ANGINA AND AMI DR. HANA OMER

ANGINA PECTORIS

DEFINITION

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 .

TYPES OF ANGINA

Stable angina . Unstable angina .

STABLE ANGINA

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 .

UNSTABLE ANGINA

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

Angina Pectoris

Prinzmetal angina Caused by coronary artery vasospasm Causes chest pain at rest Increased risk of: ▪ Ventricular dysrhythmias▪ Myocardial infarction▪ Heart block▪ Sudden death

DIAGNOSIS

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 .

MYOCARDIAL INFARCTION

DEFINITION

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 .

Acute Coronary Syndrome

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 .

Acute Myocardial Infarction (AMI)

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

Acute Myocardial Infarction (AMI)

Other symptoms include: Diaphoresis Dyspnea Anorexia, nausea, vomiting, belching,

hiccups Profound weakness, dizziness,

palpitations Feeling of impending doom

Acute Myocardial Infarction (AMI)

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

Acute Myocardial Infarction (AMI)

Symptoms (cont’d) Women more likely to present with:▪ Nausea▪ Lightheadedness▪ Epigastric burning▪ Sudden onset of weakness or tiredness▪ Pain radiating down right side

Acute Myocardial Infarction (AMI)

Assessment For history, ask usual questions, but also

if any pain medication has helped.

Acute Myocardial Infarction (AMI)

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

Acute Myocardial Infarction (AMI)

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

Management of AMI and Suspected AMI in the Field

Treatment goals: Limit size of infarct. Decrease fear and pain. Prevent serious cardiac dysrhythmias.

Management of AMI and Suspected AMI in the Field

Place patient at physical and emotional rest. Stress response can make damaged

heart race Can place peripheral circulation in a

state severe vasoconstriction

Management of AMI and Suspected AMI in the Field

To begin treatment, place patient in a semi-Fowler position. Do not allow patient to get on stretcher

alone.

Management of AMI and Suspected AMI in the Field

Treat (MONA) in following order: Oxygen Aspirin Nitroglycerine Morphine

Management of AMI and Suspected AMI in the Field

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.

Management of AMI and Suspected AMI in the Field

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.

Management of AMI and Suspected AMI in the Field

Perform cardiac monitoring. Document the initial rhythm. Place anterior chest leads. Keep cardiac drugs close at hand.

Management of AMI and Suspected AMI in the Field

Record vital signs. Measure blood pressure at least every

5 minutes. Measure pulse rate.

Management of AMI and Suspected AMI in the Field

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.

Management of AMI and Suspected AMI in the Field

Transport the patient. Once stable, transport in semi-Fowler

position Use safe and appropriate transport. If serious dysrhythmia develops,

consider stopping and treating immediately.