What is angina?
- Symptom of coronary artery disease
- Type of chest pain due to lack of blood supply and oxygen to the heart
- Pain often spreads to shoulders, arm, neck and jaw
- Feels like squeezing, pressure, heaviness, tightness or pain in the chest.
- Can be sudden or recur over time
- Depending on severity, can be treated by lifestyle changes, medication, angioplasty or surgery
What is chronic stable angina?
- Same pattern of onset, duration, intensity of symptoms
- Pain lasts 5-15 mins
- Usually predictable - provoked by exertion
- Relieved by rest or GTN
What is unstable angina?
- New in onset, occurs at rest, has a worsening pain
- Other symptoms of SOB, fatigue, indigestion, anxiety
- Not relieved with GTN
- Associated with plaque rupture exposing a thrombus
- Medical emergency
What is Acute Coronary Syndrome (ACS)?
The name given to three types of cardiovascular diseases that are associated with sudden plaque rupture
What are three types of CAD that are associated with sudden plaque rupture?
UA
N-STEMI
STEMI
How does a patient with acute coronary syndrome present with?
- Collapse
- Sweating
- Pallor
- Chest pain
- Dyspnoea
- Nausea
- Vomiting
- Pale and clammy
- Pulmonary oedema
- Hypotensive
- Brady/tachycardia
What are the modifiable risk factors for CAD?
- Elevated serum lipids
- HTN
- Tobacco use
- Sedentary lifestyle
- Obesity
- DM
- Metabolic syndrome
- Stress
- Homocysterine levels
What are the non-modifiable risk factors for CAD?
- Age
- Gender
- Ethnicity
- Family history and genetics
What are the complications of MI?
- Arrythmias (atrial fibrillations, ectopic beats)
- Cardiac arrest
- Heart failure
- Cardiogenic shock
- Pulmonary oedema
- Acute respiratory failure
What are some diagnostic studies done for cardiac diseases?
Lab tests
- Lipid profile
- Serum cardiac markers (Trop & T)
Medical imaging
- 12-lead ECG
- Cardiac cathtensation + coronary angiography
- Chest x-ray
- Echocardiogram
- Exercise stress testing
What are the priorities of nursing care (acute interventions)?
- Pain assessment and relief - IV access, morphine if needed
- Ongoing physiological monitoring and assessment, continuous cardiac monitoring, frequent vitals
- Promotion of rest and comfort; positioning, bed rest, limited activity for 12-24 hours
- Alleviation of stress and anxiety
- Understanding patients emotional and behavioural reactions - life defining event - loss, grief, depression
- Oxygen therapy, drug therapy, GTN and aspirin, cared for in critical care unit, coronary care or setting with telemetry
What are the priorities for the multidisciplinary team?
- Rapid diagnosis and treatment is extremely important
- Clinical decision making re-treatment, pharmacology, surgical management
- Best practice treatment
How to reperfuse STEMI’s
- STEMI’s need immediate reperfusion
- Stop the infarction process by dissolving thrombus and reperfusing myocardium
- Treatment if no PCI available in timely manner
- Mortality reduced by 25% if reperfusion occurs within 6 hours
- Inclusion criteria
- Safety alert - risk of bleeding
What are the nursing interventions for acute heart failure; pulmonary oedema?
- C-XRAY
- Monitoring
- Treat cause
- Positioning
- Oxygen therapy - nasal prong, high flow
- Drug therapy
- Daily weight
- Rest
- Regular assessment
- Combine physical, psychosocial and relational needs with each care encounter
What needs to be included in patient education?
- Needs to occur at every stage of the hospitilisation and recovery/rehab journey
- For teaching to be meaningful, the patient must be aware of the need to learn
- Timing is important - initially in crisis - shock, disbelief
- Simple, brief language
- Learning what to expect = sense of control
- Use evidence-based teaching duides
What does a ST-segment elevation mean?
- The higher the elevation and the more leads involved, the larger the infarct and the greater the mortality
- Watch out for other causes of ST-segment elevation, such as pericarditis and LV hypertrophy, PE, Digoxin
What are the nursing assessments for chest pain?
- Pain assessment
- Vital signs
- Precipitating factors
- Skin
- ECG
- Blood work
- Medications
- Patient history - cardiac history
- Perfusion: capillary refill
What is MI?
- Occlusion of coronary artery for over 4-6 hours
- Cell death - irreversible necrosis of myocardium
What are the characteristics of unstable angina?
No change in ECG, possible ST elevations and T wave depression
- No change in biomarkers
What are the characteristics of NSTEMI?
- Possible ST elevations and Q waves
- Can be St depression or T wave inversion
- Change in biomarkers
What are the characteristics of STEMI?
- ST elevation, presence of Q wave
- Change in biomarkers
What does MONATAS stand for
M - morphine O - oxygen N - nitrates A - aspirin T - thrombolytics A - anticoagulants S - stool softener
What does MONATAS stand for
M - morphine O - oxygen N - nitrates A - aspirin T - thrombolytics A - anticoagulants S - stool softener
What is heart failure?
Linked to cardiovascular disease
