CAD & Stable Angina

ALL cardiovascular problems will be a problem of ….

profusion

2 biggest problems with CAD/angina

1. perfusion

2. adequate oxygenation

what is the most common cardiovascular disease

coronary artery disease (CAD)

CAD is caused by …

atherosclerosis

an occluded lumen causes …

decreased blood flow leading to decreased perfusion

atherosclerosis process

lipids deposit within inner lining of the coronary artery in response to injury and inflammation to the cell walls

CAD nonmodifiable risk factors

• increasing age

• sex

• ethnicity

• genetic predisposition

CAD modifiable risk factors

• serum lipids

• hypertension

• diabetes

• tobacco use

• physical inactivity

• obesity

contributing: psychosocial, substance abuse

CAD health promotion goals

• identify high risk people

• manage high risk people

• lifestyle modification

• physical activity

• nutrition therapy

• lipid-lowering drug therapy

• limit red met, simple carbs, sodium, and fats

CAD client and caregiver teaching

• physical activity → FITT formula (frequency, intensity, time, type)

• nutrition therapy

• drug therapy → admission and side effects

• daily weights

3 parts of drug therapy for CAD

1. statins (lower LDL) → be mindful of liver and rhabdomylosis

2. niacin → flushing, take with food, elevates homocysteine

3. fibric acid derivatives → increases effects of warfarin

4. bile-acid sequestrants → GI upset, interferes with multiple drugs

5. cholesterol absorption inhibitors → do not use with liver impairment antiplatelet therapy

rhabdomylosis

serious medical condition where damaged muscle tissue breaks down rapidly and releases its proteins and electrolytes into the bloodstream

chronic stable angina is a

symptom of CAD

chronic stable angina occurs due to

the presence of atherosclerosis that narrow pathways or sometimes occlude pathways in coronary arteries

MONA

M - morphine

O - O2

N - nitroglycerin

A - aspirin (vasodilator)

if demand for oxygen exceeds the supply what can occur

myocardial ischemia angina

what is chronic stable angina

episodic chest pain lasting for 5-15 minutes and the pain is predictable in terms of onset, duration, and intensity

precipitating factors of chronic stable angina

physical, temperature, psychosocial, heavy meals, smoking, stimulants, sexual activity, circadian rhythm

PQRST assessment of chronic stable angina

P - precipitating events

Q - quality of pain

R - radiation of pain

S - severity of pain

T - timing

ABCDEF treatment of chronic stable angina

A - antiplatelet/anticoagulant therapy

B - beta blockers (BP control)

C - cigarette smoke cessation, cholesterol management, calcium channel blockers, cardiac rehab

D - diet, diabetes management, depression screening

E - education, exercise

F - flu vaccine

primary nursing goal with chronic stable angina

decrease O2 demand while increasing O2 supply

steps of the primary nursing goal for chronic stable angina

1. relief of pain

2. give immediate/appropriate Tx

3. preserve heart muscle if MI suspected

4. assist with patients anxiety

5. identify precipitating factors and reduce personal risk factors

6. participate in rehab plan

nitroglycerin and chronic stable angina

• Vasodilation: It relaxes and widens blood vessels, particularly the veins, which reduces the workload on the heart.

• Oxygen Balance: By lowering the volume of blood returning to the heart, it decreases oxygen demand during physical stress or activity

ACE inhibitors and CAD

help treat coronary artery disease (CAD) by widening blood vessels, lowering blood pressure, and reducing the heart's workload

beta-blockers and CAD

slowing the heart rate, lowering blood pressure, and reducing the heart's demand for oxygen

calcium channel blockers and CAD

relax blood vessels and heart muscles to lower blood pressure and prevent or treat chest pain (angina) in patients with coronary artery disease (CAD)