N/V
- Diaphoresis
-
MI ECG
ST elevation, T wave inversion (ischemia!)
-
ventricular remodeling occurs
10-14 days after MI
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Assess angina
- P
- Q
- R
- S
- T
- Interventions taken (ASA, NTG)
-
Nsg Mgmt for Ua/NSTEMI with negative cardia markers
- MONA-BAH PCI
- no thrombolytics
-
STEMI/NSTEMI with positive cardiac markers
MONA-BATH PCI
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Thrombolytic therapy drugs
- w/in 6 hrs of onset
- dissolves clots
- meds: --plase, APSAC, Streptokinase
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Coronary arterial bypass graft
- when PCI failed or L main coronary artery blocked
- 3 or more coronary arteries blocked
-
CABG Nsg mgmt
- 1st 24hrs in ICU
- Telemetry
- endo trach to ventilate
- foley
- NG for gastric decompression
- would care
- pain mgmt
- After icu: early ambulation
- SQD
- incentive spirometer
- deep breath, splinting
- monitor LOC
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Sudden cardiac death caused by
- ventricular dysrthymias
- L ventricular fxn
- not always with CAD
- death within 1 hr of onset of angina, palpitations
- implantable cardioverter-defib prevents recurrence of VT/VF
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