1. ANGINA PECTORIS Tb Tuberculosis Carl Matol, RN

2. ANGINA-to choke CLASSIC/STABLE ANGINA Due to insufficiency of O2 supply against myocardial demand Accumulated effect of sedentary lifestyle and physical inactivity Easily triggered by emotional and physical stress A.K.A. EXERTIONAL ANGINA

3. VARIANT/RRINZMETAL ANGINA occurs during rest or with minimal exertion It is Nocturnal It follows a cyclic pattern Dysrrhythmias are present during severe attacks vasospasm due to hyperactive SNS A.K.A. VASOSPASTIC ANGINA

4. UNSTABLE ANGINA Increase in probability of progressing to MI Occurs due to sublte/minor injury to atheromatous plaque A.K.A. PREINFACTION ANGINA No increase in oxygen demand is placed on the Heart muscle, but an acute lack of blood flow to the muscle occurs. 1. Change in frequency, duration, and intensity of stable angina. 2. Last longer than 10 minutes

5. SILENT ISCHEMIA The ABSENCE of Chest Pain. : Documented by evidence of an imbalance between myocardial oxygen and demand. : Determined by ECG, Exercise Stress Test, or ambulatory [Holter] ECG Monitoring. 1. Occurs in early morning hours [6 AM – 12 PM] 2. Arousal causes increase in sympathetic stimulation and blood viscosity, and coronary stimulation and blood viscosity, and coronary vessel tone increase in the morning. vessel tone increase in the morning.

6. PHARMACOLOGICAL MANAGEMENT Nitroglycerin (Gycerol Trinitrate) Vasodilating agent (both veins and artery) Sublingual, Ointment, patch Beta Blockers Calcium Channel blockers

7. Antiplatelets/anticoagulants ASPIRIN 160-325 mg dose given to angina pt at ER 81-325 mg as mainenance medication ASPIRIN+H2 BLOCS HEPARIN A bolus dose may be given and then an IV infusion Q4-6 hours Watch out for bleeding tendencies

8. Myocardial Infarction Tb Carl Matol, RN

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10. 10  Pain related to an imbalance oxygen supply and demand  Decreased Cardiac Output related to impaired contractility  Activity Intolerance related to insufficient oxygenation to perform activities of daily living [ADL]  Risk for Injury [bleeding] related to dissolution of protective clots.  Altered Tissue Perfusion [myocardial] related to coronary restenosis, extension of infarction  Anxiety related to chest pain, fear of death, threatening environment

11. PERCUTANEOUS CORONARY INTERVENTION (PCI) PTCA CORONARY ARTERY STENT ATHERECTOMY

12. SURGICAL MANAGEMENT CABG candidates for CABG: 1.Uncontrolled angina 2.A positive exercise tolerance test 3.A blockage of more than 20% on the left main coronary artery 4.Blockage of two or more coronary artery 5.Complications from unsuccessful PCI 6.Left ventricular dysfunction with blockage

13. Important consideration!!! For a patient to be considered for CABG, the coronary artery to be bypassed must have at least 70% occlusion (60% if it is the left main coronary artery)

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16. NURSING MANAGEMENT: 1.Promote oxygenation & tissue perfusion – O2 therapy 24-48H or longer, position on semi-fowler’s, avoid overfatigue 2.Promote adequate cardiac output – monitor ECG, VS, effects of daily activities, give medications 3.Promote comfort – relieve pain 4.Provide rest – CBR w/BRP 24-48H, administer diazepam, psychosocial support 5.Promote activity – gradual increase in activity after 24- 48H 6.Promote nutrition & elimination-small, frequent feedings, low chole, low Na diet, avoid stimulants, avoid very hot or cold beverages.

17. COMPLICATIONS OF MI: 1.Dysrhythmias 2.Cardiogenic shock 3.Thromboembolism 4.Pericarditis 5.Rupture of Myocardium 6.Ventricular aneurysm 7.CHF