Presentation on theme: "DR. HANA OMER. ANGINA PECTORIS :is a clinical syndrome characterized by paroxysmal chest pain due to transient myocardial ischemia. It may be occur."— Presentation transcript:
ANGINA PECTORIS :is a clinical syndrome characterized by paroxysmal chest pain due to transient myocardial ischemia. It may be occur whenever there is imbalance between myocardial oxygen supply and demand. The most common cause is atherosclerosis, aortic stenosis, and hypertrophic cardiomyopathy.
is the angina that occurs when coronary perfusion is impaired by fixed or stable atheroma of coronary arteries i-e patient has fixed capacity of exertion after that he starts feeling chest pain.
is the angina that is characterized by rapidly worsening chest pain, pain on minimal exertion or pain at rest. It is carachterized by :- More serious, higher level of obstruction Changes in frequency, severity, duration May begin during sleep or at rest Warning of impending MI
Usually diagnosis is clinically, by present of these symptoms :- 1. Chest pain increase with exertion. 2. Typical chest pain. 3. Releaved by Nitroglycerin. all 3 ₌ stable angina, 2 ₌ unstable angina 1 ₌ no angina.
Acute ischemic necrosis of an area of myocardium is known as myocardial infarction, OR myocardial necrosis occurring as a result of critical imbalance between coronary blood supply and myocardial demand is called myocardial infarction. It has the the same symptoms and signs, etiology, as angina pectoris.
Any group of clinical symptoms consistent with acute MI Patients should receive a 12-lead ECG. ▪ ST-segment elevation: “Q-wave AMI” ▪ No ST-segment elevation: unstable angina or a non-ST- segment elevation (UA/NSTEMI) we find inverted T.
Symptoms Chest pain is the most common symptom. ▪ Patient often clenches fist when describing ▪ May radiate to arms, fingers, neck, jaw, upper back, or epigastrium. ▪ Sometimes mistaken for indigestion ▪ Not influenced by body movements
Symptoms (cont’d) Patients with silent MI may present with: ▪ Sudden dyspnea ▪ Rapid progress to pulmonary edema ▪ Sudden loss of consciousness ▪ Unexplained drop in blood pressure ▪ Apparent stroke or simply confusion
Symptoms (cont’d) Women more likely to present with: ▪ Nausea ▪ Lightheadedness ▪ Epigastric burning ▪ Sudden onset of weakness or tiredness ▪ Pain radiating down right side
Assessment For history, ask usual questions, but also if any pain medication has helped.
Take note of: Patient’s general appearance Patient’s state of consciousness Pale, cold, and clammy skin Vital signs Left-sided heart failure signs Right-sided heart failure signs
Typical signs include: Ashen-gray pallor Cold, wet skin Rapid pulse rate Decreased blood pressure from decreased CO Increased blood pressure from pain and anxiety
Treatment goals: Limit size of infarct. Decrease fear and pain. Prevent serious cardiac dysrhythmias.
Place patient at physical and emotional rest. Stress response can make damaged heart race Can place peripheral circulation in a state severe vasoconstriction
To begin treatment, place patient in a semi- Fowler position. Do not allow patient to get on stretcher alone.
Treat (MONA) in following order: Oxygen Aspirin Nitroglycerine Morphine
Give nitroglycerin if BP is adequate. Do not mix with PDE-5 inhibitors. Place 0.4-mg under tongue. Do not give with hypotension or bradycardia. Repeat every 3 to 5 minutes, up to three doses.
Morphine sulfate may be given by IV. 2- to 4-mg doses as needed Do not give if patient has/is: ▪ Low blood pressure ▪ Dehydrated ▪ AMI involving the heart’s inferior wall Some protocols prefer fentanyl.
Perform cardiac monitoring. Document the initial rhythm. Place anterior chest leads. Keep cardiac drugs close at hand.
Record vital signs. Measure blood pressure at least every 5 minutes. Measure pulse rate.
History and secondary assessment Find out if patient: ▪ Has history of cardiac disease ▪ Takes any heart medications ▪ Has had a previous heart attack or heart surgery Obtain more details about current symptoms and any relevant past medical history.
Transport the patient. Once stable, transport in semi-Fowler position Use safe and appropriate transport. If serious dysrhythmia develops, consider stopping and treating immediately.