ANGINA PECTORIS Tb Tuberculosis

Carl Matol, RN

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

• 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

• 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

• 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 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.

PHARMACOLOGICAL MANAGEMENT

• Nitroglycerin (Gycerol Trinitrate)• Vasodilating agent (both veins and

artery)• Sublingual, Ointment, patch

• Beta Blockers• Calcium Channel blockers

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

Myocardial InfarctionTb

Carl Matol, RN

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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

PERCUTANEOUS CORONARY INTERVENTION (PCI)

• PTCA• CORONARY ARTERY STENT• ATHERECTOMY

SURGICAL MANAGEMENT• CABG

candidates for CABG:1. Uncontrolled angina2. A positive exercise tolerance test3. A blockage of more than 20% on the left main

coronary artery4. Blockage of two or more coronary artery5. Complications from unsuccessful PCI6. Left ventricular dysfunction with blockage

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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• 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.

COMPLICATIONS OF MI:

1. Dysrhythmias

2. Cardiogenic shock

3. Thromboembolism

4. Pericarditis

5. Rupture of Myocardium

6. Ventricular aneurysm

7. CHF