Chapter 16 - Ischemic Heart Disease

Stable Angina (Angina Pectoris) - Etiology

consistent/chronic chest pain due to myocardial ischemia

Stable Angina (Angina Pectoris) - Signs and Symptoms

- chest pain caused by exertion

- crushing sensation on left-side of the chest

- pain radiating to the shoulder, jaw, and down the arm

- levine's sign: clenched fist over chest

Stable Angina (Angina Pectoris) - Diagnosis (Graded Exercise Stress Test)

assesses how the heart performs under physical stress and identifies areas with reduced blood flow

Stable Angina (Angina Pectoris) - Treatment

- nitroglycerin/nitrates (vasodilators)

- percutaneous coronary intervention (PCI)

- rest

Stable Angina (Angina Pectoris) - Treatment (Nitroglycerin/Nitrate)

- administered via transdermal patch, sublingual tab, nasal spray, and iv

- 3 NTG tablets within a 10 min period without relief, assume the patient is enduring an MI

- should not be taken with sildenafil (viagra)

Unstable Angina - Etiology

- new or increased severity of chest pain (angina)

- new regions of the heart are experiencing ischemia

Unstable Angina - Signs and Symptoms

prolonged chest pain and present at rest

Unstable Angina - Diagnosis

- ECG

- cardiac enzyme tests

- coronary angiography

Unstable Angina - Treatment

- nitroglycerin/nitrates (vasodilators)

- percutaneous transluminal coronary angioplasty (PCTA)

- coronary artery bypass graft (CABG)

Myocardial Infarction - Etiology

prolonged ischemia leading to irreversible damage due to blood flow obstruction or myocardial oxygen demand exceeds supply

Myocardial Infarction - Signs and Symptoms

- levine's sign (clenched fist over chest)

- pain radiating to shoulder, jaw, down left arm

- diaphoresis (sweaty)

- pallor

- dyspnea

- weak pulses

Myocardial Infarction - Diagnosis (ECG)

- STEMI (ST elevation; infarction through a cell wall)

- NSTEMI (Non-ST elevation; infarction not through a cell wall)

- CAN'T CONFIRM MI

Myocardial Infarction - Diagnosis

- cardiac troponin

- creatinine kinase myocardial band

- radionuclide myocardial perfusion

(dye highlights areas of the heart that lack perfusion)

Myocardial Infarction - Treatment

- MONA (morphine, oxygen, nitroglycerin, aspirin)

- percutaneous coronary intervention (PCI)

- coronary artery bypass graft (CABG)

- heparin (anticoagulant)

Pericarditis - Etiology

inflammation of the pericardium

Pericarditis - Signs and Symptoms

- chest pain

- dyspnea

- pericardial friction rubs

- beck triad (hypotension, jugular vein distention, muffled heart sound)

Pericarditis - Diagnosis

- ECG

- MRI (cardiac)

Pericarditis - Treatment

- if infection, antibiotics

- if excessive fluids, drain, and diuretics

Endocarditis - Etiology

caused by a bacterial infection that damages the valves causing backflow

Endocarditis - Signs and Symptoms

new or worsening heart murmur

Endocarditis - Diagnosis

based on labs and ECG findings using duke criteria for definitive diagnosis

Endocarditis - Treatment

IV antibiotics for 6 weeks or longer